弥漫性中线胶质瘤(H3 K27改变)的影像特征及鉴别诊断

Imaging Features of Diffuse Midline Glioma(H3 K27-altered)and Differential Diagnosis

目的 总结弥漫性中线胶质瘤(H3 K27改变)的影像特征及鉴别诊断,以提高该病的术前诊断准确率。方法 回顾性分析26例经病理证实为弥漫性中线胶质瘤(H3 K27改变)患者的临床、影像和病理资料,总结病变的MRI表现及相应病理特征。结果 26例中,肿瘤发生于脊髓7例,丘脑6例,桥脑5例,延髓3例。位于幕上的病灶占位效应明显且形态多样,桥脑病灶肿胀且倾向无强化,延髓病灶表现为明显强化结节或肿块,脊髓病变呈多发长段、斑片状明显强化。儿童组患者女性多见,病灶多见于桥脑。成人组患者男性略多于女性,病灶多见于丘脑、脊髓。成人组病灶边界不清晰者较儿童组多(P=0.028),儿童组病灶出现坏死较成人组多(P=0.036)。儿童组Ki-67表达≥30%占比大于成人组(77.8%、41.2%)。结论 不同部位、不同年龄段弥漫性中线胶质瘤(H3 K27改变)影像具有相对特异性,结合临床症状、MRI平扫及增强扫描、DWI、PWI有助于提高弥漫性中线胶质瘤(H3 K27改变)的诊断准确率。

Objective To summarize the imaging features and differential diagnosis of diffuse midline glioma(H3 K27-altered)in order to improve the accuracy of preoperative diagnosis.Methods The clinical,imaging and pathological in-formation of 26 pathologically confirmed diffuse midline glioma(H3 K27-altered)cases were retrospectively analyzed,and MRI manifestations and the corresponding pathological features were summarized.Results Of the 26 cases,7 cases were located in the spinal cord,6 in the thalamus,5 in the pons,and 3 in the medulla oblongata.Diffuse midline gliomas(H3 K27-altered)located supratentorially had a significant occupying effect and multiple morphologies,pontine lesions were swollen and tend to be non-enhancing,medullary lesions showed markedly enhancing nodules or masses,and spinal cord lesions showed multiple long segments and patches of marked enhancement.There were more females than males in children's group,and most of the lesions were found in the pontine brain,while in the adult group there were slightly more males than females,and most of the lesions were found in the thalamus and spinal cord.More lesions were ill-defined in the adult group than in the children's group(P=0.028);a higher proportion of lesions in the children's group showed necrosis than in the adult group(P=0.036).The percentage of Ki67 expression≥30%was greater in children's group than in the adult group(77.8%>41.2%).Conclusion Diffuse midline gliomas(H3 K27-altered)at different sites and ages have relative specificity of images.The combination of clinical symptoms,MRI plain scan and contrast-enhanced scan,DWI and PWI helps to improve the diagnosis accuracy of diffuse midline gliomas(H3 K27-altered).