原发性硬脑膜低级别B细胞边缘区淋巴瘤的临床及影像学表现

Clinical and Imaging Findings of Primary Dural Low-Grade B-Cell Marginal Area Lymphoma

摘要: 目的：探讨原发性硬脑膜低级别B细胞边缘区淋巴瘤的临床及影像学表现。方法：回顾性分析5例经手术与病理证实的原发性硬脑膜低级别B细胞边缘区淋巴瘤的临床表现及影像学特征。结果：共5例患者，其中男性1例，女性4例。年龄45~69岁，平均年龄54岁，中位年龄54岁。5例(100%)患者均有头痛，2例(40%)癫痫，2例(40%)肢体无力，1例(20%)恶心，1例(20%)言语不能，1例(20%)视野缺损。5例患者病变均位于颅板下硬脑膜。3例(60%)呈新月形，1例(20%)呈双凸透镜形，1例(20%)呈匍匐形。5例(100%)与脑实质呈等密度，边界不清。病变最大者最大截面约75 mm × 12 mm，最小者病变最大截面约17 mm × 4 mm。4例(80%)可见邻近颅骨不同程度骨质破坏。T1WI稍低信号3例(60%)，等信号2例(40%)；T2WI稍高信号5例(100%)；T2-FLAIR稍高信号5例(100%)；DWI稍高信号4例(80%)，等信号1例(20%)；5例(100%)均明显强化，脑实质呈受压推移改变。结论：原发性硬脑膜淋巴结较为罕见，在影像上容易被误诊为硬膜下血肿等。接受正确的诊断与治疗，病人预后较好，所以当临床与影像表现不符时，将其纳入鉴别诊断是及其重要的。

Abstract: Objective: To investigate the clinical and imaging manifestations of primary dural lymphoma. Methods: The clinical manifestations and imaging features of 5 cases of primary dural low-grade B-cell marginal zone lymphoma confirmed by operation and pathology were analyzed retrospectively. Results: There were 5 patients, including 1 male and 4 females. The age ranged from 45 to 69 years old, the average age was 54 years old, and the median age was 54 years old. All 5 (100%) patients had headache, 2 (40%) epilepsy, 2 (40%) limb weakness, 1 (20%) nausea, 1 (20%) speech disability and 1 (20%) visual field defect. The lesions of 5 patients were located in the subcranial dura mater. 3 cases (60%) were crescent-shaped, 1 case (20%) was biconvex lens, and 1 case (20%) was creeping. 5 cases (100%) were isodensity with brain parenchyma, and the boundary was not clear. The maximum cross section of the largest lesion was about 75 mm × 12 mm, and the maximum cross section of the smallest lesion was about 17 mm × 4 mm. Different degrees of bone destruction of the adjacent skull could be seen in 4 cases (80%). T1WI slightly low signal in 3 cases, iso-signal in 2 cases, T2WI slightly high signal in 5 cases, T2-FLAIR slightly high signal in 5 cases (100%); DWI slightly high signal in 4 cases, iso-signal in 1 case, 20%), obvious enhancement in 5 cases (100%), brain parenchyma changed by compression. Conclusion: primary dural lymph nodes are rare and are easily misdiagnosed as subdural hematoma. When patients receive correct diagnosis and treatment, the prognosis is good, so when the clinical and imaging manifestations are not consistent, it is very important to include it in the differential diagnosis.