脑胶质瘤病的影像学诊断特点及不同手术方式的疗效分析  

Neuroimaging diagnosis and therapeutic efficacy of different surgical methods of gliomatosis cerebri

作　　者：钱若兵 吴旻 魏祥品 凌士营 计颖 傅先明 汪业汉 牛朝诗 

机构地区：[1]安徽医科大学附属省立医院神经外科安徽省脑立体定向神经外科研究所脑功能与脑疾病安徽省重点实验室,合肥230001

出　　处：《中华医学杂志》2014年第21期1639-1642,共4页National Medical Journal of China

基　　金：国家自然科学基金（81172407）;安徽省科技攻关项目（11010402165）;安徽省重点实验室绩效考核项目（1306c083028）

摘　　要：目的探讨脑胶质瘤病的影像学诊断特点及不同手术方式的疗效。方法回顾性分析2008年9月—2013年9月安徽医科大学附属省立医院神经外科收治的26例脑胶质瘤病患者，术前行头颅CT、MR等多模态影像学检查，11例行立体定向多靶点活体组织检查术，15例行大骨瓣开颅脑叶切除术，术后选择放射治疗和（或）替莫唑胺化疗，随访分析立体定向活体组织检查和开颅脑叶切除术两组患者的生存期差异。结果根据多模态神经影像学表现，脑胶质瘤病分为两型：（1）I型（19例）表现为以胼胝体为中心的侵犯多个脑叶或脑区的弥漫性、浸润性病变，增强扫描无明显强化；（2）Ⅱ型（7例）表现为在I型的基础上，增强扫描时出现散在或结节状强化。病理学类型：毛细胞型星形细胞瘤2例、弥漫性星形细胞瘤13例、少突胶质细胞瘤3例，少突．星形细胞瘤1例、间变性星形细胞瘤5例、胶质母细胞瘤2例；肿瘤的恶性程度越高，术后生存期越短，其中开颅脑叶切除术组的术后平均生存期（23±7）个月，明显长于立体定向手术活体组织检查组（13±3）个月（P〈0．05）。结论脑胶质瘤病是一种弥漫性、浸润性生长又保留神经系统大体结构的脑内原发性胶质性肿瘤，多模态神经影像学结合病理检查可以明确诊断；手术结合放、化疗的综合治疗可以提高患者的生存时间。Objective To explore the neuroimaging diagnosis and therapeutic efficacy of different surgical methods of gliomatosis cerebri. Methods 26 cases of gliomatosis cerebri at our department between September 2008 and September 2013 were retrospectively analyzed. Preoperative cranial computed tomography （CT）, magnetic resonance imaging （MRI） and other muhimodal imaging scans were performed. The procedures included stereotactic brain biopsy （ n = 11 ） and large craniotomy lobotomy （ n = 15 ）. Whole brain radiotherapy and/or temozolomide therapy was performed postoperatively according to the malignancy of tumors. Follow-ups were conducted to analyze the survival differences between stereotactie brain biopsy and large craniotomy lobotomy groups. Results According to the different features of multimodal imaging, gliomatosis cerebri could be divided into two types ： （ 1 ） type I （ n = 19） showed a diffuse infiltrating lesion infringing multiple brain lobes or regions with central corpus callosum but without obvious enhancement; （2） type II （ n = 7 ） appeared as sporadic or tuberous enhancement in addition to the features of type I . Pathological diagnosis： piloeytic astrocytoma （n = 2）, diffuse astroeytoma （n = 13 ）, oligodendroglial tumors （ n = 3 ）, oligoastrocytoma （ n = 1 ）, anaplastic astrocytoma （ n = 5 ） and glioblastoma （ n = 2 ）. The degree of malignancy was a prognostic factor for postoperative survival in patients with gliomatosis cerebri. The mean survival time （MST） of large eraniotomy lobotomy group （ 23 ± 7 ） was significantly longer than that of stereotactie brain biopsy group（ 13 ± 3 ） （ P 〈 0. 05 ）. Conclusion Gliomatosis cerebri is a primary brain glial tumor with diffuse infiltrative growth but retaining the general structure of central nervous system. Multimodal imaging studies plus pathological examination yield a definitive diagnosis. Comprehensive treatment of operation plus chemo- or radio-therapy can prolong postoperati

关 键 词：肿瘤 神经上皮 脑胶质瘤病 诊断 磁共振成像 外科手术 

分 类 号：R739.4[医药卫生—肿瘤]