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脑胶质肉瘤的MRI表现和病理对照研究
作者:陈真平  马玲  刘晓  邹玉林  漆强 
单位:东莞东华医院放射科  广东 东莞 523110 
关键词:脑肿瘤/诊断 脑肿瘤/病理学 神经胶质肉瘤/诊断 神经胶质肉瘤/病理学 磁共振成像 诊断 鉴别 回顾性研究 
DOI:10.13267/j.cnki.syzlzz.2019.01.001
出版年,卷(期):页码:2019,34(1):11-15
摘要:

目的 探讨脑胶质肉瘤的MRI表现及病理特征,提高其术前诊断准确率。方法 回顾性分析12例胶质肉瘤患者的病理资料和MRI影像学特点,所有病例术前均行MRI常规及增强扫描,其中4例行磁共振波谱检查,2例行弥散加权成像检查。结果 12例患者共17处病灶,均位于幕上,边界清楚,周围伴轻中度水肿。MRI表现包括3种类型:(1)9处实性,信号欠均匀,以稍长T1、稍长T2信号为主,增强扫描不均匀明显强化,边缘强化更明显,DWI高信号;(2)5处囊实性,囊性部分位于瘤体一侧,边界清楚,增强扫描瘤内呈栅栏样强化;(3)3处表现为囊结节型,增强扫描囊壁及结节明显强化。结论 脑胶质肉瘤临床少见,MRI表现复杂多样,但信号混杂,增强扫描不均匀明显强化,边缘强化更明显,瘤内栅栏样强化具有一定特异性,结合DWI高信号有助于该肿瘤的术前诊断及鉴别,但确诊仍需病理定性。

Objective To analyze the MRI imaging features and pathological characteristics of gliosarcoma, and to improve the diagnostic accuracy. Methods The pathological data and MRI results of 12 cases of gliosarcoma were retrospectively analyzed. All patients were examined with MRI before the surgery. Four patients received magnetic resonance spectroscopy, and 2 cases received diffusion-weighted imaging test. Results There were a total of 17 lesions in the 12 patients, which were all located in supratentorium with clear boundary and were surrounded with moderate degree edema. MRI features could be categorized into three types:(1) 9 lesions were solid tumors with heterogeneous signals. Mixed hypointensity of T1WI signals and hyperintensity of T2WI signals were observed. The lesions were unevenly enhanced after administrating Gd-DTPA, with more obvious enhancement on the margin and strong DWI signals. (2) 5 lesions were cystic solid mass. The cysts were located on one side of the tumor, with clear margin. The lesions showed irregular railing-like enhancement after injecting Gd-DTPA. (3) 3 lesions were cystic nodule mass, and showed obvious enhancement on the cystic wall and in the nodules. Conclusions Gliosarcoma is clinically rare with complicated MRI manifestations. But gliosarcoma exhibits some characteristic MRI features, including mixed signal, unevenly enhancement with strong enhancement on the margins, railing-like enhancement, and strong DWI signals. The MRI findings are helpful for the preoperational diagnosis of gliosarcoma, but a definite diagnosis of it still requires pathological tests.

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