作者单位：510630 广州，中山大学附属第三医院放射科(吴春梅，邹艳，康庄)；100037 北京，中国人民解放军海军总医院病理科(宁浩勇)

    MRI表现非典型的原发性中枢神经系统淋巴瘤三例

    吴春梅邹艳康庄宁浩勇

    【摘要】原发性中枢神经系统淋巴瘤(PCNSL)是少见的中枢神经系统肿瘤。少数PCNSL患者的临床症状及影像学表现与中枢神经系统炎症性脱髓鞘病变非常相似。该文报道MRI表现非典型的3例PCNSL患者，最初均被误诊为中枢神经系统炎症性脱髓鞘病变，首次经糖皮质激素治疗后病情均缓解，MRI显示病灶减少、缩小，但其后病情反复发作且加重，MRI显示病灶增多、增大，磁共振波谱均显示胆碱峰与氮-乙酰天门冬氨酸峰的比值大于2.0，最后均经脑病理活组织检查(活检)才确诊为PCNSL，化学治疗后病情均稳定。部分PCNSL患者因临床症状无特异性且MRI表现非典型，容易被误诊为炎症性脱髓鞘病变，延误了治疗，因此，临床上对于与该文报道的有相似表现的患者，应高度怀疑PCNSL，尽快行脑病理活检以助确诊，及时选择合适的治疗方案。

    【关键词】原发性中枢神经系统淋巴瘤；炎症性脱髓鞘病变；病理学检查；磁共振成像

    DOI:10.3969/g.issn.0253-9802.2015.03.014

    基金项目：广东省自然科学基金(S2012010008254)；广州市科技计划项目(2011Y2-00017)

    通讯作者,邹艳，E-mail：zouy927@126.com

    收稿日期：(2014-11-08)

    MRI manifestations of atypical primary central nervous system lymphoma: three cases reportWuChunmei,ZouYan,KangZhuang,NingHaoyong.TheThirdAffiliatedHospitalofSunYat-senuniversity,Guangzhou510630,China.

    Correspondingauthor,ZouYan,E-mail:zouy927@126.com

    Abstract【】Primary central nervous system lymphoma (PCNSL) is a rare central nervous system tumor. Clinical symptoms and imaging manifestations of a minority of PCNSL patients are similar to those of central nervous system inflammatory demyelinating disease. In this article, the MRI manifestations of three patients with atypical PCNSL were reported. They were initially misdiagnosed with central nervous system inflammatory demyelinating disease. The severity of disease in all patients was alleviated after the initial glucocorticoid treatment. MRI revealed the lesions were reduced in both size and number. However, the disease recurred and was aggravated. MRI revealed that the number and size of the lesions were both increased. Magnetic resonance spectroscopic imaging detected that the ratio of the peak values of choline and N-acetyl-l-aspartate exceeded 2.0. The diagnosis of PCNSL was eventually confirmed by brain histopathological biopsy. The severity of disease was stabilized after chemotherapy. It is highly likely to misdiagnose PCNSL with inflammatory demyelinating disease due to atypical clinical symptoms and MRI manifestations, which delays the delivery of treatment. Consequently, the cases presenting with similar manifestations to this study should be highly suspected with PCNSL. Brain pathological biopsy should be performed as soon as possible to confirm the diagnosis. Appropriate treatments should be timely selected. ......