多发性多形性成胶质细胞瘤的鉴别诊断:1例报告及专家解读  

Differential diagnosis of multiple glioblastoma multiforme: One case report and expert interpretation

作　　者：吴宜凡 吴恒趋[1] 李建萍[1] 陈增爱[2] 管阳太[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经内科,上海200127 [2]上海交通大学医学院附属仁济医院影像科,上海200127

出　　处：《神经病学与神经康复学杂志》2018年第1期11-17,共7页Journal of Neurology and Neurorehabilitation

摘　　要：目的 :探讨1例多发性多形性成胶质细胞瘤(glioblastoma multiforme,GBM)患者的临床和影像学特征,以提高对多发性GBM的早期诊断及鉴别诊断水平。方法 :报道1例多发性GBM患者的临床诊治经过,邀请神经内科及影像科专家结合相关文献对GBM的临床和影像学特征进行解读。结果 :1例以癫痫样发作起病的多发性GBM患者,同时伴有一过性记忆模糊病史。脑脊液中未见恶性依据。磁共振成像(magnetic resonance imaging,MRI)检查发现颅内多发近皮层的T1加权成像低信号影,T2加权成像及液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列表现为高信号影;磁共振弥散加权成像(diffusion weighted imaging,DWI)呈高信号影,伴斑片状强化。磁共振波谱分析(magnetic resonance spectroscopy,MRS)结果提示病灶处胆碱代谢水平升高。病理诊断为成胶质细胞瘤[未分型(not otherwise specified,NOS)]。结论 :GBM是最常见的颅内恶性肿瘤,其临床症状多样且不典型;计算机断层成像(computed tomography,CT)及增强MRI检查并无特异性发现;临床上,需与脑血管疾病及颅内转移瘤等进行鉴别。MRS等可对病灶的组织代谢情况进行分析,以进一步明确病灶的性质。Objective: To discuss the clinical and radiological characteristics of multiple glioblastoma multiforme(GBM) and help clinicians to diagnose GBM in early stage.Methods: The process of clinical diagnosis and treatment of a patient with multiple GBM was reported.Neurology and imaging experts were invited to discuss the clinical and imaging characteristics of GBM based on literature reviews.Results: One patient was diagnosed of multiple GBM with the onset of seizures and a history of transient memory loss.Cerebrospinal fluid(CSF) examination showed no indications for malignant tumors.Cranial magnetic resonance imaging(MRI) demonstrated multiple subcortical lesions which exhibited hypo-intense on T1-weighted image and hyper-intense on T2-weighted image and fluid attenuated inversion recovery(FLAIR) image; there was also hyper-intense on diffusion weighted imaging(DWI) with patchy enhancement.Magnetic resonance spectroscopy(MRS) showed elevated choline level in the lesion sites.The final pathological diagnosis was glioblastoma multiforme,not otherwise specified(NOS).Conclusion: GBM is the most prevalent and malignant primary brain tumor and its clinical manifestations are diverse and untypical.Computed tomography(CT) and enhanced MRI examinations show no specificity of the lesions.GBM should be distinguished from cerebrovascular diseases and intracranial metastatic tumors.MRS can analyze the metabolism of the lesions to help identifying the lesions properly.

关 键 词：成胶质细胞瘤 颅内转移瘤 脑血管疾病 颅内多发病灶 

分 类 号：R739.4[医药卫生—肿瘤]