心脏黏液瘤颅内并发症的影像学表现

Imaging spectrum of cerebral complications from cardiac myxomas

目的将心脏黏液瘤颅内并发症的影像学特点与其发病机制相结合,了解其发生、发展过程,通过影像学特点帮助鉴别诊断。方法回顾性分析2009年3月至2018年7月首都医科大学附属北京天坛医院收治的25例心脏黏液瘤颅内并发症患者,并进行详细的临床和神经影像学研究。结果颅内并发症主要包括:脑梗死11例,黏液瘤性动脉瘤8例,脑实质转移瘤8例,脑微出血5例。7例患者同时合并两种并发症。其中,脑梗死在磁共振成像上主要表现为皮层及皮层下的多灶、点状梗死灶。动脉瘤在CT血管造影/磁共振血管造影/数字减影血管造影上主要影像学表现为血管远端、多发、梭形或囊状。脑实质转移瘤的影像学表现为恶性表现,呈进行性、多灶性、出血性病变,信号多样。微出血灶在SWI/GRE上表现为点状低信号,伴或不伴有强化,强化的病灶有生长的趋势,考虑为小转移瘤可能,建议密切随访复查。结论心脏黏液瘤颅内并发症多样,包括梗死、黏液瘤性动脉瘤、转移瘤和微出血。因颅内并发症可发生在心脏黏液瘤切除前后,故对黏液瘤患者进行神经影像学随访十分重要。

Objective To obtain a more detailed understanding of the occurrence and development of these complications by combining the imaging features with the mechanism owing to cardiac myxoma and better differentiate them from other diseases by neuroimaging.Methods From March 2009 to July 2018,baseline information including neuroimaging and neuropathology data from 25 patients with cardiac myxoma and neurological symptoms admitted to Beijing Tiantan Hospital,Capital Medical University were retrospectively analyzed,and the imaging features were discussed.Results Twenty-five patients with cardiac myxoma and neurological symptoms were identified.Positive neuroimaging findings were recorded in all patients,including 11 cerebral infarction,8 multiple intracranial aneurysms,8 parenchymal metastasis,and 5 cerebral microbleeds.Seven of the patients had two forms of abnormal appearance.Firstly,the cerebral infarct was mainly exhibited as multifocal punctate cortical and subcortical infarcts on magnetic resonance imaging.Secondly,the prominent imaging features of aneurysms were multiplicity,fusiform oncotic or saccular shape and distal location with or without rupture on computed tomography angiography,magnetic resonance angiography or digital subtraction angiography.Thirdly,parenchymal metastases were exhibited as multifocal and hemorrhagic lesions with various signals at different times,showing the appearance of malignant tumors in all eight patients.Lastly,all of the cerebral microbleeds were manifested as multiple low punctate intensity lesions on MR gradient-recalled echo image or MR susceptibility-weighted image,with or without enhancement.The enhanced lesions had a tendency to grow,which was considered as a possibility of small metastases,and close follow-up is recommended for review.Conclusion Cerebral complications from cardiac myxomas are diverse and presented as infarction,myxomatous aneurysms,myxomatous metastases,and microbleeds.Considering that the progression is over a long period of time after primary tumor resection,neuroimaging follow-up is necessary.