CAJ | 학술논문

目的：探讨免疫功能正常的原发性中枢神经系统淋巴瘤常规MRI征象及3D增强多平面重建在诊断中的价值。方法回顾性分析93例病理证实的PCNSL患者，共计167个病灶的MRI特征；其中40例行术前常规增强扫描，41例因术中导航或穿刺行3D-TRA序列增强扫描，另有12名患者前后分别做了常规与3D增强扫描。通过X2检验比较常规MR增强与3D增强多平面重建对于PCNSL典型征象的显示率。结果93例患者均为B细胞性非霍奇金淋巴瘤。单发49例(52.6%)，多发44例(47.3%)；共检出167个病灶。病灶好发于幕上(142个，85%)主要分布于深部脑白质等近中线部位及靠近脑膜表面。MRI平扫病灶T1WI多呈等或稍低信号，T2WI多呈等或稍高信号。159个病灶在DWI上均呈高或稍高信号。增强后163个病灶实质成分均呈团块状、结节状明显强化，仅4例无强化。43个病灶出现典型的“马蹄征”；23个病灶内或周围出现包绕血管征；8个出现“蝴蝶征”；81个病灶邻近软脑膜强化；40个病灶周围室管膜强化；常规MRI增强和3D多平面重建对以上征象的显示率分别为(17.1%、34.7%；34.3%、32.0%；14.3%、32%；10.0%,18.7%)。结论 PCNSL的MR表现具有特征性，3D增强扫描后的多平面重建可以提供更多的诊断信息，有助于提高该病诊断准确率。
목적：탐토면역공능정상적원발성중추신경계통림파류상규MRI정상급3D증강다평면중건재진단중적개치。방법회고성분석93례병리증실적PCNSL환자，공계167개병조적MRI특정；기중40례행술전상규증강소묘，41례인술중도항혹천자행3D-TRA서렬증강소묘，령유12명환자전후분별주료상규여3D증강소묘。통과X2검험비교상규MR증강여3D증강다평면중건대우PCNSL전형정상적현시솔。결과93례환자균위B세포성비곽기금림파류。단발49례(52.6%)，다발44례(47.3%)；공검출167개병조。병조호발우막상(142개，85%)주요분포우심부뇌백질등근중선부위급고근뇌막표면。MRI평소병조T1WI다정등혹초저신호，T2WI다정등혹초고신호。159개병조재DWI상균정고혹초고신호。증강후163개병조실질성분균정단괴상、결절상명현강화，부4례무강화。43개병조출현전형적“마제정”；23개병조내혹주위출현포요혈관정；8개출현“호접정”；81개병조린근연뇌막강화；40개병조주위실관막강화；상규MRI증강화3D다평면중건대이상정상적현시솔분별위(17.1%、34.7%；34.3%、32.0%；14.3%、32%；10.0%,18.7%)。결론 PCNSL적MR표현구유특정성，3D증강소묘후적다평면중건가이제공경다적진단신식，유조우제고해병진단준학솔。
Objective To evaluate the traditional and Multi-planar Reconstruction MRI findings of primary central nervous system lymphoma in immunocompetent patients. Methods 93 cases of PCNSL proved by pathology or biopsy were collected in the study analyzed retrospectively, including the traditional MRI(n-53)and Multi-planar Reconstruction MRI(n-40)feature, Another 12 patients before and after were done with conventional 3D enhanced scan ,in addition comparison between the twos. Results 93 cases all were B-cell type non-Hodgkin's lymphoma. There was a single lesion in 52.6% of the cases, and the remainder were multiple lesions. Total 167 lesions were found. PCNSL have a predilection for the periventricular and superficial regions80%, often abutting the ventricular or meningeal Surfaces, mainly located in the deep white matter near the midline supratentorial. Lesion occur in the infratentorial is rare. On unenhanced T1-weighted MR imaging, lesions are typically hypo-or isointense and on T2-weighted MR imaging, iso-to hyperintense but often hypointense to gray matter. Most lesions (n-159) appear hyperintense on DWI. Most lesions (n-163) show marked mass-like or nodular contrast enhancement on MR imaging, without enhanced (n-4), and the presence of "horseshoe sign" (n-43) were specific, the presence of "butterfly sign"(n-8),with ependymal (n-40) or meningeal enhancement(n-81) and the presence of vascular enhancement(n-23). Conventional MRI enhancement and 3D multi-planar reconstruction of the above signs show rates were (17.1%, 34.7%; 34.3%, 32.0%; 14.3%, 32%; 10.0%, 18.7%). Conclusion PCNSL have characteristic MR performances, multi-planar reconstruction 3D enhanced scan can provide more diagnostic information to help improve the diagnostic accuracy of the disease.