经病理证实颅内肿瘤样脱髓鞘病变患者临床及影像学分析

Imaging and clinical characteristics of tumefactive demyelinationlesion:to be re-diagnosed by pathology

目的总结肿瘤样脱髓鞘病变的磁共振(MRI)表现,进一步探讨MRI成像对该病的诊断价值。方法回顾性分析13例经病理证实的肿瘤样脱髓鞘患者MRI表现特点,并复习相关临床及文献资料。结果 13例患者中,肢体无力发病4例,失语发病3例,头疼发病2例,头晕发病2例,认知功能障碍发病1例,视野缺损发病1例。所有患者常规MRI示病灶为直径大于20mm,有不同程度的占位效应及水肿,增强均见明显强化。增强MRI显示7例病变呈开环状强化,4例呈闭环状强化,2例病灶呈结节或斑片样强化。结论全面了解并掌握脱髓鞘假瘤(TDLs)及同心圆硬化(BCS)的MRI表现及发病特点对其诊断、鉴别诊断有重要价值。大多数患者预后较好。

Objective To elucidate typical MRI features in 13 patients with large tumefac- tire demyelinating lesion （TDL） （~20 mm in diameter）. Methods We identified 13 patients with large TDL （seven men, six women; age range 23--65 years,median age 44 years） and studied the clinical manifestation and various radiological studies in these patients. All cases were histopatho- logically confirmed. Results Common MRI features of large TDLs included size ~20 ram,varia- ble degrees of mass effect and edema,Open-- ring enhancement w as observed in 7 cases; closed -- ring enhancement in 4 cases; nodular or patchy enhancement in 2 cases. Conclusion Our find- ings suggest that it is mandatory to consider a demyelinating process in the differential diagnosis of TDLs. the comprehensive understanding of the characteristic features of TDLs on MR imaging is of great value in differential diagnosis. Many TDLs cases may have a favourable long term prog- nosis.