CAJ | 학술논문

目的探讨磁共振成像(MRI)在恶性实体肿瘤脑膜转移诊断及治疗中的价值.方法对63例恶性实体肿瘤脑膜转移患者的影像学特点、临床、治疗及随访资料进行回顾性分析.结果全部患者接受头部MRI检查,26例患者行颈或腰椎MRI检查,表现为脑沟回内结节样强化、脑脊膜线性强化、硬膜增厚强化、室管膜强化、脑室内转移、椎管内转移结节、交通性脑积液、硬膜下积液、影像学阴性.发生室管膜强化、脑室内转移及椎管内种植转移的小细胞癌患者分别为5、7及9例,多于其他病理类型(P=0.002、P=0.009、P＜ 0.000 1).7例患者鞘内注射化疗后出现癫痫发作,其中5例影像学表现为软脑膜线性强化.33例接受放疗联合鞘内注射化疗综合治疗的患者中3例预后极差,其中2例影像学表现阴性.25例患者治疗后症状明显缓解,其中21例复查头部MRI,影像学缓解程度不一.结论 MRI增强扫描对恶性实体肿瘤脯膜转移患者诊断有重要辅助作用.磁共振表现及临床特点与病理类型具有相关性.影像学表现为软脑膜线性强化型的患者鞘内注射化疗后癫痫发作可能性大,可考虑给予相关预防治疗.MRI不适用于疾病严重程度与预后判断及疗效评估.
목적 탐토자공진성상(MRI)재악성실체종류뇌막전이진단급치료중적개치.방법 대63례악성실체종류뇌막전이환자적영상학특점、림상、치료급수방자료진행회고성분석.결과 전부환자접수두부MRI검사,26례환자행경혹요추MRI검사,표현위뇌구회내결절양강화、뇌척막선성강화、경막증후강화、실관막강화、뇌실내전이、추관내전이결절、교통성뇌적액、경막하적액、영상학음성.발생실관막강화、뇌실내전이급추관내충식전이적소세포암환자분별위5、7급9례,다우기타병리류형(P=0.002、P=0.009、P＜ 0.000 1).7례환자초내주사화료후출현전간발작,기중5례영상학표현위연뇌막선성강화.33례접수방료연합초내주사화료종합치료적환자중3례예후겁차,기중2례영상학표현음성.25례환자치료후증상명현완해,기중21례복사두부MRI,영상학완해정도불일.결론 MRI증강소묘대악성실체종류포막전이환자진단유중요보조작용.자공진표현급림상특점여병리류형구유상관성.영상학표현위연뇌막선성강화형적환자초내주사화료후전간발작가능성대,가고필급여상관예방치료.MRI불괄용우질병엄중정도여예후판단급료효평고.
Objective To investigate the value of application of magnetic resonance imaging (MRI) in diagnosis and treatment of leptomeningeal metastases from malignant solid tumors.Methods A retrospective analysis was conducted depend on the radiological data of 63 patients who had been diagnosed as leptomeningcal metastasis of malignant solid tumors.Results All patients received brain MRI examination.26 patients underwent cervical or lumbar spine MRI examination.The MRI images showed nodular enhancement in the gyri and sulci,leptomeningeal linear enhancement,dura mater thickening and enhancement,ependymal enhancement,intraventricular metastasis,intraspinal metastatic nodules,communicating hydrocephalus,subdural hydroma and negative imaging.Ncuroimages of ependymal enhancenent,intraventricular metastasis and intraspinal implantation metastasis appeared in 5,7 and 9 patients with small cell carcinoma,respectively,which were higher than that of the other pathological types (P =0.002,P =0.009,P ＜ 0.000 1).Seizure occurred in 7 patients after intrathecal chemotherapy,of which 5 patients had pia mater linear enhancement.Among 33 patients treated with radiotherapy combined with intrathecal chemotherapy,3 patients had poor prognosis,of which 2 patients had negative imaging findings.The conditions of 25 patients were improved obviously after treatment,of which 21 patients showed different imaging remission in MRI re-examination.Conclusions The contrast MRI has an important assistant effect in diagnosis of leptomeningeal metastasis of malignant solid tumors.The MRI findings and clinical features are related with the pathological types.The pia mater linear enhancement indicates a high possibility of seizures after inthathecal chemotherapy,and it suggests that the preventive treatment should be given for such patients.MRI is not applicable to evaluate severity,prognosis and curative effect of the disease.