常见恶性肿瘤颅内转移的MRI征象分析

发布时间：2018-04-19 07:27

  本文选题：磁共振成像 + 增强扫描　； 参考：《内蒙古医科大学》2014年硕士论文

【摘要】：目的颅脑是各种恶性肿瘤常见的转移部位之一,如能及早发现并选择合理的治疗方案,就可以最大限度的延长患者生命,提高生存质量。而对于不同原发肿瘤的颅内转移,临床治疗方案的选择有所不同。一些很难通过穿刺活检确定原发肿瘤类型以及部分先于原发肿瘤发现的脑转移瘤患者,若能通过脑转移瘤的影像学表现推断出原发肿瘤的类型,就可以对临床治疗方案的选择提供一定的指导作用。本文收集从2011年6月~2013年7月行MRI检查、经临床确诊为脑转移瘤且已明确原发肿瘤类型的病例210例,回顾性分析其MRI的特征性表现。材料及方法收集内蒙古医科大学附属医院2011年6月~2013年7月间行MRI检查、经临床确诊为脑转移瘤且已明确原发肿瘤类型的病例210例。将颅内转移常见的原发肿瘤进行分组(不包括病例总数≤4的原发肿瘤),分为肺腺癌64例,肺小细胞癌60例,肺鳞癌27例,乳腺癌19例,结直肠癌15例。所有患者均接受MRI平扫及增强扫描,并由两位长期从事MRI诊断的资深副主任或以上医师双盲读片并结合临床、病理结果取得一致意见后获得MRI结果。记录常见恶性肿瘤颅内转移的数目、大小、发生部位、信号特点、强化方式及瘤周水肿程度等,并绘制表格。统计学方法采用SPSS13.0软件,χ2检验的统计学方法,以P0.05为有统计学意义。结果MRI扫描中,肺癌、乳癌等常见恶性肿瘤颅内转移多表现为长T1、长T2信号,结直肠癌转移灶中有20个(71.4%)呈混杂/短T2信号,DWI上170个(69.4%)转移灶边界清楚。颅内转移的数目、大小、强化形态、瘤周水肿均与原发肿瘤相关(P0.05)。45例(70.3%)肺腺癌脑转移、33例(55.0%)肺小细胞癌及15例(78.9%)乳腺癌,MRI表现以多发转移灶居多;16例(59.3%)肺鳞癌以单发转移灶居多。72个(57.1%)肺小细胞癌的转移灶为Ⅱ型大小,22个(59.5%)肺鳞癌的转移灶为Ⅰ型大小;肺鳞癌有27个(72.9%)转移灶为环形强化;18个(48.6%)肺鳞癌转移灶的瘤周水肿为轻度,重度水肿中有21个(52.5%)转移灶为肺腺癌。颅内转移病灶的分布与原发肿瘤无关,但与颅内血供分布有关,以幕上病灶288个居多(占79.3%),多分布于额、顶、颞叶,幕下为61个,小脑半球占90.2%(55/61)。结论不同恶性肿瘤颅内转移可有不同的MRI特征;MRI平扫、增强及DWI综合运用对脑转移瘤的诊断及鉴别有重要价值。
[Abstract]:Objective craniocerebral brain is one of the most common metastatic sites in malignant tumors. If we can find and choose reasonable treatment plan early, we can prolong the life of patients and improve the quality of life.For different primary tumors, the choice of clinical treatment is different.It is difficult to determine the type of primary tumor by puncture biopsy and some patients with brain metastases found before the primary tumor, if the type of primary tumor can be inferred from the imaging findings of brain metastases.It can provide some guidance to the choice of clinical treatment plan.From June 2011 to July 2013, 210 cases with brain metastases diagnosed as brain metastases and whose types of primary tumors have been confirmed by MRI were collected and analyzed retrospectively the characteristic features of MRI.Materials and methods 210 cases of brain metastases confirmed by MRI from June 2011 to July 2013 in affiliated Hospital of Inner Mongolia Medical University were collected.The primary tumors with common intracranial metastasis (excluding the total number of cases 鈮，

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