星形胶质细胞瘤术后残留或复发与放射性坏死的影像鉴别诊断  

The differential diagnosis of recurrent astro glioma and radiological necrosis with MRI, CT and SPECT

作　　者：耿道颖[1] 方黎明[1] 沈天真[1] 陈星荣[1] 

机构地区：[1]上海医科大学附属华山医院放射科

出　　处：《中华放射学杂志》1997年第9期614-620,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金

摘　　要：目的：描述星形胶质细胞瘤（ＡＧ）术后残留或复发的ＣＴ、ＭＲＩ特征，客观评价ＭＲＩ、ＣＴ、单光子发射计算机体层摄影（ＳＰＥＣＴ）对肿瘤残留或复发及放射性坏死的诊断和鉴别诊断能力。材料与方法：搜集１９８８年６月至１９９５年３月间，经两次手术和病理证实的复发星形胶质瘤５５例，放射性坏死５例；搜集同期手术，并经ＣＴ、ＭＲＩ随访确诊无复发ＡＧ病例１３例作为对照组。ＭＲ机采用美国Ｄｉａｓｏｎ－ｉｃ０．５ＴＭＴＳ，造影剂为Ｍａｇｎｅｖｉｓｔ；ＣＴ采用Ｅｌｓｃｉｎｉｔ２４００全身扫描仪，采用Ｏｍｎｉｐａｑｕｅ为对比剂；ＳＰＥＣＴ扫描使用ＡＰＥＸＡＧ型平行孔准直器，标记物为９９ｍ锝甲氧基异丁基异腈。结果：在对比研究中，我们发现：（１）手术方式与复发率密切相关而与复发类型（原位型、扩展型、异位型）无关；（２）复发与放射性坏死多发生在２年之内，其发生率分别为８７％、８０％；（３）复发肿瘤大多在ＣＴ、ＭＲＩ随访影像中呈现术后生长活跃综合征（本组为１００％）；而放射性坏死多呈现广泛指样水肿；（４）增强扫描在手术野或异位出现结节或环形强化时高度提示复发，而放射性坏死则不强化或呈地图样强化。结论：术后２年内定期ＭＲＩ或ＣＴ增强前后随访是?Purpose:To study the specific features of recurrent astro glioma and radiational necrosis on MRI, CT and SPECT. Materials and methods: Fifty five patients of recurrent tumors and 5 patients of radiological necrosis were imaged on with CT or MRI and proved by second operation and pathology. Thirteen cases of nonrecurrence verfied by clinical course and follow up CT or MRI were taken as control group.The images were acquired with Diasonic 0.5 MTS imager and Eliscint 2400CT scanner ;Magnevist and Omnipaque were used as contrast medium respectively on MRI and CT;SPECT was done on APEX 409AG SPECT image with 99m Tc MIBI. Results: We found that (1)The operative patterns were closely related to the rate of tumor recurrence, but not related to recurrent type which classified as primary type, expandent type, and distant type.(2)87% of recurrence and 80% of radiological necrosis were found within 2 years of after operation.(3)100% of recurrent tumor in this study displayed post operative active growing syndrome on CT or MRI;Finger like edema could be seen in radiological necrosis.(4) Most recurrent tumors showed nodule or ring like contrasted study while map like enhancement or non enhanced were considered as specific feature of radiological necrosis.Conlusion: In patients with astro glioma postoperative, follow up pre and post contrasted scan using CT or MRI within 2 years after operation is very helpful in defecting and for differentiating recurrent tumor from radiological necrosis with 100% of specificity.

关 键 词：星形胶质细胞瘤 复发 放射性坏死 CT NMR 成像 

分 类 号：R730.264[医药卫生—肿瘤] R818.74[医药卫生—临床医学]