胶质母细胞瘤的CT、MRI表现与组织病理学的对照研究

Comparative study of CT and MRI appearances of glioblastoma with pathologic findings

目的探讨CT、MRI在胶质母细胞瘤(GBM)诊断中的临床意义。方法收集经手术病理证实的脑胶质母细胞瘤29例,其中17例行CT检查,24例行MRI检查,其中16例经过随访并复查。结果肿瘤的部位有额叶、颞叶、顶叶、基底节等,跨中线结构生长的7例,多发性胶质母细胞瘤4例。平扫病灶形态多不规则,呈混杂密度或信号,边界不清,病灶内常见囊变坏死区,8例病灶内见出血,9例病灶内见血管流空信号。27例病灶周围水肿及占位效应明显,2例无明显水肿。增强扫描22例呈厚薄不均的环状、花环状明显强化,5例轻度或中度强化。16例复查病例中,12例短期内复发,时间为术后2～13个月,平均7.4个月。结论 CT和MRI均能很好地反映胶质母细胞瘤影像学的恶性特征,多数病例可作出正确的术前诊断,结合病理,特别是免疫组化,能更准确地判断临床预后。

Objective To investigate the clinical significance of CT and MRI appearance in glioblastoma（GBM）.MethodsTwenty-nine cases of GBM proved by surgery and pathology were collected.CT was performed in 17 cases and MRI was performed in 24 cases.Sixteen cases were followed-up and rechecked.ResultsThe location of tumors included frontal lobe,temporal lobe,top lobe,basal ganglia,and so on,with growing across the midline structures in 7 cases and multiple GBM in 4 cases.The lesions showed irregular shape,mixed density or signal and areas of necrosis and cyst formation almost could be seen.Lesions with hemorrhage were seen in among 8 cases,Lesions with vascular flow void signal were seen in 9 cases.Marked edema around lesion and mass effect could be revealed in 27 cases,without edema in 2 patitents.After enhanced scan,the lesions showed ring-like marked or enhancement garland-like with varied thickness in 22 cases,and mild to moderate enhancement among 5 patients.Among 16 rechecked cases,12 cases recurred in 2～13 months after operation,with a mean time of 7.4 months.Conclusions CT and MR imaging can reflect malignant imaging characteristics of GBM very well,and most cases can be diagnosed before operation.Clinical outcome can be accurately determined by combining pathology and immunohistochemistry especially.