磁源性影像与MRI相结合对胚胎发育不良性神经上皮瘤的诊治研究

Combination of MSI and MRI in diagnosis and treatment of dysembryoplastic neuroepithelial tumor

目的:探讨胚胎发育不良性神经上皮瘤(DNT)的磁源性影像(MSI)与MRI特点及两者相结合对其诊治的结果。方法:分析总结经我院MSI及MRI检查并经手术病理证实的4例DNT患者的MSI及MRI表现。结果:男2例,女2例,年龄14～21岁,平均17.5岁,所有病例临床表现均以癫痫发作为主,表现为部分性发作及全面性发作。MRI显示病变位于幕上,累及大脑皮质,表现为T1WI低信号,T2WI高信号,病灶周围无水肿,无占位效应,2例表现为多发囊性改变,病变可强化或不强化。MSI可以明确癫痫样放电区域与肿瘤的位置关系。本组4例5个病灶中,1个病灶与癫痫灶位置距离较远,其余4个病灶与癫痫灶紧邻(位于病灶前方或后方)。手术全部切除病灶及癫痫灶很好地控制了癫痫发作。结论:磁源性影像可以明确DNT患者癫痫样放电区域与肿瘤的位置关系,将其与DNT的MRI表现相结合,经手术全部切除病灶及癫痫灶可以很好地控制癫痫发作。

Objective： To evaluate the magnetic source imaging （MSI）, MRI characteristics of dysembryoplastic neuroepithelial tumor （DNT） and the diagnosis and treatment result by the combination of these two methods. Methods： To analyse and summarize the MSI appearance and MRI characteristics in 4 cases of histopathologic confirmed DNT. Results： There were 2 men and 2 women, the age ranged from 14-21 years old, with an average age of 17.5 years old. All of the patients had partial seizures and generalized seizures. All lesions were located in the supratentorial region and involved the cortex on MRI. All lesions showed hypointensity on T1-weighted image and hyperintensity on T2-weighted image. There were no edema surrounding the tumor and no mass effect. In 2 cases, MRI showed multiple cystic changes. The lesion might have contrast enhancement or no contrast enhancement. MSI defined the relationship between lesions and epileptic focus. Of all the 5 lesions in 4 cases, 1 lesion located a little farther from the epileptic focus, 4 lesions showed abnormal spikes in front of the lesions or behind the lesions. A rather radical resection（tumor plus surrounding tissue showing active epilepogenicity） was essential for achievement of excellent seizures control in DNT-associated epilepsy. Conclusion： MSI can define the relationship between the active epiletogenicity and the lesions. Combining with MRI, tumors plus epileptic zones resection may get an excellent seizure control.