Proton MRS imaging in the follow-up of patients with suspected low-grade gliomas

We compared the value of changes in proton magnetic resonance spectroscopic imaging (¹H-MRSI) with changes in clinical status and/or contrast-enhanced magnetic resonance imaging (MRI) in the monitoring of patients with suspected low-grade glioma (LGG). From June 1, 1999 till May 31, 2002, we included consecutive, neurologically intact adult patients suspected of having an LGG, demonstrating non-enhancing supratentorial lesions without edema or mass effect on MRI, and in whom all treatment (including a diagnostic biopsy) was deferred. Till January 1, 2003, patients were surveyed clinically and radiologically (contrast-enhanced MRI and ¹H-MRSI). Patients who showed progression on clinical examination and/or MRI were denoted as progressive disease. Other patients were denoted as stable disease. A decrease in NAA/CHO ratio of 20% compared to the baseline value was considered as indicative for progression on ¹H-MRSI. We included 14 patients with suspected LGG. Seven patients demonstrated progressive disease during the follow-up period, preceded or accompanied by concomitant ¹H-MRSI changes in five patients. Four of these five patients were operated on within the follow-up interval. The histological diagnosis demonstrated high-grade glioma in three and LGG in one patient. In the other two patients with progressive disease, no progression was found on ¹H-MRSI. The other seven patients demonstrated stable disease, but four of them showed progression on ¹H-MRSI. Our data do not show convincing evidence that ¹H-MRSI contributes to adequate monitoring and follow-up of patients with suspected LGG. Future research should preferably include pathological data at the time of ¹H-MRSI changes.     

The role of MRI in patients with astrocytoma WHO II treated with fractionated stereotactic radiotherapy

Aim of this study was to evaluate the role of pre-therapeutic and follow-up MRI in the clinical treatment and outcome in patients with astrocytoma WHO grade II after fractionated stereotactic radiation therapy (FSRT). One hundred thirty-nine patients with histologically proven astrocytoma WHO grade II were treated with FSRT and retrospectively evaluated. All patients had follow-up MRI studies (Gd-DTPA-enhanced T1- and T2-weighted MR images). Progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method. Multivariate analysis was performed on five potential MRI related prognosticators. Median follow-up was 3.8 years. Positive contrast enhancement (CM+) prior to FSRT proved to be a significant prognosticator for PFS and OS (p<0.01). Pre-therapeutic oedema on T2-weighted images and multifocality of contrast medium (CM) enhancement did not prove to be significant prognosticators. Also, diameter and volume of CM enhancement showed no significance on clinical outcome. Negative contrast enhancing (CM–) patients developing a de novo CM enhancement during follow-up showed a significantly worse clinical outcome compared with generally CM– patients (p<0.05). Pre-therapeutic CM enhancement and the development of CM-enhancing areas during follow-up are negative prognosticators for PFS and OS. They must be interpreted as signs of secondary malignity.     

累及补充运动区额上回胶质瘤的外科治疗

目的　探讨累及补充运动区额上回胶质瘤的外科治疗。方法　对 16例累及补充运动区的低级别星形细胞瘤患者的临床资料及随访结果进行分析。结果　手术切除范围距中央前沟 >1cm的病变 8例 ,其中 6例表现为补充运动区综合征 ,虽出现暂时的运动和语言功能障碍 ,但随访 12个月 ,均得到恢复 ;而手术切除范围距中央前沟 <1cm的 8例病变 ,术后均立即出现对侧肢体偏瘫 ,随访 12个月 ,仍有 5例遗留运动障碍。结论　对于累及补充运动区的额上回胶质瘤 ,当手术切除范围距中央前沟 <1cm时 ,很可能造成永久性的功能障碍     

GST-π与MGMT蛋白在星形细胞瘤中表达的意义

目的探讨胎盘型谷胱甘肽S转移酶-π(GST-π)与06-甲基鸟嘌呤-DNA甲基转移酶(06-methylguanine-DNA methyltransferase,MGMT)在星形细胞瘤病变中表达的临床意义及相互关系。方法应用免疫组织化学SP法检测脑星形细胞瘤病变组织中GST-π与MGMT蛋白的表达情况。结果43例星形细胞瘤中GST-π与MGMT蛋白的阳性表达率分别为56%和58%,MGMT在星形细胞瘤中的表达与患者的性别、年龄和肿瘤的大小无关,GST-π在星形细胞瘤中的表达与患者的性别无关,而与年龄和肿瘤大小有关,在高龄组患者的表达显著高于低龄患者组(P<0.05)。GST-π在<3cm组患者中表达的阳性率显著高于≥3cm组患者(P<0.05)。结论GST-π与MGMT蛋白的表达随着星形细胞瘤的恶性程度的增高表达率显著增高,提示它们可作为星形细胞瘤的标志物。GST-π与MGMT蛋白的表达呈正相关,提示两者共同参与烷化剂耐药的过程。     

毛细胞型星形细胞瘤9例临床病理分析

目的 研究毛细胞型星形细胞瘤的病理形态学特点和免疫组织化学表型，并探讨特殊类型——粘液性毛细胞型星形细胞瘤。方法采用光镜观察（HE）结合临床资料对9例毛细胞型星形细胞瘤进行临床病理分析。结果9例患者均较年轻，年龄5—33岁，平均14．7岁，其中8例为毛细胞星形细胞瘤，1例为粘液性毛细胞型星形细胞瘤。结论①毛细胞型星形细胞瘤多发病于青少年，以小脑居首。（多粘液性毛细胞型星形细胞瘤是一种最近才被描述的中枢神经系统肿瘤，在其生物学行为上与毛细胞型星形细胞瘤有细微的差异。     

Primary diffuse leptomeningeal glioneuronal tumors of the central nervous system: Report of three cases and review of literature

Abstract

Primary diffuse leptomeningeal glioneuronal tumors (DLGNT) are rare tumors, recently recognized as a unique entity based on their unique pathologic and clinical characteristics. We report three cases of DLGNT and compare their clinical characteristics and presentation with other reported cases, and with primary leptomeningeal gliomatosis. Because their prognosis is better than that of diffuse leptomeningeal gliomatosis, and pathologic diagnosis may be difficult, clinicians should consider this diagnosis in patients who present with new neurological symptoms, hydrocephalus and diffuse leptomeningeal enhancement on MRI. Further studies are required to better understand the unique biological characteristics of these tumors and to improve therapy.     

泛素结合酶基因UbcH10在脑星形胶质细胞瘤组织中的表达及意义

目的 探讨泛素结合酶基因UbcH10在脑星形胶质细胞瘤组织中mRNA和蛋白表达水平及其与星形胶质细胞瘤病理级别的相关性. 方法 应用实时荧光定量PCR、免疫组织化学染色和蛋白印迹实验检测UbcH10 mRNA和蛋白在32例不同级别脑星形胶质细胞瘤和6例正常脑组织中的表达,并检测UbcH 10蛋白表达与增殖抗原Ki-67蛋白表达的相关性. 结果实时荧光定量PCR结果、免疫组织化学染色结果和蛋白印迹实验结果提示:与正常脑组织(1.00±1.57;O%;0.43±0.42)比较.UbcH10 mRNA和蛋白表达水平在高级别星形胶质细胞瘤(64.33±60.98;9.65%±5.75%;0.69±0.38)和低级别星形胶质细胞瘤(8.36±8.15;4.82%±3.30%;0.10±0.08)中明显上调,差异均有统计学意义(P<0.05);且高、低级别星形胶质细胞瘤之间比较差异也有统计学意义(P<0.05).UbcH10阳性细胞表达率与增殖抗原Ki-67阳性细胞表达率呈显著的正相关关系(r=0.67,P=0.000). 结论 泛素结合酶基因UbcH10可能在星形胶质细胞瘤的发生发展恶变过程中具有重要作用.     

热休克蛋白70对星形细胞瘤凋亡调控的研究

目的 :研究热休克蛋白 70 (HSP70 )在星形细胞瘤 (astrocytoma)中的表达与意义。方法 :采用鼠抗人 HSP70单克隆抗体及免疫组织化学 SABC法。结果 :在 99例星形细胞瘤中 ,HSP70表达 70例 (70 .7% ) ;用于对照的正常脑组织中 ,HSP70阳性仅 1例 (10 % )。HSP70在星形细胞瘤中的表达强于正常对照组 (P<0 .0 5) ,HSP70在 级和 级、 级和 级、 级和 级星形细胞瘤相互之间表达无显著性差异 (P>0 .0 5) ,但在 50例低度恶性星形细胞瘤 (WHO 级～ 级 )中表达强于在49例高度恶性星形细胞瘤 (WHO 级～ 级 )中的表达 (P<0 .0 5)。结论 :HSP70在大部分星形细胞瘤中有不同程度表达 ,HSP70可能参与星形细胞瘤的凋亡调变 ;其表达与星形细胞瘤分化有关     

鞍区毛细胞黏液样星形细胞瘤MRI表现

目的观察发生于鞍区的毛细胞黏液样星形细胞瘤(PMA)的MRI特点。方法回顾性分析经手术病理证实的21例PMA的MRI表现。结果 MRI图像上,21例PMA具有如下特点:肿瘤均呈不规则分叶状,边界清楚,体积较大[最大径29.13~73.25mm,平均(47.52±15.33)mm],肿瘤最长轴多为腹背方向(11/21,52.38%)。MR平扫肿瘤病灶信号多不均匀,T1WI多呈等、低信号(16/21,76.19%),T2WI多呈高信号(21/21,100%),部分内见低信号(13/21,61.90%)。增强扫描肿瘤多为明显不均匀强化(20/21,95.24%),常可见多发微小囊样表现(11/21,52.38%)。21例中,20例发生脑积水,9例发生蛛网膜下腔播散。结论 PMA的MRI表现具有一定的特征性,应用多种MR检查方法,结合患者的年龄及临床表现,有助于其术前诊断。     

脊髓室管膜下瘤与星形细胞瘤的MRI对照

目的 对比观察脊髓室管膜下瘤与星形细胞瘤的MRI表现.方法 回顾性分析12例脊髓室管膜下瘤和30例星形细胞瘤的平扫和增强MRI表现及临床资料,对比分析二者发病年龄、性别分布、病变部位、病变纵轴长度、椎体数目、生长方式、T1WI信号、T2WI信号、有无强化、边界是否清楚、是否有囊变、是否有脊髓空洞、是否有瘤周水肿的差异.结果 脊髓室管膜下瘤与星形细胞瘤发病年龄、性别分布、病变部位、T1WI信号、T2WI信号差异均无统计学意义(P均 >0.05).脊髓室管膜下瘤纵轴长度大于星形细胞瘤(t=3.21,P <0.05),椎体数目亦多于星形细胞瘤(t=2.58,P <0.05);脊髓室管膜下瘤多无强化、呈偏心生长、边界清、无囊变及瘤周水肿,与星形细胞瘤比较差异均有统计学意义χ²=6.43、10.63、15.42、4.67、13.67,P均 <0.05).两种肿瘤脊髓空洞均少见.结论 肿瘤生长方式、边界及瘤周水肿等MRI表现有助于鉴别脊髓室管膜下瘤与星形细胞瘤.