MRI评价乳腺癌脑膜转移

目的探讨乳腺癌脑膜转移的MRI表现特点及转移途径。方法回顾性分析21例经临床病理证实的乳腺癌脑膜转移患者的临床及MRI资料。结果 MRI表现:平扫仅3例表现为条片状或结节状异常信号。增强后18例表现为硬脑膜-蛛网膜型,3例为软脑膜-蛛网膜型。12例伴有颅骨骨质破坏,6例伴有脑内转移。乳腺癌脑膜转移途径:11例经邻近颅骨转移灶直接侵犯邻近硬脑膜;5例脑实质表浅部位的转移瘤侵犯邻近硬脑膜;4例经血行直接转移至硬脑膜和(或)柔脑膜,1例经血行转移至脑脊液后播散至柔脑膜。结论 MR增强扫描是乳腺癌脑膜转移的重要检查方法。经颅骨转移瘤侵犯邻近硬脑膜是乳腺癌脑膜转移的主要途径和特点。

MR imaging in evaluation on meningeal metastases from breast cancer

Objective To observe MRI features and metastatic routes of meningeal metastases from breast cancer. Methods Twenty-one patients with meningeal metastases confirmed by clinical data and (or) pathology were retrospectively analyzed. Results Flake or meningeal nodules were found in 3 cases on plain MRI. After enhancement, dura-arachnoid enhancement was found in 18 cases, and pia-subarachnoid space enhancement was found in 3 cases. Of 21 patients, skull destruction was found in 12 cases and cerebral metastasis were found in 6 cases. There were four main routes for meningeal involvment of breast cancer: Through adjacent bony metastasis directly involving dura mater (n=11), through cerebral metastasis directly involving dura mater (n=5), though hematogenous metastasis to dura mater and (or) leptomeninx (n=4), while through cerebrospinal fluid spreading to leptomeninx (n=1). Conclusion Contrast-enhanced MR is an important tool for detecting meningeal metastases. Direct involvement of dura mater from adjacent bony metastasis is the main route of meningeal metastasis from breast cancer.