儿童原发性脑膜瘤的磁共振影像诊断  

Magnetic Resonance Imaging for Diagnosis of Idiopathic Pediatric Meningiomas

作　　者：顾卫彬[1] 方世元 马丁[1,3] 侯欣怡 GU Weibin;FANG Shiyuan;MA Ding;HOU Xinyi(Department of Radiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Class 2015,Eight-Year M.D.Program,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院放射科,北京100050 [2]中国医学科学院北京协和医学院临床医学(八年制)2015级,北京100730 [3]北京市神经外科研究所,北京100050

出　　处：《中国医学科学院学报》2021年第3期421-428,共8页Acta Academiae Medicinae Sinicae

摘　　要：目的分析儿童原发性脑膜瘤的影像学特征,探讨其与病理分级、误诊情况和术中出血量的关系。方法回顾性分析2014年11月至2018年7月在北京天坛医院经病理确诊且术前行磁共振检查的29例儿童脑膜瘤患者的临床资料,观察其影像学特征,并对其与病理分级、误诊情况、术中出血量的关系进行统计学分析。结果定位脑实质内的肿瘤误诊7例,定位脑实质外的肿瘤误诊5例,定位脑室内的肿瘤误诊4例,定位颅内外沟通的肿瘤误诊1例,不同位置的肿瘤诊断正确率间差异有统计学意义(P=0.021),定位脑实质内的肿瘤极易误诊。12例患者有硬膜尾征,8例诊断正确,4例误诊;16例无硬膜尾征,4例诊断正确,12例误诊;Fisher精确概率法得到单侧P=0.034,硬膜尾征阳性可明显降低误诊率。单因素回归分析结果显示,肿瘤包绕动脉或有静脉受累(P=0.020)及肿瘤最大径(P=0.001)与术中出血量正线性相关,两者联合进行多元回归分析时模型拟合程度更优(Rad2=0.468)。结论儿童脑膜瘤影像学缺乏特征,诊断难度大,位于脑实质内的肿瘤极易被误诊,应引起警惕。影像学指标中,肿瘤包绕动脉或有静脉受累和肿瘤最大径与术中出血量正相关。Objective To analyze the radiological features of idiopathic pediatric meningiomas and explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery.Methods We retrospectively reviewed 29 cases of pathologically confirmed pediatric meningiomas with pre-operative magnetic resonance imaging in Beijing Tiantan Hospital from November 2014 to July 2018.We assessed the imaging features to explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery.Results Among the 29 cases,7 intraparenchymal meningiomas,5 extraparenchymal meningiomas,4 ventricular meningiomas,and 1 transcranial meningioma were misdiagnosed.Tumor location was significantly associated with possibility of misdiagnoses(P=0.021),and intraparenchymal tumors were most likely to be misdiagnosed.Twelve patients had positive dural tail sign,and 4 of them were misdiagnosed;16 patients did not have dural tail sign,and 12 of them were misdiagnosed.Fisher exact test showed that positive dural tail sign was associated with decreased possibility of misdiagnoses(one-sided P=0.034).Univariable regression analysis showed that the feature of tumor surrounding arteries or interfering with veins(P=0.020)and the tumor maximum diameter(P=0.001)had positively linear relationships with blood loss volume during surgery.Combining these two variables,the multivariable regression model showed better fitting performance(Rad2=0.468).Conclusions Pediatric meningiomas are extremely rare,with scarce radiological characteristics.They are hard to diagnose,and the intraparenchymal meningiomas are very likely to be misdiagnosed and therefore should be treated with extra caution.Among all the radiological features,tumor surrounding arteries or interfering with veins and tumor maximum diameter were associated with increased blood loss during surgery.

关 键 词：儿童原发性脑膜瘤 磁共振成像 术中出血量 脑膜瘤分级 

分 类 号：R445.2[医药卫生—影像医学与核医学]