脑多形性黄色星形细胞瘤8例临床、病理、MRI特征及文献复习
Pleomorphic xanthoastrocytoma:the features of clinic, pathology and MRI in 8 cases and literature review
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摘要: 目的: 提高对脑多形性黄色星形细胞瘤(PXA)临床、病理及MRI特征的认识.方法: 回顾性分析8例PXA的MRI表现并复习相关文献,8例脑PXA均经病理证实,均行MRI平扫、增强扫描及扩散加权成像,2例行多体素磁共振波谱(TE135ms)和灌注加权成像检查.结果: 8例PXA年龄14~56岁,25岁以下者6例.伴间变特征者2例.7例单发,1例伴间变特征者为单发肿块伴周围子灶.5例发生或累及颞叶,6例位于皮层及皮层下.MRI表现5例呈囊实性,3例呈实性,1例伴局部软脑膜受侵,1例伴出血及室管膜受侵(伴间变特征),1例伴侧脑室播散(伴间变特征).肿瘤实性区均呈明显强化的稍长T1稍长T2信号,扩散加权成像呈等或稍高信号,表观扩散系数值与正常皮层下脑白质差异无统计学意义(P>0.05).2例囊实性者囊壁强化.所有肿瘤周围均有轻到中度水肿.2例肿瘤实性区呈高灌注,胆碱峰明显升高,N-乙酰天门冬氨酸峰明显下降,多见乳酸峰.结论: PXA好发于青少年,多发生于幕上脑浅部,多位于颞叶,其病理学及遗传学特征有别于其他星形细胞瘤,肿瘤全切是预后的主要保证.PXA的常规MRI、磁共振灌注加权成像和磁共振波谱具有一定特点.Abstract: Objective: To analyze the MRI features of brain pleomorphic xanthoastrocytomas(PXA) in 8 cases for improving its clinical,pathological and MRI features understanding.Methods: The MRI plain scans,enhanced scans and DWI were explored in 8 cases with brain PXA diagnosed by pathology,and the MRS combined with PWI were examined in 2 cases.Results: Three patients were male and 5 patients were female,the age of all patients ranged from 14 to 56 years old(including 6 patients less than 25 years old).Interstitial change in 2 cases were found.Single lesion in 7 cases and single lesion complicated with round multiple lesions in 1 case with interstitial change were found.Five cases located or involved in temporal lobe,6 cases located in the cortex and subcortical region.Solid-cystic tumors in 5 cases and solid tumors in 3 cases(including 1 case with partial pia mater invasion,1 case with bleeding and ependymal invasion and 1 case with lateral ventricle spread) were identified by MRI.The tumor solid area showed slightly hypointense on T1-weighted images,slightly hyperintense on T2-weighted images and marked enhancement.The difference between the apparent diffusion coefficient value and subcortex alba was not statistical significance(P>0.05).The solid-cystic capsule wall enhanced in 2 cases.The light to moderate degree edema around the tumor were detected in all tumors.The significant increasing Cho peak and decreasing N-acetyl aspartic acid peak and Lip peak were found in tumor solid area with high perfusion.Conclusions: PXA occurres usually in adolescent,which locates the brain shallow position of the temporal lobe.The tumor pathologic and genetic characteristics are different from other astrocytomas,complete surgical excision is important for a good prognosis.The conventional magnetic resonance imaging,magnetic resonance perfusion weighted imaging and magnetic resonance spectroscopy of PXA have certain characteristics.