Résumé
Objective:To investigate multimodality imaging characteristics and clinical features of lymphomatosis cerebri (LC) and reasons for misdiagnosis,with the goal of potentially facilitating an early and accurate diagnosis for this often-missed disease.Methods:Clinical data and cerebral multimodality imaging findings from 11 patients with LC proven basing on pathology in the Affiliated Hospital of Guizhou Medical University from November 30, 2011 to December 28, 2020 were retrospectively extracted, analyzed, and reviewed in combination with the literatures.Results:The common presenting symptoms with subacute onset included cognitive decline (8/11), gait disturbance (9/11), and behavioral disturbance (5/11). Test of cerebrospinal fluid showed that the number of cells and the level of protein increased (8/10), the sugar content (2/10) and chloride (4/10) decreased. The imaging manifestations of 11 patients with LC were diffuse lesions of bilateral cerebral white matter in the both deep and lobar lesion distribution, involving the cerebral cortex and subcortical white matter in eight cases (8/11), basal ganglia in seven cases (7/11), thalamus in five cases (5/11), cerebellum in six cases and brain stem in six cases (6/11). All 11 patients showed equal or slightly low-density shadows on CT plain scan and slightly longer T 1WI and T 2WI signals on magnetic resonance imaging. Six cases (6/11) had no obvious enhancement in the early stage, and five cases and six follow-up cases showed heterogenous spots, patches, nodules or clusters of distinct enhancement. Diffusion-weighted imaging showed non restricted diffusion in nine (9/11) cases initially diagnosed, and restricted diffusion in two cases (2/11) and nine follow-up cases, which were hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient maps. Five patients (5/5) presented a marked decrease in N-acetyl aspartic acid (NAA)/creatine (Cr) and increase in choline (Cho)/Cr on hydrogen proton magnetic resonance spectrum, including an increase in lipid/Cr in three cases. One case (1/3) showed no abnormal increase in lesion metabolism, and two cases (2/3) showed slightly increased uptake on positron emission tomography/CT. Conclusions:Diffuse bilateral cerebral lesions especially in deep and lobar region, without enhancement or with patchy enhancement, marked decrease in NAA/Cr and increase in Cho/Cr and Lip/Cr are suggestive of LC. Misdiagnosis may be mainly due to insufficient understanding and improper brain biopsy.
Résumé
Objective To investigate the diagnostic value of cranial ultrasonic examination combined with the detection of serum neuron specific enolase(NSE),S100B and interleukin-6(IL-6)on cerebral white matter lesions of premature infant. Methods Thirty-nine premature infants with cerebral white matter injury diagnosed by cranial magnetic resonance imaging (MRI)in Women and Infants Hospital of Zhengzhou City from August 2016 to July 2017 were selected as observation group. Another thirty premature infants without brain white matter injury were selected as control group in the same period. On the 1st , 3rd and 7th day after birth,the serum NSE level was detected by the automatic time resolved fluoroimmunoassay system,the lev-els of serum S100B and IL-6 were detected by double anti sandwich enzyme-linked immunosorbent assay,and the changes of the cerebral white matter echoes around the cerebral ventricles were observed by cranial ultrasonic examination. The sensitivi-ty,specificity and accuracy combined detection of cranial ultrasonic examination combined with serum NSE,S100B and IL-6 in the diagnosis of white matter lesions in premature infants were analyzed. Results The detection rate of cerebral white matter lesions by cranial ultrasonic examination in the control group was 6. 45％(2 / 31),3. 23％(1 / 31)and 0. 00％(0 / 31)respec-tively;and it was 92. 31％(36 / 39),87. 18％(34 / 39)and 84. 62％(33 / 39)respectively on the 1st ,3rd and 7th day after birth in the observation group;the detection rate of cerebral white matter lesions in the observation group was significantly higher than that in the control group on the 1st ,3rd and 7th day after birth(χ2 = 51. 30,48. 69,49. 63;P < 0. 05). There was no signifi-cant difference in the grayscale value of cerebral white matter among the 1st ,3rd and 7th day after birth in the two groups(P >0. 05). The grayscale value of cerebral white matter in the observation group was significantly higher than that in the control group on the 1st ,3rd and 7th day after birth(P < 0. 05). There was no significant difference in serum S100B and IL-6 levels a-mong the 1st ,3rd and 7th day after birth in the control group(F = 0. 319,0. 307;P > 0. 05). There was the significant difference in serum NSE level among the 1st ,3rd and 7th day after birth in the control group(F = 3. 298,P < 0. 05),the serum NSE level on the 3rd and 7th day after birth was significantly lower than that on the 1st day after birth(P < 0. 05),the serum NSE level on the 7th day after birth was significantly lower than that on the 3rd day after birth(P < 0. 05). The levels of serum NSE,S100B and IL-6 in the observation group showed the downward trend on the 1st ,3rd and 7th day after birth(F = 3. 323,3. 517,3. 706;P < 0. 05). The levels of serum NSE,S100B and IL-6 on the 3rd and 7th day after birth were significantly lower than those on the 1st day after birth in the observation group(P < 0. 05). There was no significant difference in the levels of serum NSE, S100B and IL-6 between the 3rd and 7th day after birth in the observation group(P < 0. 05). The levels of serum NSE,S100B and IL-6 in the observation group were significantly higher than those in the control group on the 1st ,3rd and 7th day after birth (P < 0. 05). In the observation group,the grayscale value of cerebral white matter was positively correlated with the levels of serum NSE,S100B and IL-6 on the 1st day after birth(r = 3. 137,3. 358,3. 056;P < 0. 05);the grayscale value of cerebral white matter was positively correlated with the levels of serum NSE and S100B on the 3rd day after birth(r = 2. 872,2. 347;P <0. 05);the grayscale value of cerebral white matter was positively correlated with serum S100B level on the 7th day after birth (r = 2. 791,P < 0. 05). The sensitivity,specificity and accuracy of combined detection of cranial ultrasonic examination and, serum NSE and S100B in the diagnosis of cerebral white matter lesions in premature infants was 100. 00％,93. 54％ and 97. 14％ respectively. Conclusion The combined detection of cranial ultrasonic examination,serum NSE and S100B can sig-nificantly improve the accuracy of early diagnosis of cerebral white matter lesions.