不同病理类型脑转移瘤MRI表现特点

MRI features of different pathological types of brain metastases

目的回顾性分析不同病理类型脑转移瘤磁共振(MR)平扫、弥散加权成像(DWI)特点及增强表现特点,探讨不同病理类型脑转移瘤MR表现特点,以期为临床提供影像学层面较为可靠的信息。方法分析兰州大学第一医院确诊不同病理类型187例脑转移瘤患者影像及临床资料,所有患者均行常规头颅MR平扫和增强检查,观察并记录脑转移瘤平扫信号、大小、数目、部位、病灶内出血及囊变坏死、病灶弥散特征、病灶强化方式及瘤周水肿程度。结果187例转移瘤颅内分布以幕上多见(占78.8%),腺癌直径多<1cm,鳞癌直径多>3cm;单发病灶63例,以肺鳞癌多见(23.8%,15/63),病灶较大且易发生囊变坏死并环形强化,瘤周水肿较重;多发病灶124例,以肺腺癌多见(43.5%,54/124)实质均匀强化且肺腺癌瘤内出血较常见;胰腺癌及乳腺癌脑膜转移多见(分别占54.5%,33.0%),脑膜呈团片状强化;弥散受限以肺小细胞癌脑转移瘤较为多见。结论不同病理类型脑转移瘤大小、数目、DWI信号特点、强化及瘤周水肿具有一定的特征性,对临床诊断具有一定的价值。

Objective To retrospectively analyze the MR plain,DWI and contrast-enhanced features of different pathological types of brain metastases,and to explore the MR features of those types of brain metastases,in order to provide more reliable information for clinical imaging.Methods The imaging and clinical data of 187 patients with brain metastasis diagnosed in The First Hospital of Lanzhou University were analyzed.All patients underwent routine cranial MR plain scan and contrast-enhanced examination.The signal,size,number,location,intracerebral hemorrhage and cystic necrosis,diffusion characteristics,enhancement mode and degree of peri-tumor edema of brain metastases were observed and recorded.Results The intracranial distribution of 187 cases of metastatic tumors was mostly supratentorial(78.8%),the diameter of adenocarcinoma was less than 1 cm,and the diameter of squamous cell carcinoma was more than 3 cm.63 cases were of single lesions,most of which were squamous cell carcinoma of the lung(23.8%,15/63).The lesions were large,prone to cystic necrosis and annular enhancement,and the peri-tumor edema was severe.In 124 cases of multiple lesions,lung adenocarcinoma was more common(43.5%,54/124)with homogeneous enhancement of parenchyma and intratumoral hemorrhage of lung adenocarcinoma.Meningeal metastasis of pancreatic cancer and breast cancer was more common(54.5%and 33.0%),showing meningeal mass enhancement,and DWI diffusion limitation was more common in brain metastases of small cell lung cancer.Conclusion The size,number,DWI signal characteristics,enhancement and peri-tumor edema of different pathological types of brain metastases have certain characteristics and certain value in clinical diagnosis.