脑干胶质瘤磁共振成像与病理学特点的相关性研究

Correlation between MRI findings and histological diagnosis of brainstem glioma

目的 分析比较脑干胶质瘤磁共振成像（MRI）及病理学特点,并对两者之间的相关性进行探讨.方法 回顾性分析2002年1月至2012年1月首都医科大学附属北京天坛医院神经外科收治的150例疑似脑干胶质瘤患者的MRI及病理学特点,并对其进行统计学分析.结果 150例脑干胶质瘤患者,其中低级别胶质瘤108例（72.0％）,高级别胶质瘤35例（23.3％）,其他病理类型7例.术前依据MRI诊断脑干胶质瘤的正确率为95.3％.统计学分析显示,内生局限型脑干胶质瘤（与内生弥散型脑干胶质瘤相比,P =0.005）及外生局限型脑干胶质瘤（与外生弥散型脑干胶质瘤相比,P =0.001）病理级别较低;内生弥散型脑干胶质瘤中,无强化型病理级别较低（P=0.009）;成人与儿童脑干胶质瘤病理级别的差异无统计学意义（内生型P =0.624,外生型P=0.771）.结论 MRI诊断脑干胶质瘤准确性高,但有些类型的肿瘤仍需获得病理诊断;是否局限及有无强化是判断脑干胶质瘤病理性质的重要因素;成人与儿童脑干胶质瘤病理级别的差异无统计学意义,预后差异可能与脑干内环境的差异有关.

Objective To compare the MRI characteristics with histopathological findings of brainstem glioma and identify the characteristics associated with the diagnosis of pathologies.Methods From January 2002 to January 2012,150 patients was diagnosed as brainstem gliomas by MRI and received operations in Beijing Tiantan Hospital.All the MRI and histopathological findings of these patients were respectively reviewed.Results One hundred and eight patients were low-grade glioma （72.0%）,and 35 high-grade （23.3%）.The accuracy of the MRI diagnosis for brainstem glioma was 95.3%.The data analysis of the MRI findings revealed that in not only the intrinsic （P =0.005） but also the exophytic （P =0.001） brainstem glioma patients,having a focal lesion was a significant factor associated with a more favorable histopathological diagnosis.In the intrinsic diffuse type,tumors without enhancement had the better pathologies （P =0.009）.There was no significant difference of the histopathological diagnosis between the adults and children in not only the intrinsic （P =0.624） but also the exophytic （P =0.771） brainstem glioma.Conclusions The results of this study could help us to estimate the pathology with data obtained from MRI and help to obviate the need for invasive biopsy.The pathology of tumors with a focal appearance was better than their diffuse counterparts.For the intrinsic diffuse type,tumors with nonenhancement might have a better pathology.The different growth pattern and invasiveness of brainstem glioma between children and adult could be due to the different host cellular environments between the two age groups.