X线计算机断层平扫联合磁共振成像对脑内脱髓鞘假瘤的诊断价值  

Diagnostic value of plain computed tomography scan combined with magnetic resonance imaging in brain demyelinating pseudotumor

作　　者：杨洁 Yang Jie(Department of Medical Imaging,First Affiliated Hospital of Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学第一附属医院影像科,开封475000

出　　处：《实用医技杂志》2022年第11期1128-1131,I0001,I0002,共6页Journal of Practical Medical Techniques

基　　金：河南省开封市科技发展计划项目(2003043)。

摘　　要：目的分析X线计算机断层(CT)联合磁共振成像(MRI)在脑内脱髓鞘假瘤(DPT)的影像表现,以提高对DPT的诊断。方法总结河南大学第一附属医院自2016年9月至2020年9月经临床诊治和手术确诊的30例DPT患者(经临床诊治证实的18例;手术者为12例)的临床资料作为研究对象。结果30例中共检出44个病灶,24例患者呈孤立性肿瘤样病变,6例患者呈多发病变。CT平扫38个病灶呈低密度病灶,6个病变呈不均匀低密度,周边均有轻中度占位效应;MRI平扫12个病变呈均匀长T_(1)长T_(2)信号,32个病灶呈不均匀长T_(1)长T_(2)信号,可能囊变或坏死所致,液体衰减反转恢复(FLAIR)像44个病灶呈不同程度高信号,磁共振弥散加权成像(DWI)上36个病灶呈不同程度高信号,8个病灶未见高信号。36个病变呈不同形态明显强化,8个病变未见强化。14个病变呈典型“开环征状强化”,10个病变呈典型闭环状强化,6个病变呈垂直于侧脑室的“火焰状”强化,14个病变呈多发小斑片状、不连续、结节样强化呈松散状;MRI显示34个病变强化区,而CT表现为低衰减区,而脑肿瘤很少有这种影像表现。结论DPT的影像学表现与脑部肿瘤相似,但仍具有一定影像特征性,如“开环状”或“火焰状”强化等,而不典型结节样、斑片状呈松散状强化需要结合CT平扫,在CT上表现为低衰减区,有利于与肿瘤的鉴别。Objective To investigate the imaging performances of X-ray computed tomography(CT)combined with magnetic resonance imaging(MRI)in brain demyelinating pseudotumor(DPT)in order to improve the diagnosis of this disorder.Methods The clinical data of 30 patients with DPT diagnosed clinically(n=18)or at surgery(n=12)between September 2016 and September 2020 in our hospital were reviewed.Results A total of 44 lesions were identified from the 30 patients,with solitary lesions in 24 and multiple lesions in 6.On plain CT scan,38 lesions were with uniform low density and the other 6 were heterogeneously hypodense,all with mild to moderate space-occupying effect at their boundaries.On plain MRI scan,12 lesions showed homogeneous long T_(1)and long T_(2)signals,while the other 32 showed heterogeneous long T_(1)and long T_(2)signals probably due to cystic degeneration or necrosis.On fluid-attenuated inversion recovery(FLAIR)images,the 44 lesions showed varying high signal intensities;on diffusion weighted imaging(DWI)images,36 lesions showed varying high signal intensities which was not significantly noted in the other 8.Remarkable enhancement,although in diverse patterns,was shown in 36 but not in the remaining 8 lesions.The enhance-ment of lesions was of typical"open-loop"pattern in 14 lesions,typical closed-loop in 10,"flame-like"pattern vertical to the lateral ventricles in 6,and multiple small patchy,discrete,or loosely nodular in 14 lesions.Thir-ty-four lesions showed enhancement on MRI but low-attenuation areas on CT,a phenomenon rarely seen with brain tumors.Conclusion Whereas with certain similarity to other brain tumors,the imaging of DPT is some-what characteristic,as in cases with pattern of"open-loop"or"flame-like"enhancement.For lesions with atypical nodular or loosely patchy enhancement,a plain CT scan may be needed on which show-up of low-attenuation areas could help distinguishing DPT from other brain tumors.

关 键 词：体层摄影术 X线 磁共振成像 脑内脱髓鞘假瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学] R730.44[医药卫生—临床医学]