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,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,CNS 淋巴瘤的CT和 MRI表现,武汉同济医院放射科,周义成,2002.1,CNS 淋巴瘤的CT和 MRI表现武汉同济医院放射科,Lymphoma of the Central Nervous System:imaging findings and diagnosis,武汉同济医院放射科,周义成,2002.1,Lymphoma of the Central Nervou,Robert A.Zimmerman,MD:,Whether primary or secondary,constitutes a serious and potentially fatal threat to the patient.It is important for the treating physician as well as the radiologist who performs and interprets diagnostic imaging studies to be familiar with,how,CNS involvement occurs,where,it is found,what,its imaging findings are,and,what,ds processes may mimic it.,Robert A.Zimmerman,MD:Whether,一、概述:,1.,原发和继发,CNS,淋巴瘤少见,但近年来发病率呈增加趋势。,2.,影像表现各异,易造成误诊。,3.,所谓原发,,CNS,淋巴瘤起源淋巴组织,而,CNS,外没有或未被发现有淋巴瘤。,4,。继发,CNS,淋巴瘤,,CNS,外发现有淋巴瘤,并累及,CNS,。,一、概述:,二、病理,何杰金氏病和非何杰金氏病,PCL,肉眼呈相对局限肿块,边界欠清。亦可呈弥漫浸润型。,在非,AIDS,中,明显出血,坏死少见。,镜下,:,何杰金氏病,:,R-S,细胞,.,非何杰金氏病,:,小肿瘤细胞(以血管为中心)聚集在血管周围,多为,B-Cell,,少为,T-Cell,瘤。,二、病理 何杰金氏病和非何杰金氏病,三、发病率:,占颅内肿瘤的,4.5%,。,PCL2%,SCL8%.,占原发非何杰金氏病的,1%,。,20-40%,为多发。,在,AIDS,中,,2%,出现,PCL,。,在免疫功能正常组中,近,10,年发病率增,3-4,倍。,三、发病率:,四、临床表现:,年龄:任何年龄,正常免疫组平均,60,岁。,AIDS,组,,33,岁,症状:颅内占位(,60%,),脑炎(,25%,),,d,emyelinating Ds(a few %),stroke(7%),cranial nerve palsies(a few %),五、影像学表现,:,原发和继发,CNS,淋巴瘤有相同的影像学表现。本组多,累及脑白质,胼腋体及脑室周围,软脑膜。,平片,:,可有颅骨破坏,颅内高压表现,四、临床表现:,zyc:M,28ys,zyc:M,CT,:典型,平扫,中,高密度,,90%,等、中,高密度,增强,都有强化,不强化极少,少为环形强化(,AIDS,),13%,阴,,38%,假阴性,MR,:,优于,CT,CT:典型,T1,稍低或呈等信号灶,占位效应小,边清,类圆、扁平,脑肿块,T2,低,-,高信号,少为高信号,T2,低信号,有助于与胶质瘤、脱髓鞘疾病,DD,环形强化,见于有免疫功能障碍者中,薄壁环,不规则环,可有壁结节,并同时有条状,脑回状强化,T1稍低或呈等信号灶,部位,脑白质,,47-55%,,累及胼腋体及脑室周围,皮髓质交界或灰质深部,33%,中心灰质,底节区,17%,后颅窝,11%,脊髓,1%,并存,脑白质、灰质深部、底节、脑干等(,20-47%,)同时累及易诊断,脑膜病变,扁平,似脑膜瘤,脑膜炎,部位,类型:,脑白质型:,47-55%,,累及胼腋体及脑室周围,皮髓质交界型:,+,灰质深部,33%,中心灰质型:底节区,17%,后颅窝型:,11%,脑膜病型:扁平,似脑膜瘤,,DDx,软脑膜病型:继发多见。,脑干型:,脊髓型:,1%,混合型:脑白质、灰质深部、底节、脑干等(,20-47%,)并存,同时累及者易诊断,类型:,Compaq:,脑干型,Compaq:脑干型,中心灰质型,中心灰质型,型,脑干型,型脑干型,脑白质型,脑白质型,F,76Ys,F,76Ys,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,脑膜瘤型,脑膜瘤型,CNS-淋巴瘤的CT和-MRI表现课件,脑膜瘤型,脑膜瘤型,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,脑膜瘤型,脑膜瘤型,CNS-淋巴瘤的CT和-MRI表现课件,脑膜瘤型,脑膜瘤型,脑膜瘤型,脑膜瘤型,脑膜瘤型,脑膜瘤型,中心灰质型,中心灰质型,脑白质型,脑白质型,CNS-淋巴瘤的CT和-MRI表现课件,后颅窝型,后颅窝型,中心灰质型,中心灰质型,CNS-淋巴瘤的CT和-MRI表现课件,皮髓质交界型,皮髓质交界型,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,CNS-淋巴瘤的CT和-MRI表现课件,六、鉴别诊断,胶母,脑膜瘤,脓肿,弓形体病,脱髓鞘疾病,神经外丕瘤,TB,结节病,肉芽肿,六、鉴别诊断,CNS-淋巴瘤的CT和-MRI表现课件,
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