鼻咽癌脑膜侵犯的MRI研究  

Meningeal involvement by nasopharyngeal carcinoma:MRI findings

作　　者：龙晚生[1] 黄鸿镳[2] 汤积耀[1] 罗学毛[1] 宋彬[3] 陈卫霞[3] 徐隽[4] 

机构地区：[1]广东省江门市中心医院放射科,529070 [2]广东省江门市中心医院神经外科,529070 [3]华西医科大学附属医院放射科 [4]四川省都江堰市人民医院放射科

出　　处：《中华放射学杂志》2001年第5期355-358,共4页Chinese Journal of Radiology

基　　金：1999年广东省医学科研基金 (A199962 6)

摘　　要：目的　探讨鼻咽癌脑膜侵犯的途径、MRI表现及其病理基础。方法　搜集 2 5例鼻咽癌脑膜侵犯病例的MRI检查资料 ,全部病例经平扫加钆喷替酸葡甲胺 (Gd DTPA)增强扫描 ,9例经手术病理结果与MRI对比分析 ,1例脑脊液细胞学检查阳性。结果　 (1)鼻咽癌侵犯脑膜主要有 3条途径 :①经颅底自然骨性通道侵犯 11例 ;②经颅底骨侵犯 10例 ;③经血行转移 4例。 (2 )鼻咽癌脑膜侵犯表现为硬膜型 2 4例 ,柔脑膜型 1例。 (3)MRI表现为大片状硬脑膜增厚 ,可呈“花边状”、结节状甚至肿块形成 ,增强后有明显的对比增强。脉络膜转移 1例 ,表现为侧脑室增大 ,室管膜下结节及条片状增厚的转移灶。结论　MRI为鼻咽癌脑膜侵犯的重要检查方法 ,增强扫描对显示病灶的部位、范围有重要意义。Objective To investigate the routes and MR imaging manifestations of meningeal involvement by nasopharyngeal carcinoma (NPC) with pathological correlation. Methods Twenty five NPC patients with involvement of meninges were included into the study. All patients underwent both unenhanced and Gd DTPA enhanced MR imaging examinations. Surgical and pathological findings were correlated with MR imaging manifestations in 9 patients. Positive cytology was found in only 1 of the 25 patients. Results There were three main routes for meningeal involvement in NPC patients: (1).through the natural bony channels (foramens) of the skull base; (2).through direct bony erosion of the skull base; and (3).Through hematogenous spread. Dura mater was very frequently involved, being seen in 24 patients; pia mater was involved in only one patient. Irregular, patchy thickening in the form of “necklace”, nodules, or mass with obvious enhancement was the major MR feature of meningeal involvement by NPC. In one patient with choroid plexus involvement, dilatation of the lateral ventricles, subependymal nodules with patchy thickening were observed. Conclusion MR imaging with Gd DTPA enhancement was very useful to demonstrate the presence, location and extent of meningeal involvement in NPC patients.

关 键 词：鼻咽癌 脑膜肿瘤 肿瘤转移 磁共振成像 

分 类 号：R739.63[医药卫生—肿瘤] R739.45[医药卫生—临床医学]