MRI多模态扫描对巨细胞型胶质母细胞瘤的诊断和鉴别中的应用

The Application of Multiparametric MRI in the Diagnosis and Differentiation of Giant Cell Glioblastoma

目的分析巨细胞型胶质母细胞瘤MRI表现,提高对该病的认识和诊断水平。方法回顾性收集5例经手术及病理证实为巨细胞型胶质母细胞瘤的临床和MRI资料,总结、分析其MRI表现,包括病变的位置、不同序列信号特征及病灶周围组织侵袭状况等。结果MRI显示4例患者为单发,位于右侧额叶3例,左侧额顶叶1例;1例患者为多发,位于右侧额颞岛叶及基底节区。2例患者肿瘤呈实性,3例患者肿瘤呈囊实性。肿瘤边界清楚3例,边界模糊2例。瘤周轻度水肿2例,中度水肿3例。肿瘤出血1例。5例增强扫描的肿瘤均呈明显不均匀强化,其中3例存在坏死囊变。3例PWI扫描患者肿块实性成分rCBV均明显升高。3例DTI扫描患者肿瘤实性部分ADC_(min)值明显减低,肿瘤及瘤周水肿FA值明显减低。4例MRS扫描患者肿瘤实性成分Cho胆碱峰明显增高。5例患者免疫组化胶质纤维酸性蛋白(GFAP)均为阳性,Ki-67阳性细胞数达20%~40%。结论巨细胞型胶质母细胞瘤的发病率低,相关文献及病例报道有限,MRI多模态扫描对肿瘤的诊断具有很高的价值,能够评估病灶大小、位置、信号特点、累及范围及周围组织改变,有助于临床上的术前评估、术后随访和疗效评价,但在与经典的胶质母细胞瘤鉴别诊断方面存在不足。随着这种罕见恶性肿瘤的独特特征的继续探索,GCG诊断及治疗可能会进一步改善。

Objective This study aimed to analyze the MRI findings of Giant Cell Glioblastoma to improve the understanding and diagnosis of this disease.Methods This study retrospectively collected the clinical and MRI data of 5 patients with cytomegaloblastic glioblastoma confirmed by surgery and pathology.The researchers summarized and analyzed the MRI findings of each case,including the location of lesions,different sequence signal characteristics,and invasion of tissues around the lesions.Results MRI showed that 4 patients with single lesion,3 cases were located in the right frontal lobe,and 1 case was in the left frontoparietal lobe.One patient with multiple lesions,which were located in the right frontotemporal insular lobe and basal ganglia.The tumors of 2 patients were solid,and the tumors of 3 patients were cystic.The tumor boundaries were clear in 3 cases and blurred in 2 cases.There were 2 cases of mild edema and 3 cases of moderate edema and there was 1 case of tumor hemorrhage.All 5 tumors on Dynamic Contrast Enhanced-MRI(DCE-MRI)showed significant uneven strengthening,and 3 of them had necrotic cystitis.The rCBV of the solid components of the masses in three patients significantly increased on Perfusion Weighted Imaging(PWI).In three patients with Diffusion Tensor Imaging(DTI),the ADCmin value of the solid part of the tumor significantly reduced,and the FA value of tumor and peritumor edema was significantly reduced.In 4 patients with Magnetic Resonance Spectroscopy(MRS),the Chocholine peak of the solid component of the tumor significantly increased.The Immunohistochemical Glial Fibrillary Acid Protein(GFAP)of all 5 patients was positive,and Ki-67 positive cells reached 20%~40%.Conclusion The incidence of giant cell glioblastoma is low,and relevant literature and case reports are limited.Multiparametric MRI has high value for tumor diagnosis,can help radiologists assess lesion size,location,signal characteristics,range of involvement and surrounding tissue changes,which is helpful for clinical preoperative evaluation,postoperative follow-up and efficacy evaluation.But there are shortcomings in differential diagnosis with classical glioblastoma.As the unique features of this rare malignancy continue to be explored,the diagnosis and treatment of GCG may be further improved.