瘤样脱髓鞘病与瘤样原发性中枢神经系统血管炎MRI特点对比分析  

A comparative study on the MRI features of tumefactive primary angiitis of the central nervous system and tumefactive demyelinating lesions

作　　者：孙丽敏[1] 韩杰[1] 孙辰婧[2] 赵虎林 Sun Limin;Han Jie;Sun Chenjing;Zhao Hulin(Medical Imaging Department,The No.4 People's Hospital of Hengshui,Hengshui 053000,China)

机构地区：[1]衡水市第四人民医院影像科,053000 [2]解放军总医院第六医学中心神经内科 [3]解放军总医院第六医学中心神经外科

出　　处：《北京医学》2019年第11期1028-1032,共5页Beijing Medical Journal

摘　　要：目的总结瘤样脱髓鞘病(tumefactive demyelinating lesions, TDLs)与瘤样原发性中枢神经系统血管炎(tumefactive primary angiitis of the central nervous system, TPACNS)的MRI特点,为临床鉴别提供重要参考依据。方法选择2009年12月至2018年3月于衡水市第四人民医院和解放军总医院第六医学中心住院治疗的经病理证实的TPACNS患者19例和TDLs患者17例,回顾性分析二者的MRI特点。结果 TPACNS和TDLs的发病平均年龄分别为(32.0±13.7)岁和(39.3±12.8)岁,差异无统计学意义(P=0.113)。TPACNS平均病程(42.2±7.7)周,明显长于TDLs组[(4.0±2.7)周],差异有统计学意义(P=0.033)。TPACNS以慢性起病常见,TDLs则以亚急性起病常见,差异有统计学意义(P<0.05)。TPACNS组病灶累及皮质或皮质下明显多于TDLs组,病灶累及脑干明显少于TDLs组。所有TPACNS的T1WI、T2WI病灶均为不均匀病灶,而所有TDLs均呈均匀病灶。TPACNS组中12例的DWI呈病灶中心低信号、周边高信号,TDLs组则无。TPACNS组中12例呈现不规则、不连续、不均匀强化,可表现为不规则肠腔样强化、不规则不均一弥漫样强化、不规则不连续壁薄厚不均匀强化。TDLs组强化方式多样。结论 TDLs和TPACNS患者的MRI影像学有一定特征,累及部位、T1WI、T2WI及DWI信号特点、病灶均匀度、MRI增强图像,对于鉴别TDLs和TPACNS有重大提示意义。Objective To compare the MRI features of tumefactive primary angiitis of the central nervous system(TPACNS) and tumefactive demyelinating lesions(TDLs) in order to provide an important reference for clinical diagnosis.Methods Ninteen cases of TPACNS and seventeen cases of TDLs were enrolled in the study from December 2009 to March2018. A retrospective analysis was carried out to compare the features of MRI of TPACNS and TDLs. Results There was no significant difference of the average age of onset between TPACNS and TDLs [(30.2±13.7) years vs.(39.3±12.8) years, P =0.113]. The average course of disease in TPACNS group was significant longer than that in TDLs group [(42.2±7.7) weeks vs.(4.0±2.7) weeks, P = 0.033]. Chronic onset was more common in TPACNS group and subacute onset was more common in TDLs group, there were significant differences(P = 0.001, P = 0.010). The lesions located in cortical or subcortical area in TPACNS group were higher than those in TDLs group, and on the contrary in the brainstem. The T1 WI and T2 WI lesions of all TPACNS were heterogeneous lesions, while all TDLs were homogeneous lesions. Twelve cases in TPACNS group showed the lesions with central low signals surrounded by high signals, and no lesions of TDLs presented this way. There were 12 cases in TPACNS group showed irregular, discontinuous, inhomogeneous enhancement, some of which can be manifested as irregular luminal shaped enhancement and irregular uneven diffused enhancement, irregular discontinuous and inhomogeneous wall thickness enhancement. The reinforcement methods of TDLs group have a variety of methods. Conclusions It is significant for diagnosis of TPACNS and TDLs on MRI features involved T1 WI, T2 WI and DWI.

关 键 词：瘤样脱髓鞘病变 瘤样原发性中枢神经系统血管炎 磁共振 

分 类 号：R73[医药卫生—肿瘤]