原发性中枢神经系统淋巴瘤MRI影像特征及误诊分析
MRI Features and Misdiagnosis of Primary Central Nervous System Lym-phoma
权建华 1刘冲2
作者信息
- 1. 100069 北京,北京丰台右安门医院放疗科
- 2. 100069 北京,北京丰台右安门医院肿瘤科
- 折叠
摘要
目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的磁共振成像(MRI)影像特征及误诊原因.方法 选取2020 年7 月至2023 年2 月20 例PCNSL患者,其中10 例误诊,通过分析误诊、未误诊患者的MRI影像学资料,探讨PCNSL患者易误诊的影像学原因.结果 本组头痛15 例、肢体无力11 例、视力视野受损7 例、头晕6 例.20 例共检出30 个病灶,位于浅部脑组织19 个,深部脑组织7 个,脑室内4 个;单发病灶14 例,多发病灶6 例;合并坏死6 例.10 例首诊误诊者纳入误诊组,误诊为转移瘤5 例、脑胶质瘤5 例.误诊时间10d～2 个月.诊断正确组和误诊组在多发病灶、出血、合并坏死方面比较差异有统计学意义(P＜0.05).后经立体定向活检手术对MRI增强扫描明显增强部位取材行病理检查后,确诊弥漫大B细胞型淋巴瘤,予大剂量甲氨蝶呤联合放疗.随访1 年,病情稳定,无死亡病例.结论 接诊PCNSL患者时,当MRI增强扫描未发现典型征象时,易误诊颅内其他疾病;颅内占位性多发病灶、出血、合并坏死是PCNSL影像学误诊的因素,仔细观察、认真鉴别,必要时多学科协作会诊并及早行手术病理检查有利于降低误诊率.
Abstract
Objective To investigate the MRI features of primary central nervous system lymphoma(PCNSL)and the causes of misdiagnosis.Methods From July 2020 to February 2023,20 patients with PCNSL were selected,10 of whom were misdiagnosed.The MRI data of patients with and without misdiagnosis were analyzed to explore the imaging causes of misdiagnosis of PCNSL patients.Results There was headache in 15 patients,limb weakness in 11 patients,visual impair-ment in 7 patients and dizziness in 6 patients.A total of 30 lesions were detected in 20 patients,including 19 that were located in superficial brain tissue,7 in deep brain tissue,and 4 in the ventricle.There were 14 cases of single lesions and 6 cases of multiple lesions.There were 6 cases with necrosis.Ten patients of initial misdiagnosis were included in the misdiagnosis group,including 5 patients with metastatic tumor and 5 patients with brain glioma.The misdiagnosis lasted 10 d-2 months.There were significant differences in multiple lesions,hemorrhage and necrosis between correct diagnosis group and misdiagno-sis group(P＜0.05).After stereo-directional biopsy was performed on the sites significantly enhanced by the enhanced MRI scan for pathological examination,diffuse large B-cell lymphoma was confirmed.The patients were treated with high-dose methotrexate combined with radiotherapy.The patients were followed up for 1 year,showing stable condition,and no death was reported.Conclusion For PCNSL patients,when the MRI enhancement scan does not reveal typical signs,it is more likely to be misdiagnosed as other intracranial diseases.Intracranial space occupying multiple lesions,hemorrhage,and necro-sis are the factors of imaging misdiagnosis of PCNSL.Careful observation and identification,multidisciplinary consultation and early pathologic examination when necessary are conducive to reducing the misdiagnosis rate.
关键词
中枢神经系统淋巴瘤/原发性/误诊/转移瘤/脑胶质瘤/磁共振成像/病理学/诊断Key words
Central nervous system lymphoma/Primary/Misdiagnosis/Metastatic tumor/Brain glioma/Magnetic resonance imaging/Pathology/Diagnosis引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据