颅内恶性胶质瘤术后脑组织正常反应与术后残存的动态CT研究

Dynamic CT in Diagnosis of "Benign" Changes and Residual Tumor after Resection of Intracranial Malignant Gliomas

目的 :探讨颅内恶性胶质瘤术后反应性增强与肿瘤残存增强的动态CT时间 -密度曲线形态及发生机制。材料和方法 :选取48例恶性胶质瘤术后患者为试验组 ,其中男27例 ,女21例 ,年龄14～63岁 ,平均38.2岁。包括星形胶质细胞瘤25例 ,少枝胶质细胞瘤6例 ,胶质母细胞瘤15例 ,混合胶质细胞瘤2例。所有病例在术后7～15天内行动态增强CT检查 ,注药速度1.5ml/s ,总剂量90ml,经高压注射器注药的同时进行动态扫描。扫描速度1层/s ,间隔2.5s。扫描43层 ,共148s。同法对11例癫灶清除术后7～12天内和5例胶质瘤术前患者检查 ,经后处理后获得其时间 -密度曲线 ,并对48例恶性胶质瘤中的30例追踪观察。结果 :术后反应性增强的时间 -密度曲线表现为注药后曲线缓慢上升 ,在65～80s左右达峰值 ,然后逐渐下降 ,并维持在一定水平 ;术后残存增强的曲线在检查时间(148s)内缓慢上升 ,无明显峰值 ,或表现为峰值出现后的相对稳定状态而无明显的下降支。术后反应性增强与术后残存增强的曲线不同是由于其增强的病理机制不同所致。结论 :通过动态CT检查 ,分析其时间 -密度曲线 ,可以对术后反应性增强与残存增强进行有效的鉴别 。

Purpose:To study the dynamic CT findings of postoperative reaction and residue of malignant glioma.Materials and Method:Forty-eight cases of high-grade gliomas and 11 cases of epilepisic patients confirmed by operation and pathology were performed by dynamic CT during 7～15 days after surgery,and obtained the two kinds of Time-Density Curve(TDC).The patients were monitored prospectively,and 30 of the 48 cases were evaluated in this ongoing study. Results:The most important difference between the surgical induced and tumor-induced TDC is that whether has the descending line after the peak height of the curve or not,the former does,and the latter does not.The reason of this phenomenon is determined by the different causes of these two kinds of enhancement.Conclusion:We have applied dynamic CT method for differentiating postoperative changes from residual tumor,and the role of it is to be a useful study for the next therapy.