非增强T2-液体衰减反转恢复脑干表面高信号肺腺癌软脑膜转移的临床及影像特征分析  

Clinical and imaging features of leptomeningeal metastasis from lung adenocarcinoma with non-enhanced T2-fluid attenuated inversion recovery hyperintensity on the brainstem surface

作　　者：梁雪[1] 尹震宇[2] 林永娟[2] 张庆雷[1] 张鑫[1] 张冰[1] LIANG Xue;YIN Zhenyu;LIN Yongjuan;ZHANG Qinglei;ZHANG Xin;ZHANG Bing(Department of Radiology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Geriatrics,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院放射科,江苏南京210008 [2]南京大学医学院附属鼓楼医院老年科,江苏南京210008

出　　处：《实用放射学杂志》2024年第5期697-700,共4页Journal of Practical Radiology

基　　金：南京鼓楼医院临床研究专项基金面上项目(2022-LCYJMS-25);江苏省研究生实践创新项目(JX22014155)。

摘　　要：目的探讨非增强T_(2)-液体衰减反转恢复(T_(2)-FLAIR)脑干表面高信号肺腺癌软脑膜转移(LM)的临床及颅脑CT/MR特征。方法回顾性分析经脑脊液脱落细胞检查证实的11例非增强T_(2)-FLAIR脑干表面高信号肺腺癌LM患者,并总结其临床及影像学特点。其中,临床特征包括原发肿瘤的病理分型、基因检测结果及治疗方法;影像学特征包括病灶位置、MRI(T_(1)和T_(2))信号、扩散加权成像(DWI)信号、强化方式以及CT密度的变化特征。结果98例肺腺癌LM患者中11例非增强T_(2)-FLAIR脑干表面高信号的特征占11.2%,患者均为表皮生长因子受体(EGFR)基因突变型的肺腺癌,并在接受EGFR酪氨酸激酶抑制剂(EGFR-TKIs)靶向治疗后确诊为LM。非增强T_(2)-FLAIR影像显示高信号呈条带状对称分布,其中位于脑桥5例,中脑和脑桥2例,4例累及中脑、脑桥和延髓。在T_(1)WI上,1例呈稍高信号,10例呈等信号。在DWI上,4例呈高信号,7例呈等信号。在增强T_(1)WI上,1例轻度强化,10例无明显强化。此外,颅脑CT扫描中,1例显示脑干区钙化。结论非增强T_(2)-FLAIR脑干表面高信号肺腺癌LM,好发于有EGFR基因突变伴TKIs治疗史的患者,发生部位以脑桥多见,非增强T_(2)-FLAIR高信号、增强T_(1)WI无强化、DWI扩散受限、CT钙化具有一定特征性。Objective To assess the clinical and cranial CT/MR features of leptomeningeal metastasis(LM)from lung adenocar-cinoma with non-enhanced T_(2)-fluid attenuated inversion recovery(T_(2)-FLAIR)hyperintensity on the brainstem surface.Methods Eleven cases with LM from lung adenocarcinoma with non-enhanced T_(2)-FLAIR hyperintensity on the brainstem surface confirmed by cere-brospinal fluid cytology were analyzed retrospectively.The clinical features included the pathological classification of the primary tumor,genetic testing results,and treatment methods.The imaging features included lesion location,MRI(T_(1)and T_(2))signals,diffusion weighted imaging(DWI)signal,enhancement patterns,CT density characteristics.Results The features of non-enhanced T_(2)-FLAIR hyperintensity on the brainstem surface of 11 cases among 98 patients(11.2%)with LM from lung adenocarcinoma were reviewed.All patients were lung adenocarcinomas with epidermal growth factor receptor(EGFR)gene mutation and were diagnosed with LM after receiving EGFR-tyrosine kinase inhibitors(EGFR-TKIs)targeted therapy.There were 5 cases located in the pons,2 cases in the midbrain and pons,and 4 cases involving the midbrain,pons and medulla oblongata with the symmetrical band-like high signal on non-enhanced T_(2)FLAIR imaging.On T_(1)WI,1 case showed slightly high signal,10 cases showed equal signal.On DWI,4 cases showed high signal,7 cases showed equal signal,and on enhanced T_(1)WI,1 case showed mild enhancement,and 10 cases showed no.enhancement.Additionally,on cranial CT scans,1 case showed calcification on the brainstem.Conclusion Non-enhanced T_(2)-FLAIR hyperintensity on the brainstem surface may be more common among LM patient from lung adenocarcinoma with EGFR gene muta-tions and TKIs treatment,with the most frequent site being the pons.The features may include non-enhanced T_(2)-FLAIR high signal,non-enhancement on enhanced T_(1)WI,restricted diffusion on DWI,and calcifications on CT imaging.

关 键 词：脑干 软脑膜转移 肺腺癌 磁共振成像 计算机体层成像 

分 类 号：R739.45[医药卫生—肿瘤] R734.2[医药卫生—临床医学] R445.2R814.42