单发脑转移瘤11例术前MRI误诊分析

Analysis of Pre-operative MRI Misdiagnosis in 11 Cases of Solitary Metastasis Tumor

目的探讨单发脑转移瘤(solitary brain metastasis,SBM)的MRI特征、鉴别要点及误诊原因、防范措施。方法对术前MRI检查曾误诊的11例SBM的临床、MRI及病理资料进行回顾性分析。结果11例均以头痛、头晕、恶心和呕吐等症状就诊,伴或不伴肢体麻木、活动障碍和言语不清等。入院后均行头颅MRI检查。术前MRI检查曾误诊为脑胶质瘤6例,脑膜瘤2例,脑脓肿和室管膜瘤各1例;未能明确诊断1例。误诊时间3~10(4±6)d。入院后,11例在完善术前检查后均行手术治疗,切除病灶行病理检查结果显示腺癌5例,鳞癌3例,低分化癌、小细胞癌和腺鳞癌各1例。完善相关检查后发现原发病灶为肺腺癌、肺鳞癌和乳腺癌各2例,食管癌和结肠癌各1例;未明确原发病灶3例。11例术后切口愈合后出院,明确原发病灶8例行放化疗等治疗,未明确原发病灶3例进行密切临床观察。随访1年,11例均未复发。结论临床上SBM的MRI表现易与多种脑部疾病相混淆,正确辨认SBM的主要MRI表现,尤其要重视结合临床及病理资料,可以减少或避免其误诊的发生。

Objective To investigate the MRI features,differential diagnosis,causes of misdiagnosis and preventive measures of solitary brain metastasis(SBM).Methods The clinical,MRI and pathological data of 11 patients with SBM,which were misdiagnosed by preoperative MRI,were analyzed retrospectively.Results All of the 11 patients presented with headache,dizziness,nausea and vomiting,with or without numbness of limbs,dyskinesia and dysphonia.All patients underwent MRI examination after admission,and were misdiagnosed as glioma for 6 cases,meningioma for 2 cases,brain abscess for 1 case,ependymoma in 1 case and no definite diagnosis for 1 case.The duration of misdiagnosis ranged from 3 to 10 d(4±6 d).After admission,11 cases underwent surgery after receiving preoperative examinations.The results of pathological examination after removal of the lesion showed that there were 5 cases of adenocarcinoma,3 cases of squamous cell carcinoma,1 case of poorly differentiated carcinoma,1 case of small cell carcinoma and 1 case of adenosquamous carcinoma,which were originated by 2 cases of lung adenocarcinoma,2 cases of lung squamous cell carcinoma,2 cases of breast cancer,1 case of esophageal cancer and 1 case of colon cancer,and 3 cases undefined after relevant examination.Eleven cases were discharged after the incision was healed following operation,8 cases of primary lesions that were confirmed were treated with radiotherapy and chemotherapy,and 3 cases of primary lesions that were not identified were under close clinical observation.They were followed up for 1 year,and no recurrence was reported in all 11 cases.Conclusion The MRI manifestations of SBM are more likely to be confused with a number of other brain diseases.To correctly identify the MRI characteristics of SBM,especially to combine clinical and pathological data could reduce or avoid misdiagnosis.