原发性颅内生殖细胞瘤^(18)F-FDG PET/MRI显像模式的分析  

^(18)F-FDG PET/MRI imaging patterns of primary intracranial germinomas

作　　者：袁磊磊 陈嫱 徐洋 乔真[1] 张巍[1] 艾林[1] 陈谦[1] YUAN Leilei;CHEN Qiang;XU Yang;QIAO Zhen;ZHANG Wei;AI Lin;CHEN Qian(Department of Nuclear Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院核医学科,北京100070

出　　处：《医学影像学杂志》2022年第11期1849-1853,共5页Journal of Medical Imaging

基　　金：国家自然科学基金项目(编号:81601519);北京市医院管理局“青苗”计划专项项目(编号:QML20170106);北京市属医院科研培育计划项目(编号:PX2017035)。

摘　　要：目的探讨原发性颅内生殖细胞瘤^(18)F-FDG PET/MRI增强显像模式特点。方法选取39例确诊的原发性颅内生殖细胞瘤病例纳入分析,活检或术后病理证实33例,诊断性治疗证实6例。回顾性分析患者^(18)F-FDG PET/MRI影像学特点,根据病变部位分为5型,包括:松果体区及三脑室区(Ⅰ型)、鞍区(Ⅱ型)、基底节及丘脑区(Ⅲ型)、深部脑白质(Ⅳ型)、脑脊液播散病灶(Ⅴ型)。对比分析病变直接征象、单发病变的间接征象、脑受累程度及小脑代谢程度的差异。结果39例患者中31例单发,8例多发(5例存在脑脊液播散),共60个病灶,Ⅰ~Ⅴ型病灶个数为:14、20、11、1、14。影像结果:1)实性为主型(37个),包括全部Ⅰ、Ⅱ和Ⅳ型病灶,2个Ⅲ型位于丘脑。22个病变(59.5%)含有微囊变,增强后明显强化,FDG代谢以低、等或稍高于脑白质为主(30/31,81.1%),7个(18.9%)明显增高;2)囊性为主型(9个),均为Ⅲ型,7个位于基底节区,2个位于丘脑区;病变囊变范围较大,增强后线样强化,均为无或稍高FDG代谢;6个基底节区病变伴邻近脑组织萎缩;3)室管膜下伏壁生长型(14个)均为V型,以实性为主病变表现,12个病变(85.7%)存在微囊变,均为无或轻微稍高FDG代谢病变。中线与非中线单发病变在继发大脑皮层代谢减低方面差异无统计学意义(P>0.05);但非中线病变更易引起脑萎缩及严重CCDs(P<0.05)。结论不同部位原发性颅内生殖细胞瘤PET/MRI增强显像模式不同,在患者诊治评估中具有重要临床应用价值。Objective To evaluate the characteristics of ^(18)F-FDG PET/MRI imaging modes in primary intracranial germinomas(PIGs).Methods A total of 39 cases of PIGs were included in this study,33 cases were confirmed by biopsy or postoperative pathology,and 6 cases were confirmed by diagnostic treatment.The imaging characteristics of ^(18)F-FDG PET/MRI were retrospectively analyzed,and the patients were divided into 5 types according to the lesion sites,including pineal and third ventricle region(Type Ⅰ),sella turcica region(Type Ⅱ),basal ganglia and thalamus region(Type Ⅲ),deep white matter(Type Ⅳ),and cerebrospinal fluid spread lesions(Type V).The differences of PET/MRI direct signs,indirect signs of single lesions,brain involvement and cerebellar metabolism of germinoma in different parts of intracranial were analyzed.Results Of the 39 patients,there were 31 cases with single lesion,8 cases with multiple lesions(5 cases with cerebrospinal fluid spread lesions),60 lesions in total.The number of Type Ⅰ~Ⅴ lesions were 14,20,11,1,14.Imaging analysis results:1)Solid type(37 cases)including all Type Ⅰ,Ⅱ,Ⅳ lesions,and 2 Type III lesions located in the thalamus.Twenty-two lesions contained microcystic lesions with significant enhancement,accounting for 59.5%of this type,of which FDG metabolism was mainly low,equal or slightly higher than that of white matter(30/31,81.1%),and 7 lesions(18.9%)with significant increased uptake;2)Cystic type(9 cases)was Type Ⅲ,including 7 lesions in basal ganglia and 2 lesions in thalamus.The range of cystic lesions was larger,and linear enhancement was observed after enhancement,with no or slightly higher FDG metabolism.Atrophy of adjacent tissues(ipsilateral basal ganglia and brainstem)existed in basal ganglia lesions(6 cases);3)There were 14 cases of subependymal wall growth type,all of which were solid Type V lesions with no or slightly higher FDG metabolism,12 cases(85.7%)with microcystic lesions.There was no significant difference in secondary cerebral cortex metabolism be

关 键 词：原发性颅内生殖细胞瘤 氟代脱氧葡萄糖 正电子成像 磁共振成像 

分 类 号：R739.41[医药卫生—肿瘤] R445.6[医药卫生—临床医学]