胶质母细胞瘤局部脑膜受侵的临床和MRI特点

Localized meningeal infiltration by glioblastoma: clinical and MRI characteristics

目的探讨胶质母细胞瘤(glioblastoma,GBM)局部脑膜受侵的临床和MRI特点。方法回顾性分析62例GBM患者的术前MRI图像,明确病变水肿和坏死程度(轻度、重度)、肿瘤体积及邻近脑膜有无强化。按照病理结果分为脑膜受累组和正常组,比较组间患者年龄、性别、肿瘤水肿和坏死程度、体积及邻近脑膜强化率的差别,并对脑膜强化进行ROC曲线分析。结果脑膜受侵组30例(男23例,女7例),平均年龄(51±11. 4)岁;脑膜正常组32例(男16例,女16例),平均年龄(53. 1±13. 5)岁,组间年龄无差别(P=0. 525),性别有差异(X^2=4. 719,P=0. 030)。脑膜受侵组轻度水肿率、明显坏死率、体积中位数、局部脑膜强化率分别为60%(18/30)、43%(13/30)、69178. 8mm3及77%(23/30),正常组上述指标分别为31%(10/32)、59%(19/32)、30475mm3及34%(11/32)。两组病变在水肿率、体积、局部脑膜强化率有明显差别(X^2=5. 168,P=0. 023; P=0. 029;X^2=11,182,P=0. 001)。以局部脑膜强化判断脑膜受侵的ROC曲线下面积为0. 711,灵敏度为0. 767。结论 GBM局部脑膜受侵多见于男性患者,瘤体较大,水肿较轻,局部脑膜强化是重要的征象,从而提示术中注意切除该部分脑膜。

Objective To explore the clinical and MRI characteristics of adjacent meninges infiltrated by glioblastoma （GBM）. Methods The preoperative MRI of 62 patients with GBM were retrospectively analyzed, focused on peritumoral edema and intra-tumoral necrosis extent （mild vs vivid）, tuomor volume, and enhancement of adjacent meninges. According to pathological results, the cases were divided into two groups： tumors with involved and those with intact adjacent meninges. The two groups were compared between patient age, gender, tumor volume, edema and necrosis extent, and enhanced meninges with analysis of receiver operation curve （ROC）. Results Thirty patients （23 males, 7 females） aged （51±11.4） year-old were with infiltrated meninges. Thirty-two patients （male, 16, female, 16） aged （53.1±13.5） year-old were with intact meninges. The two groups showed no difference in patients age （ P =0.525） and difference in gender （ χ^2=4.719, P =0.030）. In the group with infiltrated meninges, the ratio of tumors with mild peritumoral edema,obvious necrosis, the median of tumor volume, and the ratio of enhanced meninges were 60%（18/30）, 43%（13/30）, 69178.8 mm ^3, and 77%（23/30）, respectively. In the group with intact meninges, the indices were 31%（10/32）, 59%（19/32）, 30475 mm ^3, and 34%（11/32）, respectively. The two groups were different in edema extent, tumor volume, and enhanced meninges （χ^2=5.168, P =0.023; P =0.029;χ^ 2=11,182, P = 0.001）. Meninges infiltration indicated by enhanced meninges showed an area under ROC of 0.711 and sensitivity of 0.767. Conclusion Localized meninges infiltration by GBM shows a male preference with a larger tumor volume and mild peritumoral edema. Enhancement of adjacent meninges is a strong radiological indicator. This is indicative for the surgical resection of the meninges.