颅底脊索瘤的影像学诊断与治疗  

IMAGING DIAGNOSIS AND CLINICAL TREATMENT OF SKULL BASE CHORDOMA

作　　者：牟立坤[1] 成立峰[1] 韩光良[1] 赵素伟[1] 宋祖耀 褚光旭 王金龙 MU Likun;CHENG Lifeng;HAN Guangliang;ZHAO Suwei;SONG Zuyao;CHU Guangxu;WANG Jinlong(Department of Neurosurgery, Shengli Oilfield Center Hospital, Dongying 257000, China)

机构地区：[1]胜利油田中心医院神经外科,山东东营257000

出　　处：《精准医学杂志》2020年第3期205-207,共3页Journal of Precision Medicine

摘　　要：目的探讨颅底脊索瘤的CT和MRI表现及临床治疗方法。方法回顾性分析我院收治的28例经术后病理证实为脊索瘤患者的影像学资料、治疗方法及患者预后情况。结果所有患者术前均行CT、MRI检查,肿瘤主要位于斜坡和鞍区。CT影像上肿瘤呈等密度或稍高密度影,常见斑片状或斑点状钙化,并且可见骨质破坏。MRI检查显示肿瘤T1加权像呈低信号,T2加权像呈高信号,Flair像呈稍高信号,肿瘤内钙化、出血和囊变坏死区信号常不均质,增强扫描肿瘤强化不均匀,典型者呈蜂房样不均质强化。所有患者均经显微手术治疗,其中25例患者术后同时行放射治疗;手术肉眼全切者16例,次全切除者10例,2例仅行少量切除或取活检;术后患者随访3个月~5年,肿瘤复发者14例,死亡者9例,失访者1例,存活者18例。结论脊索瘤具有较为典型的影像学特征,手术切除是目前首选的治疗措施,放疗是术后主要的辅助治疗方法。Objective To investigate the computed tomography(CT)and magnetic resonance imaging(MRI)findings and the clinical treatment methods for skull base chordoma.Methods A retrospective analysis was performed for the imaging data,treatment methods,and prognosis of 28 patients who were admitted to our hospital and were diagnosed with chordoma based on postoperative pathology.Results All patients underwent CT and MRI before surgery,and the tumor was mainly located in the clival region and the sellar region.CT images showed isodensity or slightly higher density,patchy or spotted calcification,and bone destruction.MRI showed hypointensity on T1WI,hyperintensity on T2WI,slight hyperintensity on Flair,and heterogeneous intensity in calcification,hemorrhage,and cystic and necrotic area,and contrast-enhanced scan showed heterogeneous enhancement of the tumor,with hive-like heterogeneous enhancement in typical cases.All patients underwent microsurgery treatment,among whom 25 also received radiotherapy.Of all 28 patients,16 underwent gross total resection,10 underwent subtotal resection,and 2 underwent resection of a small amount of tissue or biopsy.The patients were followed up for 3 months to 5 years after surgery;among these patients,14 experienced recurrence,9 died,1 was lost to follow-up,and 18 survived.Conclusion Chordoma has typical imaging features.Surgical resection is the preferred treatment method,and radiotherapy is the main adjuvant therapy after surgery.

关 键 词：脊索瘤 体层摄影术 X线计算机 磁共振成像 显微外科手术 

分 类 号：R651.1[医药卫生—外科学] R739.41[医药卫生—临床医学]