脑胶质母细胞瘤少见MRI表现:附11例病例报道

Rare MRI findings of brain glioblastoma:a report of 11 cases

目的探讨脑胶质母细胞瘤(GBM)的少见磁共振成像(MRI)表现,以提高诊断准确性。方法回顾性分析11例经手术病理证实为脑GBM的临床及MRI资料。结果11例脑GBM患者中,单发病灶5例,表现类似脑淋巴瘤、脑膜瘤及低级别胶质瘤;多发病灶6例(多灶型5例、多中心型1例),表现类似脑转移瘤。肿瘤实性部分及瘤周脑血容量(CBV)、脑血流量(CBF)较对侧不同程度增高。11例病灶表观弥散系数(ADC)值为(0.76~1.43)×10^(-3) mm^(2)/s,平均为1.01×10^(-3) mm^(2)/s。多体素质子磁共振波谱(MRS)示10例病灶N-乙酰天门冬氨酸(NAA)峰及肌酸(Cr)峰减低、胆碱(Cho)峰升高,NAA/Cr、NAA/Cho明显减低、Cho/Cr明显升高。扩散张量成像(DTI)示10例肿瘤内白质纤维束中断、破坏,瘤周白质纤维束受压推移。结论脑GBM少见MRI表现不典型,结合多模态成像有助于准确诊断。

Objective To investigate the rare MRI findings of brain glioblastoma(GBM)in order to increase its diagnostic accuracy.Methods The clinical and MRI data of 11 cases of brain GBM confirmed by surgery and pathology were analyzed retrospectively.Results Among 11 cases of brain GBM,there were 5 cases of single-focus GBM,the manifestations were similar to brain lymphoma,meningioma and low-grade glioma.There were 6 cases of multiple-focus GBM(5 cases of multifocus,1 case of multicenter),the manifestations were similar to brain metastasis.The solid part of the tumor,cerebral blood volume(CBV)and cerebral blood flow(CBF)were increased compared with those in the opposite side.The values of the apparent diffusion coefficient in varying degrees when(ADC)of the lesions in 11 cases were(0.76-1.43)×10^(-3) mm^(2)/s,with an average of 1.01×10^(-3) mm^(2)/s.MRS showed the NAA peak and Cr peak were decreased in 10 lesions,Cho peak was increase,NAA/Cr and NAA/Cho were significantly decreased,Cho/Cr was significantly increased.The diffusion tensor imaging(DTI)showed that white matter fiber tracts in the tumor were disrupted and destroyed.The white matter fiber tracts around the tumor were compressed and shifted.Conclusion Rare MRI findings of brain GBM are atypical,and combining with multimodal imaging is helpful for accurate diagnosis.