中枢神经系统脱髓鞘假瘤与胶质瘤的鉴别诊断和临床分析

发布时间：2018-02-25 19:17

本文关键词： 脱髓鞘假瘤胶质瘤临床分析鉴别诊断　出处：《临床神经病学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨CNS脱髓鞘假瘤(DPT)的临床特点,并与胶质瘤进行鉴别,以提高对DPT的认识。方法收集均经病理证实的13例DPT和17例胶质瘤患者的临床资料,对比二者之间的临床、影像学、实验室检查及病理特点,并分析DPT的治疗与转归。结果 DPT组平均发病年龄高于胶质瘤组(P0.05)。DPT组女性多见,胶质瘤组无明显性别差异。DPT组急性或亚急性起病(76.9%)常见,胶质瘤组慢性起病常见(70.5%)。DPT组首发症状以头痛(38.4%)多见,胶质瘤组以头痛(41.1%)、痫性发作(23.5%)多见。DPT组影像学部分病灶可见"垂直征"及特异性"开环征",DWI高b值呈高信号,胶质瘤DWI高b值多呈低信号。MRS检查出现特异性β,γ-谷氨酸复合物(Glx)峰升高可与胶质瘤进行鉴别。两组CSF压力、蛋白相比差异有统计学意义(均P0.05)。病理活组织检查出现特异性核分裂状的Creutzfeldt细胞及CD68免疫组化染色阳性有助于两者鉴别诊断。经激素治疗后DPT大部分病灶明显缩小或消失,部分可发展为多发性硬化。结论DPT在临床表现及影像学等方面与胶质瘤相似。影像学检查出现"垂直征"、"开环征"及β,γ-Glx峰升高可能具有特异性,DWI/MRS检查有助于鉴别胶质瘤。激素实验性治疗可能有助于鉴别病变性质,但最终确诊仍需病理结果,部分可发展为多发性硬化。
[Abstract]:Objective to investigate the clinical features of CNS demyelinating pseudotumor and to differentiate it from glioma in order to improve the understanding of DPT. Methods the clinical data of 13 cases of DPT and 17 cases of glioma confirmed by pathology were collected and compared. Results the average age of onset of DPT in DPT group was higher than that in glioma group P0.05. DPT group was more common than that in glioma group, and there was no significant gender difference in glioma group. In the glioma group, the most common symptoms of chronic onset were headache 38.4% in DPT group, 41.1% in glioma group and 23.5% in epileptic seizure group. In the DPT group, "vertical sign" and specific "open loop sign" were found in high signal intensity on DWI. The high b value of DWI in gliomas was low signal. Mrs examination showed specific 尾, 纬 -glutamate complex Glx peak elevation could be distinguished from gliomas. The CSF pressure in the two groups was higher than that in the control group. There was a significant difference in protein between the two groups (all P 0.05). The presence of specific mitotic Creutzfeldt cells and positive CD68 immunohistochemical staining were helpful in differential diagnosis. Most of the lesions of DPT were significantly reduced or disappeared after hormone therapy. Conclusion DPT is similar to glioma in clinical manifestation and imaging. The "open loop sign" and the elevation of 尾, 纬 -Glx peak may be specific for differential diagnosis. Glioma. Experimental hormone therapy may help to differentiate the nature of the lesion, But the final diagnosis still needs pathological results, some of which can develop into multiple sclerosis.
【作者单位】：郑州大学第一附属医院神经内科;河南科技大学第一附属医院肿瘤内科;
【分类号】：R739.4

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