头部CT和MR及框架立体定向活检术在松果体区生殖细胞瘤中的临床应用

The clinical value of brain CT, MR and frame-based stereotactic biopsy in patients with pinealgerminoma

目的探讨头部电子计算机体层扫描(CT)、磁共振(MR)及框架立体定向活检术在松果体区生殖细胞瘤患者中的临床应用价值,以及立体定向活检术在松果体区肿瘤中应用的安全性。方法回顾性分析2017年9月至2019年12月首都医科大学三博脑科医院疑似诊治为生殖细胞瘤患者41例,患者入院完善头部CT、MR,以及血清和脑脊液甲胎蛋白(AFP)、人绒毛膜促性腺激素β亚单位(β-hCG)表达水平检测,所有患者进行框架立体定向活检手术,明确组织学病理并作为诊断“金标准”,判定头部CT、MR及肿瘤标志物在松果体区生殖细胞瘤中诊断和应用价值。结果(1)41例患者血清和脑脊液AFP检测结果均<8μg/L。2例患者血清β-hCG≥3 U/L,3例患者脑脊液β-hCG≥3 U/L。(2)头部CT检查:40例呈稍高密度,38例呈“Engulfed”松果体,并中心性子弹样钙化(钙化通常被肿瘤包绕);头部MRI检查:38例呈T1加权成像、T2加权成像呈等信号,36例扩散加权成像呈高信号,38例注药后增强扫描呈明显强化,内见“椒盐征”;CT/MRI检查发现31例患者脑室扩大、脑积水。(3)41例患者在局部麻醉下顺利实施框架立体定向活检手术,术后头部CT检查示术区微量出血2例,余未见出血征象。术前、术后临床表现未见明显变化。(4)41例标本病理均明确为生殖细胞瘤。结论患者CT呈高密度伴“Engulfed”中心性钙化,MRI的T1、T2加权成像等信号,扩散加权成像高信号,增强扫描呈明显强化,内见“椒盐征”,以上征象均具高诊断特异性。框架立体定向活检手术具有微创、确诊率高、并发症少等优点,对松果体区病灶的精准诊断具有很高应用价值。

Objective To investigate the clinical value of CT,MR and frame stereotactic biopsy in patients with germ cell tumors in pineal region,and the safety of stereotactic biopsy in pineal region tumor.Methods From September 2017 to December 2019,a total of 41 cases of suspected of germioma treated in Sanbo Brain Hospital were analyzed retrospectively.The patients completed brain CT and MR imaging,as well as cerebrospinal fluid(CSF)and serum alpha-fetoprotein(AFP),human chorionic gonadotropinβsubunit expression level(β-hCG)monitoring.All of the patients underwent frame-based stereotactic biopsy,with the pathological examination of diseased brain tissue as the diagnosis"gold standard".Brain CT,MR and tumor markers were evaluated for diagnostic value in pineal germinoma.Results(1)AFP levels in serum and cerebrospinal fluid of 41 patients were less than 8μg/L.The serumβhCG of 2 patients was greater than or equal to 3 U/L,and that of CSF in 3 patients was greater than or equal to 3 U/L.(2)CT examinations of head:40 cases of slightly high density,38 cases of"Engulfed"pineal gland with centrical bullet like calcification(calcification is usually surrounded by tumor).MRI examination of the head:38 cases showed equal signal on T1 weighted imaging and T2 weighted imaging;36 cases showed high signal on diffusion weighted imaging,38 cases showed obvious enhancement on enhanced scan after drug injection,and"salt and pepper sign"was seen inside.CT/MRI showed ventricular enlargement and hydrocephalus in 31 patients.(3)Totally 41 patients underwent stereotactic frame biopsy under local anesthesia.Postoperative head CT examination showed 2 cases of micro bleeding in the operation area,and no bleeding sign was found in the rest.There was no significant change in clinical manifestations before and after operation.(4)All 41 cases were confirmed as germinoma by pathology.Conclusions CT showed high density with"Englfed"central calcification,MRI showed equal signal on T1 and T2 weighted imaging,high signal on diffusion weighted imaging,enhancement on enhanced scan,and"salt and pepper sign"were all signs of high diagnostic specificity.Frame stereotactic biopsy has the advantages of minimally invasive,high diagnosis rate and few complications,which has high application value for accurate diagnosis of pineal lesions.