病理证实的195例颅内占位病变患者的临床、影像特点  

Classifications,symptoms and imaging findings of 195 cases confirmed by biopsy or postoperative pathology

作　　者：董秦雯[1] 张海玲[1] 夏德雨[1] 刘建国[1] 姚生[1] 戚晓昆[1] 

机构地区：[1]第二军医大学海军临床医学院(海军总医院)神经内科,北京100048

出　　处：《中华神经科杂志》2014年第3期153-158,共6页Chinese Journal of Neurology

基　　金：首都医学发展科研基金项目（2009-2054）

摘　　要：目的 分析经病理证实的颅内占位病变（space occupying lesion,SOL）的病种分类、临床症状、影像学特点,以期对SOL的诊断及鉴别提供临床参考.方法 回顾性分析就诊于海军总医院神经内科的195例经病理证实的SOL患者的病种分类、临床及影像学特点.结果 195例患者病种分类：肿瘤性病变（NL）86例[神经上皮组织肿瘤（NET）49例,原发性中枢神经系统淋巴瘤（PCNSL）22例,生殖细胞瘤6例,脑转移瘤3例,其他肿瘤6例],非肿瘤性病变（NNL）109例,其中肿瘤样脱髓鞘病变（TDL）46例,颅内感染性疾病34例,线粒体脑肌病、原发性中枢神经系统血管炎（PACNS）各7例,脑梗死4例,脑静脉血栓3例,伴脑实质受累的硬脑膜肥厚2例,脑出血1例,其他NNL5例.头痛、头晕及肢体活动障碍为最常见的首发和高峰期症状.CT低密度灶可见于各病理类型,CT高或混杂密度多见于NL,TDL均表现为低密度;MRI增强扫描示PCNSL多为＂球样＂明显强化,且中线结构更易受累,TDL（亚急性期后）多为＂开环样＂强化.结论 本组资料中,NNL以TDL居多,其次为颅内感染性疾病,少数为线粒体脑肌病、PACNS等其他疾病.NL以NET居多,其次为PCNSL,少数为生殖细胞瘤、脑转移瘤等其他肿瘤.头颅CT显示高密度或混杂密度（排除出血及钙化）多为NL,TDL的可能性极小.MRI增强扫描示PCNSL多呈＂球样＂明显强化,亚急性期后的TDL多为＂开环样＂强化.Objective To summarize and analyze the classifications, symptoms, imaging findings of the cerebral space occupying lesions which confirmed by biopsy or postoperative pathology. Methods The classifications, symptoms, imaging findings of 195 cases who visited the Neurology Department of Naval General Hospital were analyzed by retrospective study. Results Classifications：among the 86 neoplastic lesions （NL）, there were 49 neuroepithelial tumors, 22 primary central nervous system lymphoma （PCNSL）, 6 germinoma, 3 brain metastases, and 6 other brain tumors. Among the 109 non-neoplastic lesions （NNL）, there were 46 tumefactive demyelinating lesions （TDL）, 34 intracranial infections, 8 cerebrovascular diseases, 7 mitochondrial encephalomyopathy, 7 primary angiltis of the central nervous system, 4 cerebral infarction, 3 cerebral venous thrombosis, 2 hypertrophic cranial pachymeningitis, one cerebral hemorrhage, and 5 other cerebral space occupying lesions. Headache, dizziness and disorders of limbs activity were the most common clinical manifestations. Computed tomography （CT） appearance of hypodense could be found in all kinds. CT appearance of hyperdense or mixed density might often be diagnosed with brain tumors. CT appearance of TDL displayed as hypodense lesions ; Most PCNSL showed homogeneous enhancement on magnetic resonance imaging （MRI）. Most TDL showed ＂open-ring＂ enhancement on MRI. The diagnosis of the intracranial lesions could not entirely depend on positron emission tomography. Conclusions TDL holds a large proportion in NNL, and neuroepithelial tumor holds a large proportion in NL. CT appearances of hyperdense or mixed density are often diagnosed with brain tumors, extremely unlikely in TDL. Most PCNSL show homogeneous enhancement on MRI. Most TDL show ＂open- ring＂ enhancement on MRI.

关 键 词：肿瘤 神经上皮 磁共振成像 颅内占位病变 肿瘤样脱髓鞘病变 原发性中枢神经系统淋巴瘤 

分 类 号：R739.4[医药卫生—肿瘤]