MR Signs Of Primary Central Nervous System Lymphoma Analysis And The Value Of ADC In The Differential Diagnosis

Part Ⅰ:Primary Central Nervous System Lymphoma:Characteristic Findings on Traditional and 3D Multi-planar Reconstruction MRIObjective:To evaluate the traditional and Multi-planar Reconstruction MRI findings of primary central nervous system lymphoma in immunocompetent patients.Methods:93 cases of PCNSL proved by pathology or biopsy were collected in the study analyzed retrospectively, including the traditional MRI (n-53) and Multi-planar Reconstruction MRI (n-40) feature, in addition comparison between the twos.Results:93 cases were B-cell type non-Hodgkin’s lymphoma. There was a single lesion in 52.6% of the cases, and the remainder were multiple lesions. Total 167 lesions were found. PCNSL have a predilection for the periventricular and superficial regions80%, often abutting the ventricular or meningeal Surfaces,mainly located in the deep white matter near the midline supratentorial. Lesion occur in the infratentorial is rare. On unenhanced Tl-weighted MR imaging, lesions are typically hypo- or isointense and on T2-weighted MR imaging, iso- to hyperintense but often hypointense to gray matter. Most lesions (n-159) appear hyperintense on DWI .Most lesions (n-163) show marked mass-like or nodular contrast enhancement on MR imaging, without enhanced (n-4), and the presence of "horseshoe sign"(n-43) were specific, the presence of "butterfly sign"(n-8),with ependymal (n-40) or meningeal enhancement(n-81) and the presence of vascular enhancement(n-23). 3D Multi-planar Reconstruction is more accuracier than traditional MRI.Conclusion:There are typical manifestations of MRI in PCNSL, 3D Multi-planar Reconstruction scanning features can improve MRI diagnostic accuracy of PCNSL.Part II:The Application of ADC Value in Differentiation Between Primary Central Nervous System Lymphoma Glioblastoma multiforme and Tumor-like Inflammatory Demyelinating DiseasesObjective:To explore the value of rADC in differentiating Between Primary Central Nervous System Lymphoma-. glioblastoma multiforme and Tumor-like Inflammatory Demyelinating DiseasesMethods:39 patients were pathologically proved Primary central nervous system lymphoma (lesions=47) and 35 with GMB (lesions=42)% 8 patients were pathologically proved Tumor-like Inflammatory Demyelinating Diseases underwent MR examination, including DWI. The minmum ADC values and ratio of ADC values (rADC) in solid parenchyma in all lesions were measured and compared between groups by two neuroradiologists.Variance analysis was carried out on the three sets of data and multiple comparison results were interpreted. Application specific subjects curve for evaluation of PCNSL-group and non-PCNSL-groups.Results: Intracranial rADC values is lower than the value of primary central nervous system lymphoma.Tumor-like Inflammatory Demyelinating Diseases’rADC values is the lowest among all these lesions(F=20.249, P=0.000); Multiple comparison results are get though Dunnett T3;Have a statistically significant difference between the groups(P<0.05); The area under the ROC curve is 0.803,The standard error of the area is 0.048.Determine lymphoma with rADC values with the lymphoma had remarkable significance (P=0.000);Choose maximize Youden index as the best point for judging prognosis,When rADC value of 0.722, the diagnostic sensitivity is 0.745, the specific value is 0.741.Conclusion: Intracranial lymphoma, glioblastoma, and Tumor-like Inflammatory Demyelinating Diseases lesions essence rADC value combining DWI and conventional MRI scan image can improve the differential diagnosis.