单发性脑转移瘤的CT诊断及鉴别诊断

本文回顾性分析28例经临床或手术病理证实的单发性脑转移瘤的CT表现,探讨其特征,旨在提高对本病的CT诊断及鉴别诊断能力。     

ADC直方图在高级别胶质瘤与脑单发转移瘤鉴别中的应用价值

目的 探讨表观扩散系数（ADC）直方图鉴别高级别胶质瘤（HGG）与单发脑转移瘤（SBM）的价值。方法 回顾性分析病理或临床随访证实的7例HGG与19例SBM（腺癌脑转移瘤11例,鳞癌脑转移瘤8例）的MRI资料,测量瘤体和瘤周水肿区ADC直方图参数,利用受试者工作特征曲线评价ADC直方图参数鉴别HGG与SBM的诊断效能。结果 HGG瘤体ADC第5、25百分位数（ADC_5th、ADC_25th）及瘤周水肿ADC最小值（ADCmin）均明显低于SBM（P<0.05）,而瘤体体素计数明显高于SBM（P<0.05）。鳞癌脑转移瘤瘤体ADC_5th、ADC_25th均明显低于腺癌脑转移瘤（P<0.05）。瘤体ADC_5th=926×10-6 mm2/s鉴别诊断HGG与SBM的效能最高。结论 ADC直方图有助于HGG与SBM的鉴别诊断,瘤体ADC_5th鉴别诊断HGG与SBM的效能最高。     

扩散峰度成像鉴别诊断高级别胶质瘤与脑转移瘤的临床价值

目的 探讨扩散峰度成像（DKI）鉴别诊断高级别胶质瘤（HGG）和单发脑转移瘤（BM）的临床应用价值。方法 回顾性分析2017年3月至2018年12月收治的23例HGG和19例单发BM的临床资料。所有病人均行MRI扫描及DKI扫描,分析两类肿瘤实质区和瘤周区DKI参数各向异性分数（FA）、平均扩散（MD）及平均峰度（MK）。利用ROC曲线计算敏感度、特异度及曲线下面积（AUC）。结果 HGG和单发BM病人MRI增强均显示不规则环状强化灶。HGG和单发BM实质区DKI参数FA、MD及MK值均无统计学差异（P>0.05）。与单发BM瘤周区相比,HGG瘤周区DKI参数FA和MK值更高（P<0.05）,MD值更低（P<0.05）。与DKI参数FA和MD值相比,瘤周区MK值鉴别HGG和单发BM的特异性与灵敏度更高,AUC更大。结论 瘤周区DKI参数FA、MD及MK值在HGG和单发BM鉴别诊断中具有重要的临床价值,且瘤周区MK值的诊断效能更高。     

脑转移瘤的CT分析

目的 探讨脑转移瘤的CT影像特点，以提高其诊断准确率。方法 利用84例已确诊原发灶的颅内转移瘤资料，进行回顾性分析。结果 84例中，有70例是肺癌脑转移，占83．3％，这点有助于帮助诊断。典型的CT表现有：(1)环状强化或环状和结节状混合强化为绝大多数；(2)周围大范围水肿，与病灶大小不成比例；(3)颅内多发为常见。而非典型的CT表现主要有多灶内出血和少数无水肿的病灶或单发结节灶。结论 脑转移瘤绝大多数有典型CT表现，但也要与脑脓肿和胶质瘤相鉴别。     

磁共振成像对急性脑梗死和脑转移瘤的鉴别诊断

目的研究急性脑梗死(ACI)和脑转移瘤(BM)的磁共振特征,分析磁共振在两者影像学诊断中的鉴别价值。方法收集急性脑梗死46例,脑转移瘤患者30例。行头磁共振平扫及增强检查,对二者进行鉴别诊断。结果 BM组较ACI组的多发病灶病例数明显增多。2组新发病灶在分布部位上比较,分布无明显差异。脑转移瘤组患者的周围水肿程度显著高于急性脑梗死组,有显著性差异(P0.05)。急性脑梗死组4例有轻微强化病灶,脑转移瘤组有程度不同的环状或实质性强化。ACI组有2例符合ACI的诊断标准,但在DWI上未显示。其余患者均可在DWI上呈现出高信号影。,明显多于BM组。结论以中枢神经系统症状发病的急性脑梗死和脑转移瘤在磁共振表现上存在诸多差异。通过观察分析,其特征表现助于两者的鉴别诊断。     

CT及MR对脑转移瘤与脑囊虫病的鉴别

脑转移瘤与脑囊虫病均为颅内多发性占位疾病，有时在ＣＴ及ＭＲ图像上表现很相似，容易造成误诊，但二者在治疗及预后上有明显差异，因此，进行鉴别有重要意义。现将我们所见３例误诊病例分析如下，提出它们的鉴别要点，以供参考。临床资料脑转移瘤３例，原发灶均为肺癌。男２例，女１例。年龄为４８、５０、５６岁。病程２～６月。３例在ＣＴ增强扫描及ＭＲＴ２加权像上均表现为双侧大脑半球内广泛多发性环形结节影，均误诊为脑囊虫病。误诊时间达２～６月。在重新读片时发现３例结节数分别为１５、９、８个，共３２个。直径６～１５ｍｍ，…     

敏感加权成像（SWI）在新生儿颅内出血中的应用价值

目的：探讨SWI在新生儿脑内出血上的表现及鉴别诊断。方法选取我院新生儿监控室内102例临床怀疑有脑出血症状者,通过SWI与常规T1 WI、T2 WI、FLAIR进行对比结果102例新生儿中常规T1 WI、T2 WI、FLAIR查出脑出血43例,SWI查出58例。结论 SWI对新生儿脑内出血检出率、病灶大小、数目均优于常规T1 WI、T2 WI、FLAIR序列。     

CD44s、CD44v6在颅内转移瘤与胶质母细胞瘤中的表达研究

目的:探讨粘附分子CD44基因蛋白在颅内转移瘤及胶质母细胞瘤中的表达及其与这些肿瘤侵袭、转移之间的关系。方法:应用标准型CD44(CD44s)和变异型CD44v6基因蛋白单克隆抗体,微波-LSAB免疫组化染色检测20例正常脑组织、35例脑胶质母细胞瘤和30例颅内转移瘤中CD44基因蛋白的表达情况。结果:20例正常脑组织中CD44s和CD44v6表达均为阴性:35例脑胶质母细胞瘤CD44s阳性表达率为100％(35／35),CD44v6表达为阴性:30例颅内转移瘤中CD44s阳性表达率为86.7％(26／30),CD44v6阳性表达率为66.7％(20／30)。CD44v6在颅内转移瘤及脑胶质母细胞瘤的表达差异有显著性(P<0.01)。结论:脑胶质母细胞瘤中CD44S的表达可能与其脑内侵袭过程有关,无CD44v6表达可能与其很少发生颅外转移有关,并有可能成为颅内转移瘤诊治的有用指标之一。     

SWI表现为弥漫性粟粒样病灶的肺癌脑转移一例报道及文献复习

患者 女性,58岁,因进行性记忆力减退、反应迟钝1个月于2009年6月25日入院.患者入院前1个月出现记忆力减退,对事件记忆模糊,反应迟钝,伴头晕,进行性加重,无头痛、抽搐.     

SWI 技术在脑血管疾病诊断中的应用

目的：探讨磁共振磁敏感加权成像技术在脑血管疾病诊断中的临床应用价值。方法回顾分析我院2012-09-2013-12收治的74例脑血管疾病患者的常规序列 T1WI、T2WI、DWI、FLAIR及SWI、增强 T1WI、MRA图像,评价SWI序列显示小出血灶、小静脉、海绵状血管瘤、脑内铁钙异常沉积等方面的优越性。结果 SWI可鉴别海绵状血管瘤出血与血管,发现更多的小出血灶,发现常规序列扫描不能发现的小静脉畸形并显示向大静脉的引流,显示脑外伤平扫时难以发现的更多小出血灶和脑梗死伴发的小出血灶。结论 SWI是显示脑部低流量血管畸形、小静脉的结构,多发小灶性出血以及铁钙沉积十分敏感的脉冲序列,作为M RI常规序列的重要补充,对脑血管疾病的诊断和鉴别诊断具有重要意义。     

ADC直方图鉴别脑转移瘤病理性质的价值

目的 探讨ADC直方图在腺癌脑转移瘤和鳞癌脑转移瘤鉴别诊断中的价值。方法 回顾性分析经病理证实的48例脑转移瘤（腺癌31例,鳞癌17例）术前磁共振弥散加权成像,绘制整个肿瘤的ADC直方图,并计算出最小ADC值（ADCmin）、最大ADC值（ADCmax）、平均ADC值（ADCmean）、第5百分位数（ADC_5th）、第25百分位数（ADC_25th）、中位数（ADC_50th）、第75百分位数（ADC_75th）、第95百分位数（ADC_95th）。结果 腺癌脑转移瘤ADCmin、ADCmean、ADCmax均明显高于鳞癌脑转移瘤（P<0.05）,但是两种性质脑转移瘤ADC_5th、ADC_25th、ADC_50th、ADC_75th、ADC_95th均未见显著性差异（P>0.05）。根据ROC曲线分析结果,以ADCmin=0.600×10-3 mm2/s为阈值鉴别腺癌脑转移瘤和鳞癌脑转移瘤时,诊断效能最佳,ROC曲线下面积最大,为0.700,诊断灵敏度为64.7%,特异度为74.2%。结论 ADC直方图可以提供肿瘤的整体信息,有助于鉴别诊断腺癌脑转移瘤与鳞癌脑转移瘤。     

磁共振弥散加权成像鉴别诊断脑脓肿与脑肿瘤坏死的临床研究

目的探讨磁共振弥散加权像(DWI)及表观弥散系数值(ADC)对脑脓肿与坏死囊变脑转移瘤诊断和鉴别的意义。方法选取2011-01—2015-01于我院进行脑脓肿、脑肿瘤坏死治疗的患者为研究对象,其中脑脓肿10例,脑肿瘤坏死12例,均进行常规磁共振检查及弥散加权检查。应用1.5T磁共振机SE-EPI序列,取b=1 000s/mm2,b=0s/mm2在脑脓肿脑炎期、包膜期及吸收期进行弥散信号测量,获得DWI图像,同时测量表观弥散系数值,并与坏死囊变脑转移瘤比较。结果常规MRI诊断敏感性、特异性分别为75%、70%,DWI诊断敏感性、特异性则分别为92%、90%;10例脑脓肿9例磁共振弥散加权图像表现为高信号,表观弥散系数值为0.335±0.098,12例脑肿瘤中11例坏死囊变部分磁共振弥散加权图像表现为低信号,表观弥散系数值2.481±0.391。结论在鉴别脑脓肿和坏死、囊变脑肿瘤方面磁共振弥散加权成像诊断的敏感性和特异性均明显高于常规MR诊断,帮助提高诊断的正确性。     

MRS联合Ki-67鉴别脑转移瘤与高级别胶质瘤的作用

目的 探讨磁共振波谱(MRS)参数联合Ki-67指数在鉴别脑转移瘤(BM)与原发性高级别胶质瘤(HGG)中的作用.方法 回顾性分析2018年1月至2020年8月手术及病理证实的30例原发性HGG(HGG组)和13例BM(BM组)的临床资料.所有病人术前均行MRS检查,术后均行Ki-67检测.MRS参数包括N-乙酰天冬氨...     

脑肿瘤卒中与脑出血的CT诊断及鉴别诊断

目的分析CT对脑肿瘤卒中与脑出血的诊断及鉴别诊断价值,以期对临床脑肿瘤卒中的诊疗提供借鉴。方法我们收集2012-04—2014-06入住我院经病理或临床证实的脑肿瘤卒中40例为研究对象,所有患者均发病12h内行CT扫描和灌注成像,同时入选年龄性别相同的高血压脑出血患者40例为对照组,分析CT对脑肿瘤卒中与脑出血的诊断,及2组的出血量情况、脑灌注参数如脑血流量(CBF)、脑血容量(CBV)参数、毛细血管表面通透性(PS)等灌注参数。结果脑肿瘤卒中明确诊断22例,误诊为单纯性脑出血18例,诊断率为55%。2组出血量及脑灌注参数BF、BV、PS差异有统计学意义(P0.05),高血压出血量大于脑肿瘤卒中组,且高血压出血组脑灌注强于脑肿瘤卒中组。结论对脑组织非常规部位出血提高警惕,认真询问病史,仔细观察血肿的形态、周围组织结构,综合考虑或建议采取其他物理检查,方能减少误诊,CT检查方便迅速,是检测脑肿瘤卒中与高血压脑出血的主要方法,其中高血压脑出血的表现更加特异。     

18例瘤型脑脓肿的临床特点及鉴别诊断

目的 总结瘤型脑脓肿的临床特点并探讨其诊断方法.方法 回顾性分析中山大学肿瘤防治中心神经外科自2000年10月至2007年2月间收治的18例瘤型脑脓肿患者的临床资料,并随访其术后恢复情况.结果 共有18例腩脓肿在外院诊断为肿瘤,其中诊为胶质瘤11例,转移瘤7例.冬春季节发病16例.18例均未发现原发性感染灶,2例入院前1月有发热病史.入院后白细胞总数10.1×109/L～13.7×109/L者7例,其中6例中性粒细胞比率80.8%～90.5%,白细胞总数正常11例.入院后患者均行MRI检查,14例诊为腩脓肿,2例诊为转移瘤,诊为胶质瘤及寄生虫病各一例.细菌培养结果 为无菌生长9例,革兰阳性菌4例,链球菌3例,表皮葡萄球菌、肺炎克雷伯菌各一例.手术切除12例,穿刺引流6例.术后随访1～6年,治愈17例,好转1例.结论瘤型脑脓肿常发生于冬春季节,临床表现不典型,MRI扫描是其最有价值的辅助榆查方法 .在脑脓肿与坏死囊变脑肿瘤的鉴别诊断中,MRS和DWI足常规MRI扫描的重要补充.     

Management of brain metastases

Brain metastases occur in 20–40 % of patients with cancer and their frequency has increased over time. Lung, breast and skin (melanoma) are the commonest sources of brain metastases, and in up to 15 % of patients the primary site remains unknown. After the introduction of MRI, multiple lesions have outnumbered single lesions. Contrast-enhanced MRI is the gold standard for the diagnosis. There are no pathognomonic features on CT or MRI that distinguish brain metastases from primary malignant brain tumors or nonneoplastic conditions: therefore a tissue diagnosis by biopsy should be always obtained in patients with unknown primary tumor before undergoing radiotherapy and/or chemotherapy. Some factors are prognostically important: a high Performance Status, a solitary brain metastasis, an absence of systemic metastases, a controlled primary tumor and a younger age. Based on these factors, subgroups of patients with different prognosis have been identified (RPA class I, II, III). Symptomatic therapy includes corticosteroids to reduce vasogenic cerebral edema and anticonvulsants to control seizures. In patients with newly diagnosed brain metastases prophylactic anticonvulsants should not be used routinely. The combination of surgery and whole-brain radiotherapy (WBRT) is superior to WBRT alone for the treatment of single brain metastasis in patients with limited or absent systemic disease and good neurological condition. Complete surgical resection allows a relief of intracranial hypertension, seizures and focal neurological deficits. Radiosurgery, alone or in conjunction with WBRT, yields results which are comparable to those reported after surgery followed by WBRT, provided that lesion's diameter does not exceed 3–3.5 cm. Radiosurgery offers the potential of treating patients with surgically inaccessible metastases. Still controversial is the need for WBRT after surgery or radiosurgery: local control seems better with the combined approach, but overall survival does not improve. Late neurotoxicity in long surviving patients after WBRT is not negligeable; to avoid this complication patients with favorable prognostic factors must be treated with conventional schedules of RT, and monitoring of cognitive functions is important. WBRT alone is the treatment of choice in patients with single brain metastasis not amenable to surgery or radiosurgery, and with an active systemic disease, and in patients with multiple brain metastases. A small subgroup of these latter may benefit from surgery. The response rate of brain metastases to chemotherapy is similar to the response rate of the primary tumor and extracranial metastases, some tumor types being more chemosensitive (small cell lung carcinoma, breast carcinoma, germ cell tumors). New radiosensitizers and cytotoxic or cytostatic agents, and innovative technique of drug delivery are being investigated. Received: 20 May 2002, Accepted: 23 May 2002 Correspondence to Riccardo Soffietti, MD     

伽玛刀治疗脑转移瘤的疗效观察

目的 观察伽玛刀治疗脑转移瘤的临床治疗效果.方法 采用国产OUR-XGD型头部伽玛刀,结合手术、放疗、化疗等综合治疗手段治疗112例脑转移瘤患者.结果 随访85例患者,随访期36-72个月,肿瘤控制率95%.生存期1-48个月,平均生存期14.3个月,中位生存期12个月,0.5年生存率86%,1年生存率59%,2年生存率21%.结论 伽玛刀治疗脑转移瘤是一种安全有效的治疗手段,配合科学合理的综合治疗措施可进一步提高疗效.

Abstract：

Objective To explore the efficacy of gamma knife radiosurgery for brain metastases.Method 112 cases with brain metastases were treated by gamma knife.Among them, most cases were combined surgery with whole brain radiation therapy and chemotherapy.Results 85 cases were followed up for 36-72 months,the total local control rate was 95%, the mean survival time of all patients was 12 months,0.5 year survival rate was 86%, 1 year survival rate was 59%, 2 year survival rate was 21%.Conclusions The treatment of gamma knife radiosurgery for brain metastases is an effective and safe method.     

Differentiation between glioblastomas and brain metastases and regarding their primary site of malignancy using dynamic susceptibility contrast MRI at 3T

BackgroundDifferentiation between glioblastoma and brain metastasis may be challenging in conventional contrast-enhanced MRI.PurposeTo investigate if perfusion-weighted MRI is able to differentiate glioblastoma from metastasis and, as a second aim was to see if it was possible in the latter group, to predict the primary site of neoplasm.Material and methodsHundred and fourteen patients with newly discovered tumor lesion (76 metastases and 38 glioblastomas) underwent conventional contrast-enhanced MRI including dynamic susceptibility contrast perfusion sequence. The calculated relative cerebral blood volumes were analyzed in the solid tumor area, peritumoral area, area adjacent to peritumoral area, and normal appearing white matter in contralateral semioval center. The Student t-test was used to detect statistically significant differences in relative cerebral blood volume between glioblastomas and metastases in the aforementioned areas. Furthermore, the metastasis group was divided in four sub groups (lung-, breast-, melanoma-, and gastrointestinal origin) and using one-way ANOVA test. P-values < 0.05 were considered significant.ResultsRelative cerebral blood volume (rCBV) in the peritumoral edema was significantly higher in glioblastomas than in metastases (mean 3.2 ± 1.4 and mean 0.9 ± 0.7), respectively, (P < 0.0001). No significant differences in the solid tumor area or the area adjacent to edema were found, (P = 0.28 and 0.21 respectively). There were no significant differences among metastases in the four groups.ConclusionIt is possible to differentiate glioblastomas from metastases by measuring the CBV in the peritumoral edema.It is not possible to differentiate between brain metastases from different primaries (lung-, breast-, melanoma or gastrointestinal) using CBV-measurements in the solid tumor area, peritumoral edema or area adjacent to edema.