摘要
目的:观察并总结原发性中枢神经系统淋巴瘤(PCNSL)的术中超声声像图特点,探讨术中超声在PCNSL开颅手术中的应用价值。方法:回顾性分析18例经手术病理证实为PCNSL患者的临床、术中超声及免疫组化资料。结果:本研究共入组经病理确诊PCNSL患者18例,所有病灶经术中超声扫查后均可显示。超声测量肿瘤最大径2.1~5.8 cm,平均(3.6±1.1)cm。18例中13例行手术切除,其中7例全切除,6例因肿瘤位置深且邻近脑功能区遂次全切除或部分切除;5例行开颅活检。17例病灶位于幕上,13例为单发,8例病灶范围较广泛,侵犯基底节、丘脑或胼胝体。术中超声表现为高回声团块,边界多清晰,血流信号多不丰富,瘤周水肿呈稍高回声,程度均为重度。其中10例形态规则,呈圆形或椭圆形,2例呈浅分叶状,13例内部回声均匀,1例伴囊变,1例伴钙化。18例病理诊断均为弥漫性大B细胞淋巴瘤。9例Ki-67标记指数>90%。结论:术中超声可准确定位PCNSL,协助术者确定手术入路。声像图特点可提示诊断、指导术者开颅活检,降低手术风险,并在开颅活检术中辅助术者获取理想的标本、明确病理诊断,为术后放、化疗提供依据。
Objective:To observe and summarize the intraoperative ultrasound findings of primary central nervous system lymphoma(PCNSL)and explore the application value in craniotomy of PCNSL.Methods:Data of 18 patients with pathological confirmation of PCNSL were retrospectively analyzed,including the clinical features,intraoperative ultrasound imaging and immunohistochemistry.Results:Thirteen cases underwent surgical resection and 5 cases underwent biopsy with craniotomy.Lesions in 17 cases were located in the supratentorial region and unifocal lesions were observed in 13 cases.Basal ganglia,thalamus or corpus callosum were involved in extensive lesions.On intraoperative ultrasound images,all lesions were hyperechoic.Clear boundaries,regular morphology without abundant blood flow were oberved in most cases.The internal echo in 13 cases were uniform,while the others included 1 case with cystic degeneration and 1 case with calcification.Major peritumoral edema were slightly hyperechoic compared with the surrounding healthy brain.All cases were confirmed as diffuse large B-cell lymphoma by pathological examination and Ki-67 index greater than 90%was recorded in 9 cases.Conclusion:Intraoperative ultrasound can accurately locatePCNSL and guide in choosing the surgical approach.The sonographic characteristics help operators diagnose and do biopsy with craniotomy when necessary to reduce the risk of surgery.Furthermore,the ideal specimens can be obtained under the guidance of intraoperative ultrasound during biopsy,which is important for pathological diagnosis and postoperative radiotherapy and chemotherapy.
作者
程令刚
康睿君
何文
张巍
张琳
万芳
CHENG Ling-gang;KANG Rui-jun;HE Wen;ZHANG Wei;ZHANG Lin;WAN Fang(Department of Ultrasound,Bejing Tiantan Hospital,Capital Medical University,Beijing 100160,China;Department of Ultrasound,China-Japan Friendship Hospital,Beijing 100029,China;Department of Hepatology,Peking University People's Hospital,Beijing 100034,China)
出处
《中国临床医学影像杂志》
北大核心
2025年第11期761-764,共4页
Journal of China Clinic Medical Imaging
基金
国家自然科学基金(82271995,81730050)。
关键词
淋巴瘤
中枢神经系统肿瘤
超声检查
多普勒
彩色
Lymphoma
Central Nervous System Neoplasms
Ultrasonography,Doppler,Color
