肺癌脑脊膜转移的MRI诊断探讨

MRI features of meningeal metastasis from lung cancer

目的探讨肺癌脑脊膜转移的途径及MRI表现特征。方法经临床及病理证实的肺癌伴脑膜、脊膜转移患者共44例,行头颅和(或)脊椎MRI平扫及增强检查,并进行回顾性分析。结果MRI平扫:28例颅内转移,3例硬脑膜结节状、不规则条片状异常信号影,1例显示左侧海绵窦区结节影;10例脊柱异常信号影,2例硬脊膜异常信号影。MRI增强:34例脑膜转移,其中11例表现为硬脑膜-蛛网膜强化;17例为软脑膜-蛛网膜强化;6例为混合型强化。4例见颅骨破坏。17例脊柱转移,其中12例硬脊膜条片状异常强化。结论血行转移是肺癌脑脊膜转移的主要转移途径,MRI增强检查对其具有重要诊断价值。

Objective To investigate the pathway and MRI findings of meningeal metastasis original from lung cancer. Methods 44 cases with cerebro-spinal meningeal metastasis original from lung cancer proven by clinical and pathology were retrospectively reviewed. All cases undergone plain MRI scan and Gd-DTPA enhanced MRI scan on brain and/or spine. Results MRI plain scan indicated 28 cases with brain metastases, 3 cases with meningeal nodosity or irregularly patchy abnormal signal, 1 case with nodule in left cavernous sinus, 10 cases with abnormal signal in spine, 2 cases with abnormal signal in spinal dura mater. 34 cases with cerebro meningeal metastases were found in MRI enhancement scan. Among them, 11 cases displayed cerebral dura mater-arachnoid enhancement, 17 cases revealed cerebral pia mater-arachnoid enhancement and 6 cases with mixed typed enhancement. Osteoclasia in skull was found in 4 cases, spinal metastasis was revealed in 17 cases, and patchy abnormal enhancement in spinal dura mater was showed in 12 cases. Conclusion Hematogenous metastasis is a main route of meningeal metastasis caused by lung cancer and enhanced MRI scan is of important diagnostic value.