肥胖细胞型星形细胞瘤MRI表现  

MRI features of gemistocytic astrocytoma

作　　者：吴静 汪文胜 成丽娜 林翰波 钟丽莉 黄文健 贺鹏 梁倩雯 WU Jing;WANG Wensheng;CHENG Lina;LIN Hanbo;ZHONG Lili;HUANG Wenjian;HE Peng;LIANG Qianwen(Department of Radiology ,Guangdong 999 Brain Hospital,Guangzhou 510510,China)

机构地区：[1]广东三九脑科医院影像中心,广东广州510510

出　　处：《实用放射学杂志》2019年第3期357-361,366,共6页Journal of Practical Radiology

摘　　要：目的探讨肥胖细胞型星形细胞瘤(GemA)的MRI特征及鉴别诊断价值。方法回顾性分析经手术病理证实的10例GemA的MRI表现,分析其发病部位、形态、边界、信号、强化及多模态MRI特点并文献复习。结果10例GemA均位于幕上且单发,累及额叶7例,累及颞叶5例,累及多个脑叶6例,1例通过胼胝体侵犯对侧脑组织。囊实性8例,8例呈弥漫性生长,边界不清,2例边界尚清;7例周围无水肿或水肿轻微,3例周围水肿明显。肿瘤实性部分在T1WI上呈等或稍低信号为主,1例T1WI呈高信号,T2WI呈稍高或高信号,2例CT提示钙化。增强扫描6例呈轻度强化,4例呈明显强化。4例行MRS检查,胆碱(Cho)峰轻中度增高,N-乙酰天门冬氨酸(NAA)峰明显减低,Cho/NAA比值平均约为2.91。3例行DWI序列检查,呈稍高或高信号,肿瘤ROI ADC平均值约(1.150±0.081)×10^-3mm^2/s。1例SWI序列可见肿瘤内部迂曲增粗的血管影。结论GemA的MRI兼具高、低级别胶质瘤特点,术前诊断困难,结合增强及功能检查有望提高术前诊断的准确率。Objective To explore the MRI features and differential diagnosis of gemistocytic astrocytoma (GemA).Methods The MRI features of 10 cases of GemA proved by surgery and pathology were investigated retrospectively (the location of tumor, tumor shape, boundary, signal and enhancement) and the literature was reviewed. Results All 10 cases of GemA were supratentorial and solitary.Of these 10 cases, 7 cases were located in the frontal lobe, 5 cases in the temporal lobe, 6 cases in multiple lobes and invaded the opposite brain tissues through corpus callosum.8 cases were solid-cystic,8 cases presented with unclear boundary,only 2 cases had clear boundary.There was no edema or mild edema in 7 cases and obvious edema in 3 cases.The solid part of tumors were isointense or slight hypointense on Tj WI,only 1 case showed high intensity on T)WI,isointense or slight hyperintense on T: WI.CT suggested calcification in 2 cases.6 cases were mildly enhanced,4 cases were markedly enhanced.MRS showed (n=4 ) that CHo peak was mildly or moderately increased, NAA peak was significantly reduced, the average ratio of Cho/NAA was 2.91.DWI showed hyperintense or slight hyperintense (n=3),the ADC average value of tumor ROI was about (1.150士0.081) X 10-3 mm2/s. 1 case of SWI sequence showed thickening and circuitous vascular shadow.Conclusion As MRI of GemA is characterized by high and low grade gliomas,the preoperative diagnosis is difficult.Combining enhancement with functional examination,it is expected to improve the accuracy of preoperative diagnosis of GemA.

关 键 词：肥胖细胞 星形细胞瘤 磁共振成像 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]