常规磁共振联合多模态磁共振成像对脱髓鞘假瘤与胶质瘤的鉴别诊断  

Conventional magnetic resonance combined with multimodal magnetic resonance imagingfordifferential diagnosisofdemyelinating pseudotumorandglioma

作　　者：魏丽珍 陈玉珊 王艺敏 WEI Lizhen;CHEN Yushan;WANG Yimin(Zhangzhou Affiliated Hospitalof Fujian Medical University,Zhangzhou,Fujian 363000,China)

机构地区：[1]福建医科大学附属漳州市医院,漳州363000

出　　处：《福建医药杂志》2024年第7期8-12,共5页Fujian Medical Journal

基　　金：福建省自然科学基金资助项目(2021J011409)。

摘　　要：目的探讨常规磁共振与多模态磁共振对脱髓鞘假瘤诊断的价值,并分析脱髓鞘假瘤与胶质瘤的鉴别诊断要点.方法回顾性分析我院收治的脱髓鞘假瘤患者61例与胶质瘤患者66例的临床资料、常规磁共振图像、多模态磁共振图像,评估各影像征象及影像参数对于疾病诊断的价值.结果脱髓鞘假瘤好发于年轻女性患者,临床病程一般较缓慢,容易出现共济失调、运动障碍等症状,较少出现癫痫;影像上脱髓鞘假瘤占位效应一般较轻,容易出现开环强化、中心静脉征、侧脑室垂直征等征象;弥散加权成像(DWI)上病灶一般表现为不受限/弥散受限或者开环状弥散受限;磁共振波谱成像(MRS)上脱髓鞘假瘤Cho/NAA、Cho/Cr值通常不高,NAA/Cr比值大于胶质瘤.胶质瘤MRI图像显示累及脑皮质的比率(80.3%)大于脱髓鞘假瘤累及脑皮质的比率(31.1%);胶质瘤DWI显示大多为闭环强化;57.6%的胶质瘤会出现中心结节状的弥散受限;MRS显示7例脱髓鞘假瘤表现为低灌注,仅有1例表现为高灌注,胶质瘤则全部表现为高灌注.结论常规磁共振与多模态磁共振对脱髓鞘假瘤与胶质瘤的鉴别诊断有一定的价值.Objective To explore the value of conventional magnctic resonance imaging(MRT)and multimodal MRI inthe diagnosis of demyelinating pseudotumor,and to analyze the key points of differential diagnosis between demyelinating pseud-otumor and glioma.MethodsThe clinical data,conventionalMRI and multimodal MRI of 6l patients with demyelinating pseud-otumor and 66 patients with glioma admitted to our hospital were analyzed retrospectively,and the value of imaging signs andimaging parameters for discase diagnosis was evaluated.Results Demyelinating pseudotumors were more common in youngwomen,and the clinical course was generally slow,with more symptoms such as ataxia and dyskinesia and less epilepsy.On theimage,the occupying effect of demyelinating psecudotumor was genecrally light,and it was casy to show signs such as open ringenhancement,central venous sign and latcral ventricular vertical sign.L.esions on diffusion-weighted imaging(DW)generallyappeared unrestricted/diffuse restriction or open-loop diffuse restriction,The Cho/NAA and Cho/Cr values of demyelinatingpseudotumors on magnetic resonance spectroscopy(MRS)were usually not high,and the NAA/Cr ratio was greater than that ofgliomas.MRl images of gliomas showed that the proportion of cerebral cortcx involvement(80.3%)were greater than that ofdemyclinating pscudotumor(31.1%).Glioma DWI was oftcn characterized by closed-loop enhancement:57.6.%of gliomas hadcentral nodular diffusion restriction;MRS showed that seven cases of demyelinating pseudotumors showed hypoperfusion,onlyone case showed hyperperfusion,and all gliomas showed hyperperfusion.Conclusion Conventional MRI and multimodalMRIhave certain value in the differential diagnosis of demyelinating pscudotumor and glioma.

关 键 词：脱髓鞘假瘤 胶质瘤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]