首诊于神经内科的肺癌脑转移瘤17例临床与影像学分析  

Analysis of Clinical Imaging of 17 Cases with Lung Cancer with Brain Metastasis Tumors Firstly Diagnosed in the Department of Neurology

作　　者：袁正光[1] 丁长青[2] 罗慧[2] 赵辉[1] 

机构地区：[1]江苏省丰县人民医院神经内科,江苏丰县221700 [2]江苏省丰县人民医院影像科,江苏丰县221700

出　　处：《中外医疗》2017年第10期31-33,48,共4页China & Foreign Medical Treatment

基　　金：2010年年徐州市科技发展基金(XF10c060);2014年江苏省卫生厅医学科研立项课题(YG201419);徐州市第一期医学青年后备人才培养工程"资助(徐卫科教2014年3号)

摘　　要：目的分析首诊于神经内科的肺癌脑转移瘤的临床与影像学特点,以提高早期诊断率。方法对该院2014年10月—2016年4月收治的17例首诊于神经内科的肺癌脑转移瘤的临床及影像学资料进行回顾性分析。结果 17例患者均以神经系统症状就诊,主诉主要为头痛(n=15)、头晕(n=10)、肢体无力或偏瘫(n=7)、感觉障碍(n=5)、精神情绪异常(n=3)、视力减退(n=1)及癫痫(n=1)等。脑转移及肺部原发病灶由头颅CT或MRI及胸部CT提示,原发灶均经穿刺活检或手术病理确诊,1例单发转移瘤经手术确诊。单发转移2例,多发15例。以皮层下最多见,多伴瘤周水肿,呈囊性表现3例,伴肿瘤卒中2例,增强以环形强化最多。结论首诊于神经内科的肺癌脑转移瘤首发多为神经系统症状,肺部症状及体征多缺乏或较为轻微,单凭临床易于漏误诊,及时的颅脑及胸部影像学检查有助于准确诊断及进一步的治疗。Objective To analyze the clinical imaging features of lung cancer with brain metastasis tumors firstly diagnosed in the department of neurology in order to improve the early diagnosis rate. Methods The clinical imaging data of 17 cases with lung cancer with brain metastasis tumors firstly diagnosed in the department of neurology admitted and treated in our hospital from October 2014 to April 2016 were retrospectively analyzed. Results 17 cases were diagnosed due to the nerve system symptoms, and the chief compliments were mainly headache（n=15）, dizziness（n=10）, limbs weakness or hemiplegia（n=7）, sensory disturbance（n=5）, emotional dysfunction（n=3）, hypopsia（n=1）and epilepsy（n=1）, and brain metastasis and primary lesions of lung were reminded by cranial CT or MRI and chest CT, and the primary lesions were confirmed by the percutaneous biopsy or operative pathology, 1 case was diagnosed with solitary metastases, 2 cases were solitary metastasis and 15 cases were multiple metastases, and subcortex was the most common, most were with peritumoral brain edema, 3cases were with cystic manifestations, 2 cases were with hemorrhagic brain tumor, and the ring enhancing lesions were the most. Conclusion The nerve system symptoms are the common first-episode symptoms of patients with lung cancer with brain metastasis tumors firstly diagnosed in the department of neurology, lung symptoms or body signs are shortage or mild,and misdiagnosis or missed diagnosis are easy to occur in clinic, and the timey craniocerebral and chest imaging examination contributes to the accurate diagnosis and further treatment.

关 键 词：肺癌脑转移瘤 首发症状 神经系统症状 影像学诊断 

分 类 号：R73[医药卫生—肿瘤]