星形胶质细胞瘤MRI与病理对照研究(附280例分析)  

Correlative study of MRI and pathology in astroglioma of the brain

作　　者：耿道颖[1,2] 沈天真[1,2] 陈星荣[1,2] 沈霞 

机构地区：[1]上海医科大学华山医院放射科 [2]徐州医学院附属医院神经科

出　　处：《中华放射学杂志》1999年第2期79-84,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金

摘　　要：目的探索不同分级星形胶质细胞瘤的ＭＲＩ表现的规律性，研究ＭＲＩ对该肿瘤的诊断要点和诊断价值。方法搜集经ＭＲＩ诊断及手术病理证实的星形胶质细胞瘤（ＡＧ）２８０例，其中应用钆喷替酸葡甲胺（ＧｄＤＴＰＡ）增强成像８４例；取５０例肉眼全切标本，行ＭＲＩ表现的病理基础研究。结果发现Ⅰ级ＡＧ边界多较清楚，信号较均匀，水肿及占位效应较轻，囊变、出血少见，分别为３２％、１％；Ⅲ～Ⅳ级ＡＧ则边界多不清楚，信号不均，水肿及占位效应明显，囊变或坏死、出血多见，分别为５７％、２２％；Ⅱ级介于二者之间。众多ＭＲＩ征象中，有分级价值的特征为多位、多发、出血及坏死。而肿瘤在增强前后的信号不均匀性随着恶性度的增加呈递增趋势（Ｐ＜０．０１）。其病理基础主要与肿瘤内坏死、囊变、出血、含铁血黄素沉着等病理改变较多有关。另外，镜下尚发现瘤周水肿及邻近脑组织内有孤立肿瘤细胞浸润现象，而ＭＲＩ上无法分辨。结论不同分级的星形胶质细胞瘤的ＭＲＩ表现有一定规律性。Objective To study specific features and main diagnostic points of astroglioma on MRI. Methods 280 cases of astroglioma were imaged with MRI and proved by pathology. 84 patients had Gd DTPA enhancement. The correlation of MRI and pathology were investigated in 50 cases of pathological specimens. Results The research showed that grade Ⅰ astroglioma was well defined with little mass effect and mild edema; The signal intensity was homogeneous. Cyst degeneration and hemorrhage were 32%、1%, respectively. Grade Ⅲ Ⅳ were poorly defined with marked mass effect and edema. The signal intensity was heterogeneous. Cystic degeneration or necrosis and hemorrhage were 57%, 22%, respectively. The MRI features of grade Ⅱ were between grade Ⅰ Ⅳ. The statistically significant MRI features were multi lesion necrosis or cystic degeneration and hemorrhage. The heterogeneity of signal increased with malignancy on MRI. The pathological bases were related to necrosis, cyst degeneation, hemorrhage, and hemosiderin deposition etc. Isolated tumor cell could be found at peritumoral edema and surrounding normal brain on pathological slices, which couldn't be identified on MRI. Conclusions There are regular MRI features of grade Ⅰ Ⅳ of astroglioma. The signal intensity of the tumor was related to pathological changes.

关 键 词：星形细胞瘤 磁共振成像 病理学 脑肿瘤 

分 类 号：R739.410.4[医药卫生—肿瘤] R730.44[医药卫生—临床医学]