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目的探讨大脑胶质瘤病的MRI影像学特征及其病理学基础,评价MRI和MRS对大脑胶质瘤病诊断、分级的临床应用价值。方法回顾性分析16例经病理证实的GC患者的MRI影像资料,并与其临床和病理信息进行对照分析。16例均行颅脑MRI平扫加增强扫描,12例行MR质子波谱分析(1H-MRS)。结果 10例(62.5%)病变累及双侧大脑,15例(93.8%)病变累及三脑叶及以上部位。各脑叶中,以额、颞、岛叶受累最多见;胼胝体受侵9例(56.3%)。所有病变均呈弥漫性片状或斑片状,边界不清,灰白质均受累,以白质受累为主,占位效应较轻;对应脑回肿胀,脑组织轮廓尚可辨识。病变区于T1WI多呈不均匀低或略低信号,T2WI及FLAIR序列上呈均匀或不均匀高信号。增强扫描10例(62.5%)病变未见明显强化;3例见局灶性团片状、结节状或环状明显强化,2例见线状、血管样明显强化,1例见条片状轻中度强化。DWI图上,病变多呈略高或等信号。16例病变区ADC值平均值高于对侧正常脑实质(P<0.05)。波谱分析(H-MRS)结果显示,病变区NAA、NAA/Cr降低,Cho、MI及Cho/NAA、Cho/Cr升高。结论 MRI对于GC的诊断具有重要临床价值,增强扫描、DWI和MRS检查有助于判断肿瘤分级和评估预后。
Objective To investigate the MRI features and pathology of gliomatosis and to evaluate the clinical value of MRI and MRS in the diagnosis and classification of gliomatosis. Methods The MRI data of 16 pathologically confirmed GC patients were retrospectively analyzed and compared with the clinical and pathological information. Sixteen patients underwent craniocerebral MRI scan and enhanced scan, and MR proton spectrum analysis (1H-MRS) was performed in 12 patients. Results Ten patients (62.5%) had bilateral brain lesions, and 15 (93.8%) lesions involved three brain lobes and above. In each brain lobe, the forehead, temporal, insula were the most common involvement; corpus callosum invaded in 9 cases (56.3%). All lesions were diffuse patchy or patchy, unclear boundaries, gray matter are involved, the main white matter involvement, placeholder effect lighter; corresponding brain swelling, brain tissue profile is still identifiable. Lesions in T1WI mostly uneven low or slightly low signal, T2WI and FLAIR sequence was uniform or uneven high signal. Enhanced scanning in 10 cases (62.5%) lesions were not significantly enhanced; 3 cases, see the focal group of lumps, nodular or ring significantly enhanced, 2 cases see linear, vascular samples were significantly enhanced, 1 case of see flake Light to moderate enhancement. DWI chart, lesions were slightly higher or equal signal. The average ADC value of 16 lesions was higher than that of contralateral normal brain parenchyma (P <0.05). The results of spectral analysis (H-MRS) showed that NAA and NAA / Cr decreased, Cho, MI, Cho / NAA and Cho / Cr increased. Conclusion MRI has important clinical value for the diagnosis of GC. Enhanced scan, DWI and MRS can be helpful for the classification of tumor and prognosis.