CT 联合MRI 在PCNSL 诊断中的临床应用

Multilayer spiral CT combined with MRI self-spin echo technique for diagnosis of primary central nervous system lymphoma

摘要:

目的 探索多层螺旋CT 与MRI 技术诊断原发性中枢神经系统淋巴瘤（PCNSL）的临床应用 及相关分析。方法 选取2015 年3 月-2017 年3 月于该院病理科PCNSL 患者的CT 与MRI 数据，患者先 进行头颅CT 平扫，对发现病灶的患者进一步进行MRI 平扫和增强扫描，并进行单体素氢质子磁共振波谱 （1H-MRS）检查，将扫描图像传至后处理工作站进行处理，观察PCNSL 的一般情况CT 表现和MRI 信号表现， 对比病灶区与对侧正常区的表现弥散系数（ADC）值和代谢产物，进一步分析1H-MRS 测量的代谢产物峰 值结果及其与ADC 值的相关性。结果 共发现58 例患者单发、15 例患者多发，共检出97 个病灶，病灶直 径0.8 ～ 5.9 cm。CT 平扫呈等或稍高密度，MRI 平扫呈等或稍长T1、T2 信号，67 个病灶周围可见少许水肿， 部分增强病灶可见尖角征、脐凹征及蝴蝶征。患者强化实性区与对侧正常区ADC、N- 乙酰天门冬氨酸、胆碱、 脂质及Cho/NAA 值比较有差异（P <0.05）。结论 PCNSL 的CT 平扫、MRI 平扫和增强及核磁1H-MRS 成像都具有一定的特征性，对PCNSL 的诊断和鉴别具有重要的临床应用价值。

Abstract:

Objective To explore the clinical value of multilayer spiral CT (MSCT) and MRI in diagnosis of primary central nervous system lymphoma (PCNSL). Methods The MSCT and MRI data of PCNSL patients confirmed in the Pathological Department of our hospital between March 2015 and March 2017 were collected. The patients underwent skull CT scan first, and in the patients with lesions further MRI scan, enhanced scanning and single-voxel 1H-MRS examination were performed, the scanned images were transferred to the post-processing workstation for processing, spectral images were obtained. The general CT manifestations and MRI signals of PCNSL were observed, the ADC values and metabolites were compared between the lesion areas and the contralateral normal areas, the peak values of metabolites measured by 1H-MRS and their correlations with ADC values were further analyzed. Results There were 58 patients with single lesion and 15 cases with multiple lesions, in all 97 lesions were detected, the lesion diameter was 0.8-5.9 cm, and there was no calcification or bleeding in any lesion. CT scan showed equal or slightly-higher density, MRI scan showed isometric or slightly-longer T1 and T2 signals, such as diffuse high signal. Mild edema was seen around 67 lesions, part of the enhanced lesions showed sharp angle sign, umbilical concave character and butterfly sign. The ADC values of the tumor parenchyma areas were significantly lower than those of the the contralateral control areas (P < 0.05). Conclusions CT scan and enhanced scan, MRI and nuclear magnetic 1H-MRS imaging for PCNSL have certain characteristics, and important clinical value for the diagnosis and differential diagnosis of PCNSL.