星形胶质细胞瘤术后残留或复发与放射性坏死的临床及MRI表现特点分析

目的 探讨星形胶质细胞瘤（AG）术后残留或复发与放射性坏死的临床及磁共振成像（MRI）特征。方法 搜集1993-2000年间，经手术病理证实的星形胶质细胞瘤54例，其中复发26例，放射性脑坏死5例，无复发者23例。分析复发与病理分级及手术方式的关系。观察复发与放射性坏死的MRI特征。结果 Ⅰ，Ⅱ，Ⅲ-Ⅳ级肿瘤的复发发生率分别为57%，61%，81%，手术方式与复发密切相关，而与复发类型无关；复发与放射性坏死大都发生在术后2年左右，复发性肿瘤在MRI随访中出现占位效应，水肿和明显增强，病灶边界模糊，结节不规则团块状增强。结论 恶性胶质瘤的术后残留或复发与病理分级与手术方式有关；其MRI表现错综复杂，但可以在全同，细致的分析中发现某些规律和特点，MRI增强扫描为一种能客观反映肿瘤术后变化的无创性的检查方法，又是一种能重复性检查鉴别残留或复发与放射性坏死的可行方法。对于评价手术效果和制定下一步治疗方案有着客观，重要的临床意义。

Study on the Specific Feature of Recurrent Astro-glioma and Radiational Necrosis on MRI before and after Therapy

Objective To evaluate the effects of radiotherapy in patients with intracranial glioma by dynamic MRI before and after therapy,and to study the specific feature of recurrent astro-glioma and radiational necrosis on MRI.Methods We compared the MRI change of glioma size,mass effect,edema,recurrent astro-glioma,radiation therapy-induced necrosis of brain and intracranial structure before and after radiotherapy,26 patients of recurrent tumors and 5 patients of radiological necrosis were imaged on CT or MRI and proved by operation and pathology evidences.Twenty-three cases of nourecurrence verfied by clinical couse and follow-up,CT or MRI were taken as control group.Result The findings of postoperative and radiotherapy malignant gliomas on MRI or dynamic contrast MRI were as follows:We found that the operative patients were closely related to the rat of tumor recurrence,but not related to recurrent type which classified as primary type,expandent type,and distant type.Radiological necrosis was found within 2 years of after operation.Recurrent tumor in this study showed post-operative active growing syndrome on CT or MRI;Fingering-like edema could be seen in radiological necrosis.Most recurrent tumors showed nodule ring-like contrast study while map-like enhancement or non-enhanced were consided as specific feature of radiological necrosis.Conclusion The finding of post-operative malignant gliomas on MRI are quit characteristic,and can be used as modality for evaluating the therapeutic effect and drawing up the next plan.It can objectively reflect the change of intracranial malignant gliomas before and after radiotherapy.It is a non-invasion and sensitive method for evaluation of the clinical state.