脑膜癌病患者的临床表现及影像学特点研究  

Clinical feature and image analysis of 29 cases of meningeal carcinomatosis

作　　者：林佳才[1] 伍思婷 石强[1] 

机构地区：[1]解放军总医院海南分院神经内科,海南三亚572013

出　　处：《解放军医学杂志》2016年第3期216-220,共5页Medical Journal of Chinese People's Liberation Army

基　　金：海南省应用技术研发与示范推广专项(ZDXM2015088)~~

摘　　要：目的探讨脑膜癌病(MC)的临床表现、实验室检查及影像学特点。方法收集29例明确诊断为MC患者的临床资料、影像学检查结果和实验室检查结果[包括颅内压,脑脊液(CSF)常规、生化、细胞学检查等],进行回顾性分析,并总结其特点。结果 MC患者的原发肿瘤以肺癌多见[16例(55.2%)],首发的神经系统症状表现多样,按出现概率排序依次为头痛(58.6%)、癫痫(13.8%)、视力减退(10.3%)、根痛(6.8%)、听力下降(6.8%)、声音嘶哑(3.4%),且部分患者存在严重的合并症状。MC患者CSF检查特点为颅压升高,CSF常规、生化及细胞学检查提示CSF白细胞、红细胞及蛋白增多,而糖及氯化物水平减低。CSF肿瘤标记物中以癌胚抗原(CEA)升高显著。26%的MC患者CSF细胞学检查为阳性。影像学检查中,头颅CT对MC诊断无价值,而增强磁共振扫描可在94.7%的MC患者中发现软脑膜异常强化,以弥漫性强化为主(94.4%),强化部位以软脑膜-蛛网膜下腔多见(83.3%)。结论 MC是恶性肿瘤颅脑转移的一种特殊表现,其临床表现多样,对疑似病例早期行CSF检查和头颅磁共振增强扫描有一定明确诊断的价值。MC患者预后极差,大多数患者生存时间均小于3个月,但对于原发疾病为肺癌的MC患者行强化治疗可延长其预期寿命。Objective To study the clinical features, laboratory results and image characteristics of meningeal carcinomatosis（MC）. Methods The clinical data, laboratory and image results, and cerebrospinal fluid（CSF） findings of 29 cases diagnosed as MC were retrospectively reviewed and analyzed. Results Lung cancer is more common as the primary malignancy in MC patients [16（55.2%）]. The earliest neurological symptoms varied in MC patients, and headache was the most common symptom（58.6%）, followed by epilepsy（13.8%）, vision loss（10.3%）, neuralgia（6.8%）, hearing loss（6.8%） and hoarseness（3.4%）, and a part of MC patients presented some serious complications. Examination of CSF of MC patients revealed an increase in intracranial pressure, and the presence of white blood cells, red blood cells and increased protein content, while the contents of glucose and chlorides decreased. The content of carcinoembryonic antigen（CEA） increased obviously, and CSF cytological exam was found to be positive in 26% patients. Head CT may not helpful for the diagnosis of the MC. The enhanced brain MRI scanning may reveal abnormal enhancement of piamater in 94.7% of MC patients, with diffuse enhancement in 94.4% of cases occurring mostly in piamater and subarachnoid space. Conclusions MC is an unique form of brain metastases of malignant tumor. The clinical feature are varied and lack of specificity. Enhanced brain MRI scanning and CSF examination may provide some value for diagnosis. Meningeal metastasis is one of the most critical complications resulting in high mortality. Early diagnosis of MC followed by enhanced treatment can prolong survival time and improve patients＇ prognosis.

关 键 词：脑膜癌病 磁共振成像 脑脊髓液 

分 类 号：R739.45[医药卫生—肿瘤]