CAJ | 학술논문

目的探讨颅内多发病变的临床病理学特征。方法对2005年1月至2009年12月期间在首都医科大学宣武医院接受治疗病例中，影像学上为颅内多发病变的62例患者的临床、影像以及病理学资料进行回顾性分析。结果 62例中男32例，女30例，平均发病年龄37.4岁，平均病程11.6个月。病灶可累及大脑半球各叶、基底节区、脑干和小脑等部位，以幕上受累较为多见。病理检查结果为：胶质瘤13例，转移瘤13例，中枢神经系统感染12例，免疫介导的炎性脱髓鞘病8例，中枢神经系统原发淋巴瘤5例，血管炎3例，线粒体脑病2例，静脉窦血栓形成2例，Rosai-Dorfman病2例，放射性脑病2例。其中，线粒体脑病、静脉窦血栓形成以皮层受累为主，转移瘤和血源性感染主要累及灰白质交界区，胶质瘤、脱髓鞘疾病和放射性脑病以白质病变为主，血管炎表现为皮层和皮层下白质的病变。结论多种肿瘤和非肿瘤性疾病在影像学上可以表现为颅内多发病变，其中以胶质瘤、转移瘤和中枢神经系统感染较为多见。积极开展颅内多发病变脑组织活检，临床、影像与病理学密切结合，是提高颅内多发病变诊断水平行之有效的方法。
목적 탐토로내다발병변적림상병이학특정。방법 대2005년1월지2009년12월기간재수도의과대학선무의원접수치료병례중，영상학상위로내다발병변적62례환자적림상、영상이급병이학자료진행회고성분석。결과 62례중남32례，녀30례，평균발병년령37.4세，평균병정11.6개월。병조가루급대뇌반구각협、기저절구、뇌간화소뇌등부위，이막상수루교위다견。병리검사결과위：효질류13례，전이류13례，중추신경계통감염12례，면역개도적염성탈수초병8례，중추신경계통원발림파류5례，혈관염3례，선립체뇌병2례，정맥두혈전형성2례，Rosai-Dorfman병2례，방사성뇌병2례。기중，선립체뇌병、정맥두혈전형성이피층수루위주，전이류화혈원성감염주요루급회백질교계구，효질류、탈수초질병화방사성뇌병이백질병변위주，혈관염표현위피층화피층하백질적병변。결론 다충종류화비종류성질병재영상학상가이표현위로내다발병변，기중이효질류、전이류화중추신경계통감염교위다견。적겁개전로내다발병변뇌조직활검，림상、영상여병이학밀절결합，시제고로내다발병변진단수평행지유효적방법。
Objective To study the clinicalpathologic features of intracranial multiple lesions.Methods The clinical, radiologic and pathologic features of intracranial multiple lesions in 62 cases during the period from 2005 to 2009 in Xuanwu Hospital were retrospectively reviewed. Results There were 32males and 30 females in 62 cases. The mean age of seize onset and duration of disease were 37.4-year-old and 11.6 months, respectively. The lesions could affect cerebral hemisphere, basal ganglia, brain stem,cerebellum and other parts, most lesions were located above the tentorium. Pathological diagnosis as follows:13 patients with glioma; metastatic tumors in 13 cases; 12 cases of central nervous system infection;immune-mediated inflammatory demyelinating disease in 8 cases; 5 cases of primary lymphoma of central nervous system; primary angiitis of the central nervous system 3 cases; mitochondrial encephalopathy 2 cases; vein thrombosis in 2 cases; Rosai-Dorfman disease in 2 cases; 2 case of radiation encephalopathy. Among them, mitochondrial encephalopathy and vein thrombosis lesions located in the cortex; metastatic tumor and blood-bome infection mainly involving junction of grey and white matter; glioma, radiation encephalopathy and demyelinating disease include white matter lesions; vascular inflammation showed cortical and subcortical white matter lesions. Conclusions A variety of tumor and non-neoplastic diseases can be expressed in intracranial multiple lesions, which gliomas, metastatic tumor and central nervous system infections are more common. In order to improve the diagnosis of intracranial multiple lesions, active work in the brian biopsy, study the clinical, imaging and pathological findings must be closely.