CAJ | 학술논문

目的通过综合分析实体瘤脑膜转移的临床特点、神经影像学表现、脑脊液细胞学检查结果,提高对实体瘤脑膜转移的认识程度,寻找有效的检查方法及诊断策略.方法回顾性分析2009-2014年我院收治的94例恶性实体肿瘤脑膜转移患者临床表现、神经影像学及脑脊液细胞学检查资料;比较不同病理类型脑膜转移患者的临床表现及辅助检查结果,采用卡方检验进行统计学分析.结果患者病理类型分为:腺癌(61例)、小细胞癌(24例)、鳞癌(6例)、大细胞癌(1例)、黑色素瘤(1例)、肝细胞癌(1例);中位年龄58 (37 ～75)岁;中位Karnofsky功能状态评分40 (10～80)分.98.9％(93/94)的患者具有相关神经系统症状.84例患者行影像学检查,敏感度为88.1％(74/84).85例患者行脑脊液细胞学检查,敏感度为88.2％(75/85).85例行脑脊液生化检查,敏感度为90.6％(77/85).腺癌细胞学敏感度(96.6％,56/58)高于小细胞癌(80％,16/20),P=0.056;小细胞癌影像学敏感度(95.8％,23/24)高于腺癌(83.3％,45/52),P=0.409;鳞癌细胞学及影像学敏感度均低,诊断需要综合分析.腺癌及小细胞癌患者的头痛及脊神经症状、室管膜瘤强化及椎管内种植转移发生率分别为88.5％(54/61)及29.2％(7/24),P＜0.01;18.0％(11/61)及45.8％ (11/24),P=0.008;2/6及25.0％ (6/24),P=0.017;1.9％(1/61)及50.0％(12/24),P＜0.01,差异均具有统计学意义.结论神经影像检查及脑脊液检查仍是恶性实体瘤脑膜转移的主要诊断依据.患者的临床特征与原发肿瘤病理类型具有一定相关性.
목적 통과종합분석실체류뇌막전이적림상특점、신경영상학표현、뇌척액세포학검사결과,제고대실체류뇌막전이적인식정도,심조유효적검사방법급진단책략.방법 회고성분석2009-2014년아원수치적94례악성실체종류뇌막전이환자림상표현、신경영상학급뇌척액세포학검사자료;비교불동병리류형뇌막전이환자적림상표현급보조검사결과,채용잡방검험진행통계학분석.결과 환자병리류형분위:선암(61례)、소세포암(24례)、린암(6례)、대세포암(1례)、흑색소류(1례)、간세포암(1례);중위년령58 (37 ～75)세;중위Karnofsky공능상태평분40 (10～80)분.98.9％(93/94)적환자구유상관신경계통증상.84례환자행영상학검사,민감도위88.1％(74/84).85례환자행뇌척액세포학검사,민감도위88.2％(75/85).85례행뇌척액생화검사,민감도위90.6％(77/85).선암세포학민감도(96.6％,56/58)고우소세포암(80％,16/20),P=0.056;소세포암영상학민감도(95.8％,23/24)고우선암(83.3％,45/52),P=0.409;린암세포학급영상학민감도균저,진단수요종합분석.선암급소세포암환자적두통급척신경증상、실관막류강화급추관내충식전이발생솔분별위88.5％(54/61)급29.2％(7/24),P＜0.01;18.0％(11/61)급45.8％ (11/24),P=0.008;2/6급25.0％ (6/24),P=0.017;1.9％(1/61)급50.0％(12/24),P＜0.01,차이균구유통계학의의.결론 신경영상검사급뇌척액검사잉시악성실체류뇌막전이적주요진단의거.환자적림상특정여원발종류병리류형구유일정상관성.
Objective To improve the understanding of leptomeningeal metastasis (LM),we analyzed the data of clinical manifestations,imaging findings and cytological analysis of cerebrospinal fluid (CSF) in a group of patients with LM of malignant solid tumors.Methods The clinical data of 94 patients with LM of malignant solid tumors between 2009 and 2014 in our hospital were retrospectively analyzed.We compared the clinical manifestations and auxiliary examinations of patients with different pathological types of LM.The Chi-square test was used to compare the results.Results The pathological types included adenocarcinoma (61),small cell carcinoma (24),squamous carcinoma (6),melanoma (1),large-cell carcinoma (1),and hepatocellular carcinoma (1).The median age was 58 (37-75) and the median KPS score was 40 (10-80).About 98.9％ (93/94) patients had neurologic symptoms.Neuroimaging examination was performed in 84 patients,with the sensitivity of 88.1％ (74/84);cytological analysis of CSF was performed in 85 patients,with the sensitivity of 88.2％ (75/85);while CSF biochemical examination was performed in 85 patients,with the sensitivity of 90.6％ (77/85).The sensitivity of cytology in adenocarcinoma (96.6％,56/58) was higher than those in small cell carcinoma (80％,16/20;P =0.056).The sensitivity of neuroimaging in small cell carcinoma (95.8％,23/24) was higher than that in adenocarcinoma (83.3％,45/52;P =0.409).However,the sensitivity of cytology (1/5) and neuroimaging (4/6) in squamous carcinoma was low,which led to the need of comprehensive analysis for the diagnosis.The incidence of headache,spinal nerve-related symptoms,ependymal enhancement and metastatic nodules of lumbosacral intraspinal in adenocarcinoma and small cell carcinoma showed statistically significant difference,which was 88.5％ (54/61) and 29.2％ (7/24;P ＜ 0.01),18.0％ (11/61) and 45.8％ (11/24;P =0.008),2/6 and 25.0％ (6/24;P=0.017),1.9％ (1/61)and50.0％ (12/24;P ＜ 0.01),respectively.Conclusions Neuroimaging and CSF examination are still the key points for the diagnosis of LM of malignant solid tumors.The clinical manifestations are correlated with pathological types of primary tumor.