儿童弥漫性高级别胶质瘤的临床及影像学表现  

Clinical and Imaging Manifestations of Diffuse High-Grade Gliomas in Children

作　　者：朱永辉 刘玥[2] 时胜利 崔得金 聂磊[1] ZHU Yonghui;LIU Yue;SHI Shengli(Department of Radiology,Children’s Hospital Afiliated of Zhengzhou University,Henan Children’s Hosipital Zhengzhou Children’s Hospital,Zhengzhou,Henan Province 450018,P.R.China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院郑州儿童医院医学影像科,450018 [2]首都医科大学附属北京儿童医院放射科,儿科重大疾病研究教育部重点实验室,国家儿童医学中心,北京100045

出　　处：《临床放射学杂志》2025年第4期700-706,共7页Journal of Clinical Radiology

基　　金：国家区域医疗中心开放课题项目(编号:NRMC0108)。

摘　　要：目的探讨根据2021年世界卫生组织(WHO)第5版中枢神经系统肿瘤分类诊断为儿童弥漫性高级别胶质瘤的临床及影像学特点。方法回顾性分析9例经手术病理证实的儿童弥漫性高级别胶质瘤临床及影像学表现。结果9例儿童弥漫性高级别胶质中弥漫性中线胶质瘤(DMG)5例,儿童弥漫性高级别胶质瘤3例;弥漫性半球胶质瘤(DHG)1例。男7例,女2例;临床表现以走路不稳为主3例、以头痛伴呕吐为主6例;位于脑干3例,其中1例出现脑脊液播散、丘脑2例、小脑1例、左侧大脑半球3例;3例轻度瘤周水肿、2例中度瘤周水肿,信号为混杂信号,4例无瘤周水肿;9例肿块内存在形态及大小不一的囊变、多位于边缘,其中4例瘤内有出血,扩散加权成像(DWI)示病变均呈不同程度扩散受限;增强后4例呈“花环状”强化,3例呈片状、结节状强化,1例可见肿瘤包绕基底动脉;6例行磁共振波谱成像(MRS)检查,均呈N-乙酰天门冬氨酸(NAA)峰明显减低,胆碱(Cho)峰明显升高,Cho/NAA明显升高,4例出现乳酸(Lac)峰。结论儿童弥漫性高级别胶质瘤临床表现不具特异性,但具有一定的影像学特征。病灶大部分位于中线部位,可以单发,也可以多发,瘤体长径一般超过3 cm,瘤内信号不均匀,出现囊变和出血,环形或团块状强化,实性部分扩散不同程度受限,Cho峰明显升高,出现Lac峰等特点。Objective To analyze the clinical and imaging characteristics of diffuse high-grade gliomas in children according to the 5th edition of the WHO classification of central nervous system tumors in 2021.Methods A retrospective analysis was performed on 9 cases of diffuse high-grade gliomas in children confirmed by surgical pathology among 120 cases of pediatric brain tumors in our hospital in the past 3 years was performed,and the clinical and imaging manifestations were analyzed.Results Among the 9cases of diffuse high-grade gliomas in children,there were 5 cases of diffuse midline gliomas,3 case of diffuse pediatric high-grade glioma,and 1 case of diffuse hemispheric glioma.There were 7 boys and 2 girls.The clinical manifestations were mainly unstable walking in 3 cases and headache with vomiting in 6 cases.The tumors were located in the brainstem in 3 cases,of which 1 case had cerebrospinal fluid dissemination,2 cases in the thalamus,1 case in the cerebellum,and 3 case in the left cerebral hemisphere.There were mild peritumoral edema in 3 cases,moderate peritumoral edema in 2 case,and mixed signals in 4 cases.There were cystic changes of different shapes and sizes in the tumors in 9 cases,mostly located at the edge,and 4 cases had hemorrhage in the tumors.Diffusion-weighted imaging showed that the lesions were restricted in diffusion to varying degrees.Enhancement was wreath-shaped in 4 cases,sheet-shaped and nodular in 3 cases,and the tumor was seen surrounding the basilar artery in 1 case.Magnetic resonance spectroscopy(MRS)was performed in 6 cases,and all showed a significant decrease in NAA peak,a significant increase in Cho peak,and a significant increase in Cho/NAA.Lactate peaks appeared in 4 cases.The tumor recurred after 1 year of follow-up,and recurrence foci appeared in the original site of the left cerebellar hemisphere,brainstem,and thalamus.Conclusion Most of the lesions of diffuse high-grade gliomas in children are located in the midline,and can be single or multiple.The clinical manifestations are

关 键 词：脑肿瘤 高级别胶质瘤 弥漫性 儿童 磁共振成像 体层摄影术 X线计算机 

分 类 号：R73[医药卫生—肿瘤]