临床和影像学表现不典型的脑肿瘤9例分析

The clinical and imaging presentations of atypical brain neoplasms:a report of 9 cases

目的提高对临床和影像学表现不典型的脑肿瘤的认识,减少诊疗失误。方法回顾性分析9例貌似非肿瘤病变,但最终经病理证实的脑肿瘤,总结其临床和影像学特点。结果9例患者的临床表现:8例无前驱感染和发热,1例有前驱感染;6例非急性起病,3例急性起病;7例呈亚急性或慢性病程,1例呈急性病程;5例行血液免疫炎性指标检测,其中3例有异常。6例行头颅CT平扫:5例呈低密度灶,1例高密度灶。9例患者病灶分布多样,头颅MRI表现:T1WI呈低信号5例,等信号2例,混合信号3例,T2WI和Flair相均呈高信号;4例有强化;5例有占位效应;9例均无灶周水肿。2例行正电子发射计算机断层显像(positron emission tomography,PET),其中1例提示肿瘤;3例行磁共振波谱分析(magnetic resonance spectroscopy,MRS)均提示为肿瘤。3例早期抗炎有效,但9例抗炎最终疗效均不佳;病理结果:星形细胞瘤4例,胶质瘤病2例,节细胞胶质瘤1例,淋巴瘤2例。结论不典型脑肿瘤的临床和影像学表现复杂多变。对于貌似非肿瘤的不典型颅内病变,需考虑肿瘤可能,当抗炎治疗效果不佳时,应行病理活检以尽快明确诊断。

Objective To explore clinical and imaging characteristics of atypical brain neoplasm, to improve accuracy and avoid its misdiagnosis and mistreatment. Methods The clinical and imaging presentations of 9 cases of atypical brain neoplasm were retrospectively reviewed. Results Prodromal infection was detected in one case. The disease course was subacute or chronic course in seven cases, acute-onset in six cases, and acute episode in one case. The blood inflammatory test was positive in three of five testing cases. CT scan of six patients revealed that neo- plasia lesions were hypodense in five cases and hyperdense in one case. MRI scan of nine cases revealed that the presentations of lesions were diverse on MRI image. On T1WI image, brain neoplasia lesions were hypointense in five cases, mixed intense in three cases and isointense in two cases; On T2WI and Flair image, neoplasia lesions were hyperintense without peritumoral edema in all nine cases, could be enhanced in four cases and had space-occupying effects in five cases, Positron emission tomography of two patients revealed brain neoplasia in one case. Magnetic res- onance spectroscopy of three patients detected brain tumors.in all three cases. All nine cases had a poor response to anti-inflammatory treatment although three cases seemed to have a response to anti-inflammatory treatment during the early period of treatment. Pathology revealed astrocytoma in four cases, gliomatosis in two cases, lymphoma in two cases and gangliogliom in one case. Conclusions Atypical brain neoplasms have complicated and diverse clinical and neuroimaging presentations. Pathological biopsy should be considered to rule out the possibility of brain neoplasms if intracranial non-neoplastic tumor-like lesions fail to response to anti-inflammatory treatment.