脑内脱髓鞘假瘤的影像与病理学研究  

Imaging and pathological features of intracerebral demyelination pseudotumor

作　　者：朱华晨[1] 周楠[1] 杨蓉[1] 徐霓霓[1] ZHU Hua-chen;ZHOU Nan;YANG Rong;XU Ni-ni(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,北京100070

出　　处：《医疗卫生装备》2023年第12期58-62,共5页Chinese Medical Equipment Journal

摘　　要：目的:探讨脑内脱髓鞘假瘤的影像学表现和病理学特征,为临床准确诊断和制订治疗策略提供参考。方法:回顾性分析2010年5月—2021年3月某院经病理检验证实为脑内脱髓鞘假瘤的18例患者的病历资料。观察患者的影像学(MRI和CT)检查结果、脑脊液免疫学检查结果和组织病理学检查结果。结果:18例患者中单发病灶患者15例、多发病灶患者3例,病灶均位于幕上脑实质内。在CT图像上,病灶呈稍低密度改变13例、呈等密度改变5例。在MRI图像上,病灶呈均匀长T1、长T2信号9例,不均匀长T1、长T2信号7例,混杂信号2例,伴有囊变、坏死3例,病灶周围轻度水肿10例、重度水肿8例;增强扫描病变呈开环样强化10例、结节样强化6例、多个开口样强化2例,病灶长轴垂直于侧脑室分布8例。脑脊液免疫学检查显示,髓鞘碱蛋白含量增高,免疫球蛋白G(immunoglobulin G,IgG)寡克隆区带呈阳性改变。组织病理学检查显示,病变区可见大量巨噬细胞呈散在或集聚性分布,淋巴细胞围绕血管呈环形浸润。结论:脑内脱髓鞘假瘤具有开环样强化和垂直于侧脑室分布的影像学特征,巨噬细胞和淋巴细胞浸润为其组织病理学特征。Objective To investigate the imaging and pathological features of intracerebral demyelination pseudotumor(DPT)so as to provide references for clinical diagnosis and treatment.Methods The medical records of 18 intrathecal DPT patients confirmed pathologically in some hospital from May 2010 to March 2021 were analyzed retrospectively,involving in the findings of imaging(MRI and CT),cerebrospinal fluid immunologic examination and histopathologic examination.Results All the patients had the lesions located in the supratentorial brain parenchyma,including 15 ones with single lesions and 3 ones with multiple lesions.In CT images,the lesions had slightly hypodense changes in 13 cases and isodense changes in 5 cases.In MRI images,the lesions showed homogeneous long T1 and long T2 signals in 9 cases,inhomogeneous long T1 and long T2 signals in 7 cases,mixed signals in 2 cases,accompanying cystic degeneration and necrosis in 3 cases,mild edema around the lesions in 10 cases and severe edema in 8 cases;enhanced scans found open ring-like enhancement in 10 cases,nodular enhancement in 6 cases,multiple openings in 2 cases and the long axis of the lesion perpendicular to the lateral ventricle in 8 cases.Immunologic examination of cerebrospinal fluid detected increased content of myelin alkaline protein and positive changes of immunoglobulin G(IgG)at the oligoclonal band.Histopathological examination found a large number of scattered or clustered macrophages in the lesion area and circular lymphocyte infiltration around the blood vessels.Conclusion Intracerebral DPT has the imaging features of open ring-like enhancement and distribution perpendicular to the lateral ventricles and the histopathologic features of macrophage and lymphocyte infiltration.

关 键 词：脑内脱髓鞘假瘤 CT MRI 影像学 组织病理学 

分 类 号：R318[医药卫生—生物医学工程] R445[医药卫生—基础医学]