脑转移瘤的CT诊断  

CT Diagnosis of Brain Metastases

作　　者：徐津磊[1] 陈九如[1] 

机构地区：[1]上海市闸北区中心医院放射科,200070

出　　处：《中国医学计算机成像杂志》2002年第3期153-157,共5页Chinese Computed Medical Imaging

摘　　要：目的 :探讨脑转移瘤的临床和CT特征、诊断与鉴别诊断。材料和方法 :经CT诊断并由手术病理或临床随访确认的脑转移瘤90例 ,男51例 ,女39例 ,年龄范围29～84岁 ,平均65.35岁。分析其临床表现、CT形态学特征和继发性瘤周水肿的影像学特点。结果 :本组脑转移瘤病例大于60岁的66例患者中 ,男性42例 ,占63.64 % ;而小于60岁的24例中 ,女性15例 ,占62.5 %。90例中CT平扫时显示107个病灶和61个无病灶可见的低密度水肿区 ,85例CT增强后共检出378个瘤灶。病灶数增加4.11倍 ,瘤灶最大者达6.5cm×6cm×3.5cm ,最小者直径仅3～4mm。增强后病灶形态表现多样 :结节状245个 ,环状116个 ,囊状17个。在63例多发病灶中 ,49例表现为多形混合。分布以幕上为主 ,77例病灶均位于幕上 ,11例幕上、幕下都有病灶 ,仅2例病灶位于幕下。本组90例中 ,77例伴有瘤周低密度水肿区。其中 ,Ⅰ级13例 ,占14.44 % ,Ⅱ级或Ⅲ级共64例 ,占71.11 % ,水肿程度与瘤灶大小可不成比例。结论 :脑转移瘤多分布于幕上、大脑灰白质交界区 ,以多发常见 ;表现为“瘤灶大小不一、部位不同、多形混合、水肿程度不同”的CT特点。CT增强扫描有利于瘤灶的检出、诊断与鉴别。Purpose:To describe the CT features and evaluate the value of CT diagnosis and differential diagnosis in brain metastases.Materials and Methods:90 consecutive patients with brain metastases were recognized by pathology or clinical course.51 males,39 females and age ranging from 29-84 years old(mean 65.35) were included in this group.The clinical symptoms of patients and CT features of metastatic lesions with secondary edema were reviewed retrospectively.Results:Forty-two males(63.64%) were found in 66 cases of >60 years elder and fifteen females(62.5%) were discovered in 24 cases of <60 years old.Of 90 cases,107 metastatic lesions and 61 low density edematous area with no lesion were identified by CT scan,whereas 378 metastatic lesions,which was 4.11 times than CT scout scan,were displayed on 85 cases of CT enhanced scan.All the lesions revealed in epi-tentorium area were 77 cases,infra-tentorium 2 cases,and both epi-and infra-tentorium areas were 11 cases.The largest lesion was 6.5×6×3.5cm3 the smallest one was only 3～4mm in diameter.Maltifarious findings were appeared on CT enhanced images,including 245 nodular,116 annular,17 cystic shadows and 49 compound shadows were seen in 63 cases of multiple brain metastases.Various types of secondary peritumor edema(Ⅰ° 13 cases, Ⅱ°Ⅲ° 64 cases) were present in 77 cases,and the extent of edematous area was not proportional with the size of the lesion.Conclusion:Most of brain metastases were located in the epitentorium area,the junction between white and gray matter.The pathological characterizes shown on CT scan were multiple,pleomorphic enhanced lesions with variant edema.CT is a convenient and efficient method for detecting and diagnosing brain metastases.

关 键 词：脑转移瘤 CT 诊断 

分 类 号：R739.41[医药卫生—肿瘤]