艾滋病相关颅内淋巴瘤的MRI影像特征及鉴别诊断
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摘要
目的探讨艾滋病相关颅内淋巴瘤的MRI影像特征,以提高对其诊断及鉴别诊断水平。方法回顾性分析2013年7月～2017年10月我院经手术和病理证实的15例艾滋病相关颅内淋巴瘤患者的MRI影像资料,结合文献总结分析艾滋病相关颅内淋巴瘤的MRI影像特征。结果 15例艾滋病相关颅内淋巴瘤的病理类型均为B细胞淋巴瘤,其中弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma, DLBCL)11例,4例为伯基特淋巴瘤(burkitt lymphoma, BL),以幕上多见,多发病灶为主(本组合计32个病灶,2例为脑膜型),多靠近中线或脑室周围,侵犯皮层并累及灰白质。本组病例单发4例,多发9例,2例为脑膜型。位于幕上10例,幕下2例,幕上下多发1例。MRI表现为实性、囊实性肿块及结节、多发不规则斑点、片状病灶,DWI病灶不同程度受限,以不规则环状高信号为主,ADC值降低,10例患者(12个病灶)T_1WI可见不规则高信号或稍高信号,增强扫描后病灶呈肿块样、结节样及点、片状明显强化、不规则厚壁环形强化或环状强化,周围轻度水肿或无水肿,其中3例为重度水肿,1例沿室管膜匍匐生长,1例可见室管膜播散。结论艾滋病相关颅内淋巴瘤MRI影像表现复杂多样、具有一定的特征性,但部分病变表现不典型,易与弓形体脑炎等病变混淆,必须结合临床并仔细分析其MRI特征有助于提高诊断率。
Objective To explore the MRI imaging features of AIDS-related intracranial lymphoma in order to improve the level of diagnosis and differential diagnosis of this disorder. Methods MRI imaging data of 15 patients with AIDS-related intracranial lymphoma, who were confirmed by surgery and pathology in Beijing Ditan Hospital from July 2013 to October 2017, were retrospectively analyzed and the MRI imaging characteristics of this disorder were summarized and analyzed in combination with literature. Results The pathological types of those 15 patients were all B cell lymphoma, in which the diffuse large B cell lymphoma(diffuse large B-cell lymphoma, DLBCL) was found in 11 cases and Burkitt's lymphoma(Burkitt lymphoma, BL) in 4 cases. The multiple lesions were the major type(with respect to 32 focuses, Meningeal type was found in 2 cases), which was located around the midline or ventricle, with invasion into cortex and involvement of gray matter. In this group, there were 4 cases of single lesion, 9 cases of multiple lesions, and 2 cases of meningeal type. 9 cases were located in supratentorial area, 2 in infratentorial area and 1 case in both infratentorial and supratentorial area with multiple lesions. MRI showed different shapes of focuses, such as a solid or cystic mass, multiple nodules, irregular spots, patchy lesions. DWI lesions were limited to different degrees, which exhibited the irregular high signal ring, with the decrease in ADC value. T_1WI showed that 10 patients(12 lesions) presented with irregular high signal or slightly high signal. After the enhanced scan, the lesions showed the mass-like, nodular or patchy enhancement, irregular thick wall ring enhancement or peripheral ring enhancement. There was mild edema or no edema. 3 cases appeared severe edema, and 1 case exhibited the prostrate growth along the ependyma, and 1 case showed ependymal dissemination. Conclusion MRI imaging features of AIDS-related intracranial lymphoma are complex and various,and may have certain characteristics. However, some lesions are atypical, which are easily confused with toxoplasmosis and other diseases. We must carefully analyzed the MRI imaging signs combined with clinical findings, which helps to improve the diagnostic accuracy.
Objective To explore the MRI imaging features of AIDS-related intracranial lymphoma in order to improve the level of diagnosis and differential diagnosis of this disorder. Methods MRI imaging data of 15 patients with AIDS-related intracranial lymphoma, who were confirmed by surgery and pathology in Beijing Ditan Hospital from July 2013 to October 2017, were retrospectively analyzed and the MRI imaging characteristics of this disorder were summarized and analyzed in combination with literature. Results The pathological types of those 15 patients were all B cell lymphoma, in which the diffuse large B cell lymphoma(diffuse large B-cell lymphoma, DLBCL) was found in 11 cases and Burkitt's lymphoma(Burkitt lymphoma, BL) in 4 cases. The multiple lesions were the major type(with respect to 32 focuses, Meningeal type was found in 2 cases), which was located around the midline or ventricle, with invasion into cortex and involvement of gray matter. In this group, there were 4 cases of single lesion, 9 cases of multiple lesions, and 2 cases of meningeal type. 9 cases were located in supratentorial area, 2 in infratentorial area and 1 case in both infratentorial and supratentorial area with multiple lesions. MRI showed different shapes of focuses, such as a solid or cystic mass, multiple nodules, irregular spots, patchy lesions. DWI lesions were limited to different degrees, which exhibited the irregular high signal ring, with the decrease in ADC value. T_1WI showed that 10 patients(12 lesions) presented with irregular high signal or slightly high signal. After the enhanced scan, the lesions showed the mass-like, nodular or patchy enhancement, irregular thick wall ring enhancement or peripheral ring enhancement. There was mild edema or no edema. 3 cases appeared severe edema, and 1 case exhibited the prostrate growth along the ependyma, and 1 case showed ependymal dissemination. Conclusion MRI imaging features of AIDS-related intracranial lymphoma are complex and various,and may have certain characteristics. However, some lesions are atypical, which are easily confused with toxoplasmosis and other diseases. We must carefully analyzed the MRI imaging signs combined with clinical findings, which helps to improve the diagnostic accuracy.
引文
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[2] 张拥波,赵伟秦,李继梅,等.艾滋病相关神经系统并发症研究进展[J].中国全科医学,2011,14(32):3667-3670.
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[4] 陈枫,赵大伟,文硕,等.艾滋病相关胃肠道非霍奇金淋巴瘤的影像表现:4例报告并文献复习[J].医学影像学杂志,2015,25(10):1807-1811.
[5] Utsuki S, Oka H, Abe K, et al. Primary central nervous system lymphoma in acquired immune deficiency syndrome mimicking toxoplasmosis [J]. Brain Tumor Pathology, 2011, 28(1): 83-87.
[6] 朱庆强,王中秋,朱文荣,等.原发性颅内淋巴瘤的MRI、扩散加权成像与1H-MRS特征分析[J].实用放射学杂志,2013,29(6):880-883,894.
[7] Baehring JM, Henchcliffe C, Ledezma CJ, et al. Intravascular lymphoma: magnetic resonance imaging correlates of disease dynamics within the central nervous system [J]. Journal of Neurology, Neurosurgery and Psychiatry, 2005, 76(4): 540-544.
[8] 耿承军,陈君坤,卢光明,等.原发性中枢神经系统淋巴瘤的CT、MRI表现与病理对照研究[J].中华放射学杂志,2003,37(3):246-250.
[9] K M, Gauvain,R C, McKinstry,P, et al.Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging [J]. AJR, 2001, 177(2): 449-454.
[10] 闫铄,李晶晶,谢汝明.艾滋病合并弓形虫脑病MRI表现及其预后预测价值[J].新发传染病电子杂志,2016,1(1):27-30.
[11] 王增奎,庞军,郑彩端.磁共振常规及其功能成像在原发性颅内淋巴瘤的应用价值[J].实用放射学杂志,2015,31(2):193-196.
[12] 喻奇志.AIDS相关脑内淋巴瘤的影像诊断及鉴别[J].中国现代医学杂志,2012,22(24):56-59.
[2] 张拥波,赵伟秦,李继梅,等.艾滋病相关神经系统并发症研究进展[J].中国全科医学,2011,14(32):3667-3670.
[3] 卫生部传染病标准专业委员会.艾滋病和艾滋病病毒感染诊断标准[J].中国艾滋病性病,2012,18(4):272-275.
[4] 陈枫,赵大伟,文硕,等.艾滋病相关胃肠道非霍奇金淋巴瘤的影像表现:4例报告并文献复习[J].医学影像学杂志,2015,25(10):1807-1811.
[5] Utsuki S, Oka H, Abe K, et al. Primary central nervous system lymphoma in acquired immune deficiency syndrome mimicking toxoplasmosis [J]. Brain Tumor Pathology, 2011, 28(1): 83-87.
[6] 朱庆强,王中秋,朱文荣,等.原发性颅内淋巴瘤的MRI、扩散加权成像与1H-MRS特征分析[J].实用放射学杂志,2013,29(6):880-883,894.
[7] Baehring JM, Henchcliffe C, Ledezma CJ, et al. Intravascular lymphoma: magnetic resonance imaging correlates of disease dynamics within the central nervous system [J]. Journal of Neurology, Neurosurgery and Psychiatry, 2005, 76(4): 540-544.
[8] 耿承军,陈君坤,卢光明,等.原发性中枢神经系统淋巴瘤的CT、MRI表现与病理对照研究[J].中华放射学杂志,2003,37(3):246-250.
[9] K M, Gauvain,R C, McKinstry,P, et al.Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging [J]. AJR, 2001, 177(2): 449-454.
[10] 闫铄,李晶晶,谢汝明.艾滋病合并弓形虫脑病MRI表现及其预后预测价值[J].新发传染病电子杂志,2016,1(1):27-30.
[11] 王增奎,庞军,郑彩端.磁共振常规及其功能成像在原发性颅内淋巴瘤的应用价值[J].实用放射学杂志,2015,31(2):193-196.
[12] 喻奇志.AIDS相关脑内淋巴瘤的影像诊断及鉴别[J].中国现代医学杂志,2012,22(24):56-59.