颅内淋巴瘤影像诊断.ppt

CASEDISCUSSION,WANGLIJUN2008-7-14,Case1:Female,66y,Case1:PLAINMRI,Case1:POST-CONTRASTMRI,Case2:F66Y,Case2:POST-CONTRASTMRI,CASE3:M58Y,NHLwasdiagnosed2.5yearsago,nowfeelheadache(2008-1-25),-C,+C,2008-1-30,2008-5-15,LYMPHOMA,Primarycentralnervoussystemlymphoma(PCNSL)isarareformoflymphaticcancerarisinginthebrain,eye,nerves,spinalfluidsurroundingthebrainandspinalcord,andthecoveringofthebrain,calledduraSecondary:metastasestothenervoussysteminlymphomaaffectingotherorgans,PCNSL:Epidemiology,Oncerare(1%),nowbecomingincreasinglymorecommonIncidencehasrisendramaticallyinpastfewdecades,asPCNSLnowaccountsfor4-7%(16%)ofallnewlydiagnosedprimarybraintumorsIncidencehasrisenintheimmunocompromisedandalsoimmunocompetentpopulation,PCNSL:Epidemiology,ImmunocompromisedCongenitalcausesofimmunodeficiency1.Wiskott-Aldrichsyndrome2.IgAdeficiency3.X-linkedlymphoproliferativesyndromeacquiredcauses1.HIVinfectionandAIDS2.immunosuppressiveregimenafterorgantransplantation,PCNSL:Epidemiology,Medianageofonset55yearsinimmunocompetent,incidenceriseswithageGreatestrisehasoccurredamongtheelderlyMaleismorecommonlyseencomparetofemale(2:1),Diagnosis,HistoryFocalneurologicdeficit(i.e.hemiparesis,aphasia)presentin50%ofallpatientswithPCNSLAlteredmentalstatus(memoryloss,confusion,etc.)foundin33%-maybeinsidiousonsetHeadache,nausea(fromincreasedICP)in33%Maypresentwithnew-onsetseizurein10%BlurredvisionifocularlymphomaispresentRadiologicimagingHeadCTdetectsmostlesions(90%)BrainMRImaydetectlesionsmissedonCT,Diagnosis,PrimaryCNSlymphomamayarisefromdifferentpartsofthebraindeephemisphericperiventricularwhitematterbeingthemostcommoncorpuscallosum,cerebellum,orbits,andcranialnervesmayalsoharborthetumorHistology:intermediate-tohigh-gradeextranodalnon-HodgkinslymphomaofB-cellorigin,RadiologicImagingTypicalAppearanceinImmunocompetentPatients,Usuallysolitary,non-hemorrhagiclesionindeepwhitematter,nearventriclesLesionisisodensetohyperdense(70%)surroundingvasogenicedemahomogeneouslyenhancingmassSurroundingedemaistypicallylessprofoundthaninmetastaticbrainlesionsorgliomas,64-year-oldwomanwithleft-sidedweakness.AxialunenhancedCTscanshowstypicalhyperdensemass(arrows)inrightparietallobesurroundedbylow-densityzone,consistentwithvasogenicedema.Axialcontrast-enhancedCTscanshowshomogeneousenhancement(arrows)oflesionnearmidline.,RadiologicImagingTypicalAppearanceinImmunocompetentPatients,intermediate-tolow-signal-intensitytumoronT1-weightedimagesIsointensetohypointensesignalrelativetothegraymatteronT2-weightedimagesAclassicpresentationisthelesionthatcrossesthecorpuscallosuminabutterflypatternEnhancesdenselyandhomogenouslywithgadoliniumcontrastMayalsorevealleptomeningealdiseaseHighsignalonDWI,64-year-oldwomanwithleft-sidedweaknessAxialT2-weightedMRimageshowsheterogeneousmass(blackarrows)ofpredominantlylowsignalintensity.NotecentrallinearT2hyperintensity(arrowhead),likelyrepresentingnecrosis.Alsonotesurroundingvasogenicedema(whitearrows).Axialgadolinium-enhancedT1-weightedMRimageshowsmarkedcontrastenhancementoflesion(arrows).Notemasseffectonadjacentrightlateralventricle.,Post-contrastCoronalT1WtdMRI,Post-contrastAxialT1WtdMRI,Homogeneouslyenhancingtumorisseeninvolvingthespleniumofthecorpuscallosum(arrows)spreadingacrossthemidline.,72-year-oldimmunocompetentwomanwithprimaryCNSnon-HodgkinsB-celllymphomawhopresentedwithprogressivemotorweakness.AxialFLAIRMRimageshowsisointensityoflesionstobrainparenchymaandsurroundingedema.Themassesinvolvedeepwhiteandgraymatter.Axialcontrast-enhancedT1-weightedMRimageshowshomogeneousenhancementofmultiplebilateraltumors.,50-year-oldimmunocompetentmanwithprimaryCNSnon-HodgkinsB-celllymphoma.AxialT2-weightedMRimageshowsinfiltrativehyperintensemassexpandinggenuandspleniumofcorpuscallosuminbutterflypattern.contrast-enhancedaxialT1-weightedMRimageshowshomogeneousenhancementoflesion.,头痛伴口周麻木2个月,RadiologicImagingAtypicalAppearanceinImmunocompetentPatients,isodensityorevenhypodensityonCTInthesettingofaperiventricularlow-densitylesion,lymphomamayeasilybemisdiagnosedaschronicsmallvesselischemiaorencephalomalaciaDiffuselyinfiltrativelymphomasmaynotexhibitparenchymalenhancementatall,90-year-oldwomanwithnormalimmunestatuswhopresentedwithright-sidedweaknessanddifficultyfindingwords.AxialT2-weightedMRimageshowsill-definedT2hyperintensity(arrows)surroundingleftinternalcapsuleandadjacentlefttemporallobe.Axialgadolinium-enhancedMRimagerevealsbarelydiscernibleparenchymalenhancementincorrespondingregion.Axialcontrast-enhancedCTscanobtained4monthslatershowsmarkedexpansionofleftbasalgangliaandthalamuscausedbyinfiltratingneoplasm,withlossofnormalanatomicboundaries(arrows).,63-year-oldwomanwithprimarymeningeallymphomawhopresentedwithfrequentfallsandvertigo.AxialFLAIRimageshowshyperintensity(arrow)involvingsulciandleptomeningesofparietotemporalconvexity.Contrast-enhancedT1-weightedaxial(B)andcoronal(C)MRimagesshowfocalthickeningandhomogeneousenhancementofleptomeningesofparietotemporalconvexity(arrows).,Male54y.rightsideweaknesswithheadacheandvomittingfor2months,RadiologicImagingAtypicalLocations,ArareprimarylymphomaofthepinealglandappearssimilartoaprimaryneoplasmofpinealoriginCranialnerves,brainstem,cavernoussinus,ortubercinereummayhavelymphomatousinvolvement,MetastaticCNSLymphoma,In59%ofsystemicnon-Hodgkinslymphoma,secondaryspreadinvolvestheCNS,usuallyintheformofleptomeningealinfiltrates,andhasapoorprognosisParenchymallesions,whenpresent,typicallyresultfromsecondaryinvolvementfromtheleptomeningesviainfiltrationoftheperivascularspaces,Post-contrastAxialT1WtdMRI,Figure.Linearenhancementofthecerebellarsulci(yellowarrows)andlefttemporalsulci(redarrow).,Diagnosis:SecondaryLymphomawithsubarachnoidtumorseeding(arrows).,Post-contrastCoronalT1WtdMRI,Diagnosis:SecondaryLymphomawithcalvarialinvolvement(greenarrow)andassociatedepiduraltumor(yellowarrows)/scalptumor(redarrow),RadiologicImagingTypicalAppearanceinHIVPatients,acerebralmassisdetectedinasupratentorialparenchymallocation(55%)withfrequentinvolvementofthecorpuscallosum,basalganglia,andotherdeepcerebralnucleiContrastenhancementisvariable,commonlyofaninhomogeneousorbizarrepattern.Solitaryringlikeenhancementismorelikelyseeninthisgroupnecrosisdevelopsinthetumor(64%)Multiplelesionsmaybeseen(50%)Periventricularlesionsfrequentlyinvadetheventricularsurface,causingependymalseeding(38%)However,meningealenhancementissurprisinglynotfrequent.,38-year-oldmanwithHIVwhopresentedwithdisorientationandconfusion.Axialgadolinium-enhancedT1-weightedMRimageshowssolitaryringlikeenhancementofmassandperipherallow-signal-intensityhalo(arrows).,35-year-oldmanwithHIVwhopresentedwithlowerextremityweakness.Noteatypicallymphomapresentedasnonenhancinglow-densitylesioninrightbasalgangliaonCT,initiallythoughttobealacunarinfarct.Axialprotondensity-weightedMRimageobtained3monthsafterAshowshyperintenselesion(arrows)withirregularbordersatsamelocation.Coronalgadolinium-enhancedT1-weig