非典型脑膜瘤的MRI表现及鉴别诊断  

MRI Features and Differential Diagnosis of Atypical Meningioma

作　　者：陆菲菲[1] 肖慧[2] 宋娟[1] 虞浩[1] 殷灿[1] 李田飞 LU Fei-fei;XIAO Hui;SONG Juan;YU Hao;YIN Can;LI Tian-fei(Fuzhou Teaching Hospital of Bengbu Medical College (Fuzhou General Hospital of Nanjing Military Region), Fuzhou Fujian 350025, China;Medical Imaging Center, Fuzhou General Hospital of Nanjing Military Region, Fuzhou Fujian 350025, China)

机构地区：[1]蚌埠医学院福州教学医院(南京军区福州总医院)医学影像中心,福建福州350025 [2]南京军区福州总医院医学影像中心,福建福州350025

出　　处：《中国医疗设备》2017年第2期60-64,共5页China Medical Devices

基　　金：福建省自然科学基金(2016J01591)

摘　　要：目的分析非典型脑膜瘤的MRI表现,提高其诊断及鉴别诊断的准确性。方法回顾性分析经手术病理证实的非典型脑膜瘤19例,并与胶质母细胞瘤20例、脑内单发转移瘤13例进行比较。全部病例均行MR常规和扩散加权成像(Diffusion Weighted Imaging,DWI)检查,其中7例脑膜瘤、9例脑内单发转移瘤和16例胶质母细胞瘤行磁共振氢质子波谱(H1-Magnetic Resonance Spectroscopy,H1-MRS)检查。结果非典型脑膜瘤瘤周多为轻度水肿,边缘模糊;实性部分多为全瘤性强化,其强化程度较其他二者明显,瘤内囊型囊壁均强化,瘤周囊型部分囊壁强化。DWI示:三者间在肿瘤实质区和水肿区ADC值均无统计学差异,但胶质母细胞瘤与转移瘤的水肿区ADC值有统计学差异(P=0.021);MRS示:三者Cho峰均明显升高,NAA峰均明显降低,脑膜瘤未见明显NAA峰,且lip峰和lac峰出现的几率明显小于其他二者。结论非典型脑膜瘤MRI表现多样,但仍具有一定特征性,运用多模态影像检查方法有助于提高诊断的准确性。Objective To analyze the Magnetic Resonance Imaging (MRI) features of atypical meningioma so as to improve accuracy of diagnosis and differential diagnosis to atypical meningioma.Methods Totally 19 cases of atypical meningiomas verified by operation and pathological examination were retrospectively analyzed, and compared with 20 cases of glioblastoma as well as 13 cases ofbrain solitary metastases. All patients were simultaneously performed by routine MRI examination anddetection of diffusion weighted imaging (DWI). Among them, 7 cases of meningioma, 9 cases of brainsolitary metastasis and 16 cases of glioblastoma were additionally detected by H1-magnetic resonancespectroscopy (H1-MRS). Differences in the three groups were analyzed. Results Atypical meningiomamostly revealed mild peritumoral edema with edge blur. The solid area of atypical meningioma mostlyshowed strengthening on the whole tumor, and strengthening degree was more obvious than that of brainsolitary metastasis or glioblastoma. Besides, the cyst wall inside the tumor was completely strengthen,but the cyst wall surrounding the tumor showed partially strengthen. DWI revealed apparent diffusioncoefficient (ADC) values of tumor solid area as well as peritumoral edema among the three groups wereof no significant difference, whilst ADC values of peritumoral edema in glioblastoma and brain solitarymetastasis respectively showed significantly different (P=0.021). MRS indicated that the three groups all showed obvious rise in choline (Cho) peak but visible decline in N-acetylaspartate (NAA) peak. In addition, atypical meningiomas showed inconspicuous NAA peak, and less possibility of obvious lipid (lip) peak or lactic acid (lac) peak as compared with the other two tumors mentioned above. Conclusion MRI features of atypical meningioma were various, but it still had certain characteristics. Multimodality imaging examination method could be applied to improve the diagnostic accuracy of atypical meningoma.

关 键 词：脑膜瘤 磁共振 弥散加权磁共振 磁共振波普 胶质母细胞瘤 脑转移瘤 

分 类 号：R739.45[医药卫生—肿瘤] R445.2[医药卫生—临床医学]