脑多发胶质瘤的磁共振影像特征及鉴别诊断

Magnetic resonance imaging features and differential diagnosis of multiple gliomas

目的当前对脑多发胶质瘤的影像学特征认识不足。文中旨在总结脑多发胶质瘤的磁共振影像(MRI)表现,分析及归纳其影像学特征及诊断思路。方法回顾性分析2014年1月至2018年12月东部战区总医院医学影像科术前MRI且有术后病理证实的63例多发胶质瘤患者的临床资料。分析多发脑胶质瘤的磁共振影像(MRI)表现,归纳其影像学模式及其鉴别诊断思路。结果63例多发胶质瘤患者可分为多灶胶质瘤(59例)和多中心胶质瘤(4例);多灶胶质瘤者按照病灶播散途径分为直接侵犯(41例),沿白质纤维束联系(35例),沿室管膜下及小血管间隙等膜性结构播散转移(24例),沿脑膜-蛛网膜下腔播散(6例)。多发胶质瘤皮层受累及者主要表现为皮层弥漫肿胀,其次是皮层结节、沿皮层样强化。病灶间存在异质性者45例(71.4%)。多发胶质瘤分为5种影像学模式:①类转移瘤型,需与转移瘤鉴别诊断;②类肉芽肿型,需与结节病、结核瘤及梅毒树胶肿等鉴别诊断;③类特异感染脓肿型,需与结核脓肿、真菌脓肿等鉴别诊断;④类脑炎型,需与病毒性脑炎鉴别诊断;⑤类代谢性脑病型,需与线粒体脑疾病急性期鉴别诊断。结论多发胶质瘤特异性表现为脑皮层受累及病灶间异质性较高;其5种影像学模式需要与其他疾病鉴别诊断;掌握上述特征可为提高脑多发胶质瘤的影像学特征认识及临床诊断水平提供依据。

Objective The magnetic resonance imaging (MRI) patterns of multiple gliomas are insufficiently understood because the related studies are rarely reported and mostly with small-size samples. This article summarizes the MR manifestations of multiple gliomas, analyzes their imaging features and proposes some diagnostic ideas. Methods We retrospectively reviewed 303 cases of diffuse glioma pathologically confirmed in our hospital from January 2014 to December 2018, including 240 cases of solitary (79.2%) and 63 cases of multiple gliomas (20.8%). We analyzed the MRI manifestations, summarized the MRI patterns, and investigated the differential diagnosis of multiple gliomas. Results According to the growth patterns, 4 of the 63 cases of multiple gliomas were classified as multicentric and the other 59 as multifocal glioma, and of the 59 cases of multifocal glioma, 35 spread along the white matter fiber bundle, 24 along the subependymal and small vessel space, 6 along the meningia-subarachnoid space, and 41 in a mode of direct invasion. The manifestations of cortical involvement included cortical tubers (37.2%[16/43]), multiple cortical tubers with high-intensity signals on T2WI, diffuse cortical swelling (44.2%[19/43]), frontal cortical swelling with high-intensity signals on T2FLAIR, and enhancement along the cortex (37.2%[16/43]). Interfocal heterogeneity was observed in 45 of 63 cases (71.4%). The imaging features of the lesions were classified into 5 types: metastasis (69.8%), granulomatosis (4.8%), abscess (12.7%), encephalitis (6.3%) and metabolic encephalopathy (6.3%). Conclusion The specific MRI presentations of multiple gliomas are cortical involvement and interfocal heterogeneity. The 5 MRI features of multiple gliomas may help improve the differential diagnosis of the lesions.