单发脑转移瘤影像学误诊分析  

Analysis of Imaging Misdiagnosis of Single Brain Metastasis

作　　者：朱友义 高律萍 曹成瑛 ZHU You-yi;GAO Lv-ping;CAO Cheng-ying(Department of Radiology,Cardio-cerebrovascular Disease Hospital of Qinghai Province,Xining 810000,China)

机构地区：[1]青海省心脑血管病医院放射科,西宁810000

出　　处：《临床误诊误治》2023年第1期30-32,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨单发脑转移瘤(SBM)的临床及影像学特点,分析SBM影像学误诊原因并总结防范误诊措施。方法回顾分析SBM误诊8例临床资料。结果8例中男6例、女2例,年龄50~68岁,发病时间1~3个月,均以头痛、头晕、恶心和呕吐等症状就诊,就诊前均未发现原发肿瘤,经常规CT平扫和(或)增强扫描发现颅内病灶,位于幕上6例,其中额叶3例、颞叶2例、顶叶1例;幕下2例,均为小脑。病灶直径1.8~6.2 cm。病灶不规则,边界欠清晰,癌周均可见不同程度低密度水肿带;6例增强扫描后病灶均不同程度强化。初步诊断为胶质瘤4例、脑膜瘤3例、脑脓肿1例。行手术治疗,术后经全身MRI检查找到原发灶,原发灶:肺癌4例,乳腺癌2例,胃癌及甲状腺癌各1例。遂确诊为SBM。误诊时间15~25(18.17±2.28)d。8例均予转移灶手术切除及原发灶二期手术切除治疗,术后切口愈合后出院,并予术后放化疗等治疗,术后随访1年,均未复发。结论SBM以中老年人高发,男性患者多于女性患者,早期临床及影像学表现多无特异性,对于此类患者,应详细询问原发肿瘤史,常规行X线胸片及全身影像学检查寻找原发肿瘤证据,以及早明确诊断并治疗。Objective To investigate the clinical and imaging characteristics of single brain metastasis(SBM),to analyze the causes of misdiagnosis of SBM by imaging and to summarize the preventive measures for misdiagnosis.Methods The clinical data of 8 patients with SBM misdiagnosed were retrospectively analyzed.Results Among the 8 cases,6 cases were males and 2 cases were females,aged 50-68 years,with onset time of 1 to 3 months.All patients presented with headache,dizziness,nausea and vomiting,and no primary tumor was found before treatment.Conventional CT plain scan and/or enhanced scan revealed intracranial lesions located in the supratentorial lobe in 6 cases,including 3 cases in the frontal lobe,2 cases in the temporal lobe and 1 case in the parietal lobe,as well as infratentorial lobe in 2 cases,which were in the cerebellum.The lesion diameter was 1.8-6.2 cm.The lesions were irregular,the boundaries were not clear,and there were low-density edema bands of different degrees around the cancer.All the 6 cases had different degree of enhancement after enhanced scan.The preliminary diagnosis was glioma in 4 cases,meningioma in 3 cases and brain abscess in 1 case.After operation,the primary lesions were found by systemic MRI examination.The primary lesions were lung cancer in 4 cases,breast cancer in 2 cases,gastric cancer in 1 case and thyroid cancer in 1 case.They were diagnosed with SBM.The duration of misdiagnosis was 15-25(18.17±2.28)d.All the 8 patients underwent surgical resection of the metastatic lesion and secondary surgical resection of the primary lesion.They were discharged from the hospital after postoperative incision healing,and received postoperative radiotherapy and chemotherapy.They were followed up for a year and no recurrence was reported.Conclusion SBM is more common in middle-aged and elderly patients,and attacks more male patients than female patients,and the early clinical and imaging findings are more likely to be non-specific.For such patients,it is necessary to inquire about the history of pri

关 键 词：脑转移瘤 单发 误诊 胶质瘤 脑膜瘤 脑脓肿 

分 类 号：R739.41[医药卫生—肿瘤]