胶质母细胞瘤多模式MRI表现及其病理组织学基础

目的探讨胶质母细胞瘤的多模式MRI表现及其病理组织学基础。材料与方法 22例经手术病理证实的胶质母细胞瘤患者中,男11例,女11例,均行T2WI、T1WI、FLAIR、DWI、T1WI增强扫描及磁敏感加权像(SWI)和氢质子MRS(1H-MRS),10例行扩散张量成像(DTI)和白质纤维束示踪成像(DTT)检查。结果 22例中病灶位于额叶7例、颞叶4例、额颞叶4例、颞枕4例、额顶1例、枕叶1例、小脑1例;其中单病灶19例,多病灶3例。常规MRI表现:(1)形态均不规整,占位效应20例 ;(2)病灶内明显坏死19例;(3)出血:明显5例,少量2例;(4)边缘模糊不清17例;(5)周围水肿:轻度4例,中度6例,重度6例。增强表现:呈不均匀强化,内壁厚薄不均或花瓣状17例。表观扩散系数(b=1000s/mm2):肿瘤实质区为0.850×10-3mm2/s～1.278×10-3mm2/s。SWI:瘤内磁敏感效应(ITSS)I级2例,Ⅱ级7例,III级13例。1H-MRS:肿瘤实质区NAA波显著减低,Cr波下降,Cho波明显增高,Cho/NAA比值6.18±1.97,Cho/Cr比值4.65±2.21,12例出现明显Lip峰。周围水肿区Cho波增高。病理组织学:多形性星形细胞,细胞核异型增生明显,核分裂活跃,明显浸润性生长,明显的坏死和血管增生是最显著的特征。免疫组织化学:胶质纤维酸性蛋白(GFAP)阳性,波形蛋白(Vimentin)阳性,增殖指数(Ki-67)高表达。结论多模式MRI能显示胶质母细胞瘤肿瘤内部结构、瘤周纤维束改变、细胞密度、代谢物浓度等诸多信息,对该肿瘤诊断和鉴别诊断具有重要临床实用价值。

Glioblastoma multi-mode MRI manifestations and pathological histology foundation

Objective： To investigate the multi mode MRI features of glioblastomas and its basis of histopathology. Materials and Methods： The collection of 22 cases confirmed by operation and pathology in patients with glioblastoma MRI data. Male 11 cases, female 11 cases. Results： （1） Position： frontal lobe 7 cases, temporal lobe 4 cases, frontotemporal 4 cases, temporal and occipital 4 cases, frontoparietal 1 cases, Occipital lobe 1 case, cerebellum in 1 cases. （2） Number： single lesion in 19 cases, multiple focal lesions in 3 cases. （3） The conventional MRI performance： ①Forms are irregular, mass effect in 20 cases. ② Intralesional obvious necrosis in 19 cases. ③ Hemorrhage： Obviously in 5 cases, a small amount of 3 cases. ④ Edge blur in 17 cases. ⑤ Peripheral edema 4 cases of mild, 6 cases of moderate, 6 cases of severe. （4） Enhance： Expression of heterogeneous enhancement, wall thickness unevenness or petal shaped in 17 cases. （5）Apparent diffusion coefficient （b=1000s/mm2）, the tumor parenchyma （0.850--1.278）×10-3mm2/s. （6） Susceptibility-weighted imaging： intratumoral susceptibility signals （ITSS） the I grade in 2 cases, II grade in 7 cases and III grade in 13 cases. （7） 1H-MRS; The NAA wave was significantly reduced in the tumor parenchyma, Cr crest drop, increased Cho wave, Cho/NAA 6.18±1.97, Cho/Cr 4.65±2.21,12 cases of apparent wave Lip. Peripheral edema increased Cho wave. Histopathology： pleomorphic astrocytoma, cell dysplasia was evident, mitotic activity, pronounced in invasive growth, obvious necrosis and hyperplasia is the most striking feature. Immunohistochemistry： Glial fibrillary acidic protein positive, Vimentin positive, high expression of Ki-67. Conclusions： multi mode MRI can display the glioblastoma tumor internal structure, peritumoral fiber beam changes, cell density, metabolite concentrations and other information, the tumor diagnosis and differential diagnosis of it has important clinical value.