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目的:总结颅内原发恶性淋巴瘤的MRI表现,分析术前误诊的原因,以提高诊断的准确度。方法:回顾性分析18例经手术病理证实的原发性颅内淋巴瘤(弥漫大B细胞型)的MRI平扫、增强及弥散加权成像(DWI)的特征性表现。结果:单发病灶15例,多发病灶3例。其中脑干1例,小颅蚓部1例,大颅半球14例,基底节区1例,右侧丘颅1例。术前误诊4例(均诊断为颅内胶质瘤)。18例均为弥漫大B细胞型非霍奇金淋巴瘤。18例病变均表现为占位性肿块,T1WI呈低、等信号;T2WI呈等、稍高信号;行马根维显增强扫描,无坏死病灶均呈较均匀显著强化,伴有坏死时,坏死区无强化。16例瘤周中度水肿,2例瘤周重度水肿。10例行DWI序列扫描病变呈均匀高信号表现。结论:原发性颅内淋巴瘤的MRI表现有一定的特征性。MRI平扫、增强扫描及弥散加权成像(DWI)特点综合分析可提高对本病诊断率。弥散加权成像(DWI)的特点对诊断与鉴别诊断具有一定的参考价值。
OBJECTIVE: To summarize the MRI findings of primary intracranial malignant lymphoma and to analyze the causes of preoperative misdiagnosis in order to improve the diagnostic accuracy. Methods: MRI features of 18 cases of primary intracranial lymphoma (diffuse large B cell type) confirmed by surgery and pathology were analyzed retrospectively. Results: Single lesions in 15 cases, multiple lesions in 3 cases. One case of brain stem, small skull in 1 case, 14 cases of the cranial hemisphere, basal ganglia in 1 case, 1 case of right cheek. Preoperative misdiagnosis in 4 cases (all diagnosed as intracranial gliomas). 18 cases were diffuse large B cell non-Hodgkin’s lymphoma. 18 cases of lesions showed space-occupying masses, T1WI was low, and other signals; T2WI was equal, slightly higher signal; line of enhanced MR imaging of root canal, no necrosis lesions were more significantly enhanced significantly, with necrosis, necrosis strengthen. 16 cases of moderate edema, 2 cases of severe peritumoral edema. 10 cases of DWI sequence scanning lesions showed a uniform high signal performance. Conclusion: MRI manifestations of primary intracranial lymphomas have certain characteristics. MRI plain scan, enhanced scan and diffusion-weighted imaging (DWI) features a comprehensive analysis can improve the diagnosis of the disease. Diffusion-weighted imaging (DWI) characteristics of diagnosis and differential diagnosis has some reference value.