基于多参数序列的儿童脑干弥漫性高级别胶质瘤临床影像学特征研究  

Clinical imaging features of diffuse high-grade glioma in the brainstem of children based on multiparameter sequences

作　　者：陈怡[1] 刘明[1] 管文斌[2] 张培荣 郑慧[1] 张海波[3] CHEN Yi;LIU Ming;GUAN Wenbin;ZHANG Peirong;ZHENG Hui;ZHANG Haibo(Department of Radiology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pathology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pediatric Neurosurgery,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院放射科,上海200092 [2]上海交通大学医学院附属新华医院病理科,上海200092 [3]上海交通大学医学院附属新华医院儿神经外科,上海200092

出　　处：《肿瘤影像学》2025年第1期72-78,共7页Oncoradiology

基　　金：中国遗传资源保护与疾病防控教育部重点实验室开放课题(LPHGRD2022-08)。

摘　　要：目的:基于多参数序列探讨儿童脑干弥漫性高级别胶质瘤临床及影像学特征,以提高对该病的全面认识。方法:回顾并分析2022年1月—2024年1月就诊上海交通大学医学院附属新华医院并经病理学检查证实的儿童脑干弥漫性高级别胶质瘤的临床及影像学资料。结果:共45例儿童脑干弥漫性高级别胶质瘤[男性19例,女性26例,年龄(6.48±2.34)岁]纳入本研究,其中4.4%(2/45)出现脑脊液播散,余脑干局限或附近浸润性生长。45例行计算机体层成像(computed tomography,CT)平扫+磁共振成像(magnetic resonance imaging,MRI)平扫/增强扫描+弥散加权成像(diffusion-weighted imaging,DWI)基础扫描,6例同时行CT灌注成像(CT perfusion imaging,CTP)扫描,8例同时行磁共振波谱成像(magnetic resonance spectroscopy,MRS)扫描,7例同时行弥散张量成像(diffusion tensor imaging,DTI)扫描,2例同时行磁敏感加权成像(susceptibility weighted imaging,SWI)扫描。45例均内生性膨胀生长,其中36例双侧均匀膨胀生长,9例偏侧膨胀生长(7例生长过程中越过中线,2例单侧头尾端弥漫生长);28.9%(13/45)局限脑桥生长,2.2%(1/45)局限延髓生长,68.9%(31/45)向头尾端(中脑/丘脑/延髓,21/31,67.7%)和向侧方(桥臂/小脑,10/31,32.3%)生长,26.7%(12/45)进展为外生性(其中11例包裹基底动脉,11/12,91.7%)。CT平扫序列显示脑干区域低密度增粗影,密度低于正常脑干(P<0.001)。CT灌注序列扫描显示83.3%(5/6)患者的肿瘤区域脑血流量(cerebral blood flow,CBF)降低(1例显示肿瘤中心区域明显低于平均水平),1例升高;双侧大脑半球灌注异常,达峰时间延迟,以侧脑室周围为主。MRI结构序列显示肿瘤实性成分T1加权成像(T1-weighted imaging,T1WI)8.9%(4/45)呈等信号、11.1%(5/45)呈低信号,80.0%呈混杂信号(36/45),T2-液体抑制反转恢复(fluid-attenuated inversion recovery,FLAIR)序列呈稍高-高信号,T1WI增强后模式呈多样性改变,6例不强化,余不同程度�Objective:To explore the clinical and imaging features of diffuse high-grade gliomas in the brainstem of children based on multi parameter sequences,so as to improve the comprehensive understanding of the disease.Methods:The clinical and imaging data of pediatric brain stem diffuse high-grade gliomas confirmed by pathology from January 2022 to January 2024 were retrospectively analyzed.Results:A total of 45 children in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine with diffuse high-grade gliomas in the brainstem(19 males and 26 females,aged 6.48±2.34 years)were included in this study.Among them,4.4%(2/45)had cerebrospinal fluid dissemination,while the rest had localized or nearby infiltration and growth in the brainstem.45 cases underwent computed tomography(CT)plain scan+magnetic resonance imaging(MRI)plain scan/enhanced scan+diffusion-weighted imaging(DWI)basic scan,6 cases underwent CT perfusion imaging(CTP)scan simultaneously,8 cases underwent magnetic resonance spectroscopy(MRS)scan simultaneously,7 cases underwent diffusion tensor imaging(DTI)scan simultaneously,and 2 cases underwent susceptibility weighted imaging(SWI)scan simultaneously.All 45 cases had endogenous swelling growth,including 36 cases with uniform swelling growth on both sides and 9 cases with lateral swelling growth(7 cases crossed the midline during the growth process,and 2 cases with diffuse growth on one side of the head and tail);28.9%(13/45)limited brainstem growth,2.2%(1/45)limited medullary growth,68.9%(31/45)grew towards the head and tail(midbrain/thalamus/medulla oblongata,21/31,67.7%)and laterally(pons/cerebellum,10/31,32.3%),and 26.7%(12/45)progressed to exogeneity(including 11 cases involving the basilar artery,11/12,91.7%).The CT plain scan sequence showed low-density thickening shadows in the brainstem area,with a density lower than that of the normal brainstem(P<0.001).CT perfusion sequence scan showed a decrease in cerebral blood flow(CBF)in the tumor area of 83.3%(5/6)of patients(1 case showed a signific

关 键 词：脑干 弥漫性胶质瘤 磁共振成像 儿童 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]