| Part 1 Comparison of pathological features between primary central nervous system lymphoma and high-grade gliomasObjective:To investigate the vascular features of primary central nervous system lymphoma and high grade glioma,and to explore the pathological basis of different imaging features.Methods:21 cases of PCNSL and 21 cases of high grade glioma were collected from Qilu Hospital of Shandong University from 2012 to 2016.All patients underwent plain and enhanced MRI,and multiple lesions were included in the study.21 lesions were included in the study.CD34+ PAS double staining was used to analyze tumor microvessel density and PAS positive structure(VM),a-SMA staining was used to analyze the number of mature vessels in tumor,and modified Gordon-Sweet reticular fiber staining was used to analyze the distribution of reticular fibers in tumor.Results:The MVD of PCNSL in PCNSL and HGG were 43.40 ± 19.68/mm2 and 93.31 ± 20.16/mm2,respectively.There was significant difference between the two diseases(t=8.117,P<0.001).The the number of mature vessels in PCNSL and HGG were 9.68 ± 4.08/mm2 and 19.68 ± 12.90/mm2,respectively.There was significant difference between the two diseases(t = 3.384,P = 0.002).The delayed enhancing degree of PILBCL was significantly correlated with the number of mature vessels,MVD(r=0.593,0.466,repectively).The EI of HGG was significantly correlated with the number of mature vessels,(r=0.608 and 0.512,repectively).Conclusion:The imaging features and biological behavior of PCNSL are related to tumor lack of blood vessels,rich VM structure and reticular fibers.Part 2 Comparative study among MRI features and angiogenesis,vascularization,reticular fibers in primary central nervous system lymphomaObjective:Record the MR imaging features and pathological findings of primary central nervous system lymphom and analyze the correlations between them,in order to deepening the imaging-pathological mechanism of PCNSLMaterials and Methods:21 patients were examined by nonenhanced and contrast-enhanced MRI.Tumor location,tumor size,enhancement characteristics,the degree of enhancement,peritumoral edema and cyst were assessed.HE staining,CD34+PAS double staining and a-SMA immunohistochemical staining were used to analyze the MVD,the number of mature vessel and PAS positive patten.The correlation analysis and multiple linear regression analysis were used to analyze the MRI features and pathological findings.Results:All the lesions were with marked enhancement,the enhanced index was 0.45-1.65,the mean was 0.998 ± 0.370.CD34+PAS staining showed that the MVDs were 16.67～85.33/mm2,the mean was 43.40 ± 19.68/mm2.a-SMA staining found that the number of mature vessels was 3～17.67/mm2,the mean was 9.68±4.08/mm2.All of 21 lesions were PAS positive,12 of which were strong positive and the PAS positive structures were connected together to form a network.The reticular fibers were widely distributed in 11 lesions,which were defined as strongly positive,while the reticular fibers were scattered in 10 lesions,which were defined as weakly positive,with prominent perivascular distribution The delayed enhancing degree of PILBCL was significantly correlated PAS positive structure(vasculogenic mimicry)and reticular fibers(r=0.446 and 0.497,repectively).Standardization regression coefficients(β)from big to small in order were MVD,PAS positive structure,the number of mature vessels and the reticular fibers,which were the most influencing factors on the delayed enhancement(β were 0.425,0.409,0.295,and 0.188,respectively).Conclusion:The rich PAS positive patten(VM)and lack of vessels are the cause of the disease early low enhancement and delay intensive enhancement,and these factors in a certain extent lead to peritumoral e necrosis.dema,focalPart3 Magnetic Resonance Imaging features of primary central nervous system lymphomaObjective:Primary central lymphoma(PCNSL)is a rare intracranial tumor.Because of its low incidence and lack of specificity in clinical and laboratory examination,missed diagnosis and misdiagnosis often occur.PCNSL is very high aggressive and with a poor prognosis.Satisfactory effect can not be got only by surgery.Chemotherapy combined with radiotherapy is the important treatment in clinic,which can obviously improve the survival rate.Therefore,correct preoperative diagnosis of PCNSL play an important role in the clinical treatment of patients,and it is of great help to improve the prognosis of the patients.Our study aim to summarize the MRI characteristics of primary central nervous system lymphoma(PCNSL)and improve the imaging diagnostic accuracy of PCNSL.Methods:a total of 21 cases of primary central nervous system lymphoma diagnosed in Qilu Hospital of Shandong University from 2013 to 2016 were collected.All patients underwent nonenhanced and contrast-enhanced MRI,5 patients underwent magnetic resonance spectroscopy(MRS).Retrospective analysis of the imaging data of lesions:the location of the disease,the characteristic of the signal,the way of strengthening,the feature of imaging(Including lobulation,notch sign,sharp angle sign,fist sign),the peritumoral edema of the tumor,etc.Results:In 21 cases of PCNSL,there were 14 cases of single occurrence,6 patients with multiple cases,there were 9 lesions.Diffuse distribution of frontal lobes in 1 cases.The most frequent sites were frontal,basal ganglia and corpus callosum.The PCNSL lesions showed isointense or hypointense signals on T1WI and on T2WI lesions appeared to be slightly hypointense to slightly hyperintense.On DWI lesions were hyperintense.Gd-DTPA enhanced,the lesions were significantly enhanced.1 cases showed ring enhancement,and other lesions were nodular and agglomerate.14 cases with lobulationsign,notch sign presented in 11 cases,7cases with sharp angles sign,6cases with fist sign,infiltration in 4 cases,cystic necrosis in 9cases,hard ring sign in 4cases.There were 9 necrotic lesions,of which7 cases were mild necrotic(3 of them were punctated necrotic),1 cases were moderate necrotic and 1 cases were severe necrotic.There were 3cases with mild peritumoral edema,7 with moderate peritumoral edema and 11 severe cases peritumoral edema.MVD was correlated with tumor infiltration and peritumoral edema(r = 0.551 and 0.578,P<0.05).There was a negative correlation between necrosis and VM(r=-0.198,P=0.015),but other MRI features were not correlated with MVD,VM and the number of mature vessels.The MVD of 4 cases with meningeal infiltration was significantly higher than that of other non infiltrating lesions,P<0.05.Necrosis,lobulation,notch and sharp angle sign were positively correlated with the size of lesions(r = 0.546,0.561,0.475,0.516,P<0.05).Conclusion:It is helpful for early diagnosis,early treatment and survival rate to raise awareness of PCNSL and master its characteristic imaging findings.PCNSLs present with typical imaging features on MRI which can be suggestive of the diagnosis.To a certain extent peritumoral edema can predict tumor angiogenesis and invasiveness. |
