颅咽管瘤侵袭脑组织的常规MRI研究

Routine MRI study of craniopharyngioma with brain invasion

目的探讨颅咽管瘤侵袭脑组织的常规MRI特点。材料与方法回顾性分析138例经病理证实的颅咽管瘤患者的术前MR图像,明确有无梗阻性脑积水、测量并计算瘤体大小,比较这些影像指标及病理类型(造釉细胞型和非造釉细胞型)在64例成年组和74例未成年组的差别。根据术后病理证实的脑组织受侵与否进行分组,比较上述影像及病理指标、患者年龄及性别的组间差别。根据脑组织是否受侵,分别将成年和未成年组分为2个亚组,对上述影像、病理和临床指标进行比较。结果(1)以年龄分组:①肿瘤体积在成年组和未成年组分别为为8619.5(5358.0~12568.8)mm^3、11469.0(5367.4~26560.1)mm^3,差别显著(P=0.008);②造釉细胞型肿瘤所占比率在成年组和未成年组分别为56.3%(36/64)和83.8%(62/74),差别显著(χ^2=12.640,P<0.01)。(2)以侵袭分组:①脑积水率在侵袭组和无侵袭组分别为46%(22/48)和18%(16/90),差别显著(χ^2=12.349,P<0.01);②造釉细胞型肿瘤的比率在侵袭组和无侵袭组分别为90%(43/48)、61%(55/90),差别显著(χ^2=12.329,P<0.01)。(3)成年组中,造釉细胞型肿瘤比率在侵袭亚组和非侵袭亚组中分别为78%(18/23)和44%(18/41),差别显著(χ^2=7.068,P=0.008)。(4)未成年组中,①造釉细胞型肿瘤比率在侵袭和无侵袭亚组分别为100%(25/25)、76%(37/49),差别显著(χ^2=5.616,P=0.018);②梗阻性脑积水率在侵袭和无侵袭亚组分别为60%(15/25)、20%(10/49),差别显著(χ^2=11.600,P=0.001)。结论颅咽管瘤瘤体大小和病理类型有年龄差别,脑组织受侵多见于造釉细胞型肿瘤,且易出现梗阻性脑积水,这些特点在未成年患者更明显。

Objective:To explore the routine MRI characteristics of craniopharyngioma(CP)with brain invasion.Materials and Methods:The retrospective study recruited 138 patients with CP which was proven by post-operative pathology.The preoperative MRI was analyzed,focused on obstructive hydrocephalus and tumor size.These radiological indices and the pathological ratio of adamantinomatous type were compared between the adult(64 cases)and the juvenile patients(74 cases).The radiological and pathological indices,patient age and sex were also compared between tumors with and those without brain invasion.Finally,according to brain invasion which was pathologically diagnosed,both the adult and juvenile patients were divided into two sub-groups with the indices compared.Results:(1)Grouped by age:①The tumor volume in the adult and juvenile group was 8619.5(5358.0—12568.8)mm^3 and 11469.0(5367.4—26560.1)mm^3,respectively.The difference was significant(P=0.008).②The ratio of adamantinomatous CP was 56.3%(36/64)in the adult group,significantly lower than that of the juvenile group[83.8%(62/74);χ^2=12.640,P<0.01].(2)Grouped by invasion:①The ratio of hydrocephalus was 46%(22/48)in the invasive group and 18%(16/90)in the non-invasive group,significantly different(χ^2=12.349,P<0.01).②The ratio of adamantinomatous CP was 90%(43/48)in the invasive group and 61%(55/90)in the noninvasive group,with a significant difference(χ^2=12.329,P<0.01).(3)In the adult group,the ratio of adamantinomatous type was 78%(18/23)and 44%(18/41)in the invasive and noninvasive sub-group,respectively,showing a significant difference(χ^2=7.068,P=0.008).(4)In the juvenile group:①The ratio of adamantinomatous tumor was 100%(25/25)and 76%(37/49)in the invasive and non-invasive subgroup,respectively,significantly different(χ^2=5.616,P=0.018).②The ratio of hydrocephalus was 60%(15/25)in the invasive sub-group and 20%(10/49)in the non-invasive sub-group.The difference was significant(χ^2=11.600,P=0.001).Conclusions:The tumor volume and pathological types are different in CP patient with different age.CP with brain invasion shows a preference of adamantinomatous type,obstructive hydrocephalus,and younger age.