左心房黏液瘤神经系统并发症的影像学表现

Clinical value of imaging for diagnosis of left atrial myxoma neurological complications

目的：神经系统并发症可为左房黏液瘤的首发症状，探讨左心房黏液瘤神经系统并发症的影像学表现，以提高对该病的认识，为临床诊断及治疗提供依据。方法回顾分析2009年1月～2015年3月119例病理证实为左心房黏液瘤患者的病例资料，对出现神经系统并发症患者的影像资料进行分析。结果119例左心房黏液瘤患者，13例行神经影像学检查，其中8例患者神经影像学出现异常改变。脑梗死5例（62．5％）和动脉瘤3例（37．5％）。脑梗死均为多发（100．0％），累及2支或2支以上血管区域4例，累及1支血管区域1例，急性脑梗死2例，急性与亚急性病变共存3例。动脉瘤呈梭形、多发且位于大脑前中脑动脉（100．0％）和大脑后动脉（66．7％）的远端，2例合并陈旧性脑梗死；动脉瘤周围在CT上呈高密度影（66．7％），T2WI呈低信号，动脉瘤周围呈均匀强化（66．7％）。8例（6．72％）患者均出现神经系统并发症，其中7例（87．5％）为初始症状，1例（12．5％）出现在左房黏液瘤术后。结论左心房黏液瘤的神经系统并发症包括急性并发症（脑梗死）和迟发并发症（动脉瘤），其神经影像学有一定特征。提高对左心房黏液瘤神经系统并发症影像学表现的认识，将有助于降低左房黏液瘤的漏诊、误诊率。

Objective Neurologic complications may be the first symptoms of atrial myxomas. In this paper , we try to identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma through a retrospective analysis to promote the understanding of the disease, and to provide the basis for clinical diagnosis and treatment. Methods We retrospectively reviewed the medical records of 119 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to March 2015. The neuroimaging data of patients with neurologic complications were analyzed. Results 13 patients had neuroimaging data, and 8 patients presented with neuroimaging changes. There were 5 cases of cerebral infarctions （62.5%） and 3 cases of aneurysms （37.5%）. The main patterns of the infarctions were multiplicity （100.0%）, two or more than two vascular areas involved in 4 cases,.and one vascular area involved in 1 cases..2 patients of acute cerebral infarction,.and acute and subacute lesions coexisting in 3 patients. The aneurysms were fusiform , multiple and located in the distal middle cerebral artery （100.0%）, posterior cerebral artery.（66.7%）,.2 cases complicated with old cerebral infarction..It was notable that high-density in the vicinity of the aneurysms was observed on CT in 2 patients.（66.7%）,.and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging in 2 patients.（66.7%）..All of the 8 patients with atrial myxomas.（6.72%） presented with neurologic manifestations, which constituted the initial symptoms in 7 patients （87.5%）, while 1 patients （12.5%） presented neurologic symptoms postoperatively. Conclusion Neurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms , which show certain characteristic features in neuroimaging..The enhancement acquaint of the neuroimaging features with neurologic complications attributed to atrial myxoma,.is likely to contribute to a significant decrease in the missed diagnosis and misdiagnosis of left atrial myxoma.