胶质瘤放射性脑病的MRI表现

MRI Representations of Glioma Radioencephalopathy

背景与目的:如何在影像上正确区分脑胶质瘤放疗后的正常组织反应性变化、肿瘤残留或复发、抑或出现放射性脑病,目前临床上仍是一个较为棘手的问题。本文回顾性分析5例胶质瘤放疗后放射性脑瘤的MRI表现,以期能进一步了解放射性脑瘤,为临床上作出正确诊断提供依据。方法:收集1998年9月至2004年5月就诊于南方医院的5例脑胶质瘤放射性脑病患者的MRI资料进行分析,其中4例患者第一次手术后病理诊断为脑质瘤;另1例未行手术,经MRI及PET诊断。5例患者均接受放疗1～2疗程,MRI平扫及增强扫描疑肿瘤复发,经手术切除确诊为放射性脑病。结果:MRI显示40天～7个月内,病灶水肿加重5例,中重度水肿多4例,占位征象加重5例,病灶增大5例,强化表现为珊瑚状、地图状、环状等不规则形。结论:胶质瘤放射性脑病多在2年内发病,MRI表现为较短时间内病灶进行性增大,占位及水肿加重,以不规则形、发散辐射感之强化方式为主。

BACKGROUND &OBJECTIVE: Correctly distinguishing normal tissue rea ct ive changes, tumor residue or relapse, and radioencephalopathy of glioma after r adiotherapy by imaging methods is difficult. This study was to analysis MRI repr esentations of glioma radioencephalopathy. METHODS: MRI records of 5 patients wi th golima radioencephalopathy treated in our hospital from Sept. 1998 to May 200 4 were collected, 4 cases were confirmed by operation, and 1 was diagnosed by MR I and PET. All these 5 cases were suspected recurrence in MRI scans after 1 or 2 radiotherapy periods, but them were confirmed radioencephalopathy pathologicall y after excision. RESULTS: MRI revealed all patients deteriorated within 40 days to 7 months. The edema aggravated (5/5), and most were moderate or severe (4/5) . Space occupying signs aggravated (5/5). Lesions enlarged (5/5) with irregular shapes like coral, map, or ring in enhanced scans. CONCLUSIONS: Radioencephalopa thy of glioma occurs within 2 years after radiotherapy mostly. MRI scans manifes t edema and space occupying signs aggravated, meanwhile the lesions enlarged pro gressively in a rather short time. It is characteristic that enhanced lesions we re irregular and radiate.