CAJ | 학술논문

目的白血病颅脑并发症严重影响患儿的治疗和生存质量.本文探讨白血病儿童化疗前后颅脑并发症的差异及MRI表现,指导临床治疗.资料与方法回顾性分析37例白血病颅脑并发症患儿的临床及MRI资料,34例行2次以上MRI检查,其中28例行增强扫描.结果 22例化疗前发生并发症,2例存在2种并发症:脑膜浸润7例,表现为脑膜广泛或局限性增厚,其中5例化疗后减轻或消失;颅内多发小、微出血灶7例,其中2例合并血肿;肿块3例,均为颞骨肿块,1例合并颞叶肿块,1例化疗后肿块消失;脑白质病变及硬膜下积液各2例,真菌感染、脑膜脑实质浸润及脑梗死各1例.17例化疗后发生并发症,2例化疗前后存在不同并发症, 8例存在2种以上并发症:脑萎缩13例;脑白质病变9例,表现为双侧脑室旁和(或)半卵圆中心脑白质对称性长T2信号,其中4例停药后减轻或消失;感染性病变3例,其中病毒性脑炎2例,结核性脑膜炎并结核瘤1例;肿块2例,确诊静脉窦血栓及可复性后部脑病综合征各1例.结论儿童白血病颅脑并发症MRI征象多样,化疗前后存在明显差异,化疗前并发症主要为脑膜浸润及颅内出血,化疗后并发症主要为脑萎缩、脑白质病变及感染性病变.MRI检查对白血病并发症的诊断、进展及疗效观察有重要价值.
목적 백혈병로뇌병발증엄중영향환인적치료화생존질량.본문탐토백혈병인동화료전후로뇌병발증적차이급MRI표현,지도림상치료.자료여방법 회고성분석37례백혈병로뇌병발증환인적림상급MRI자료,34례행2차이상MRI검사,기중28례행증강소묘.결과 22례화료전발생병발증,2례존재2충병발증:뇌막침윤7례,표현위뇌막엄범혹국한성증후,기중5례화료후감경혹소실;로내다발소、미출혈조7례,기중2례합병혈종;종괴3례,균위섭골종괴,1례합병섭협종괴,1례화료후종괴소실;뇌백질병변급경막하적액각2례,진균감염、뇌막뇌실질침윤급뇌경사각1례.17례화료후발생병발증,2례화료전후존재불동병발증, 8례존재2충이상병발증:뇌위축13례;뇌백질병변9례,표현위쌍측뇌실방화(혹)반란원중심뇌백질대칭성장T2신호,기중4례정약후감경혹소실;감염성병변3례,기중병독성뇌염2례,결핵성뇌막염병결핵류1례;종괴2례,학진정맥두혈전급가복성후부뇌병종합정각1례.결론 인동백혈병로뇌병발증MRI정상다양,화료전후존재명현차이,화료전병발증주요위뇌막침윤급로내출혈,화료후병발증주요위뇌위축、뇌백질병변급감염성병변.MRI검사대백혈병병발증적진단、진전급료효관찰유중요개치.
Purpose Brain complications severely threaten the treatment and survival of children with leukemia. This paper aims to investigate the MRI manifestations and differences of brain complications in leukemia before and after chemotherapy for a clinical guidance.Materials and Methods The clinical data and MRI findings of 37 children with leukemia and brain complications were retrospectively analyzed. Thirty-four of them underwent MRI scan twice or more, among whom 28 received contrast-enhanced MRI scan.Results Twenty-two patients were discovered with brain complications before chemotherapy, 2 of whom were with two kinds of complications. Meningopathy was found in 7 patients who showed widespread or localized meningeal thickening. Among them, 5 patients'' lesions reduced or disappeared after chemotherapy. Intracerebral multiple small and micro bleed was found in these 7 patients, 2 of them combined with hematoma. Three patients were found with intracranial tumor which all proved to be temporal bone tumor, 1 of whom combined with temporal lobe tumor and 1 had tumor disappeared after chemotherapy. The other complications before chemotherapy included leukoencephalopathy (n=2), subdural collection of fluid (n=2), meninges and parenchymal infiltration of leukemia (n=1), fungal infection (n=1) and cerebral infarction (n=1). On the contrary, 17 patients were discovered with brain complications after chemotherapy, 8 of whom were with two or more complications. Two patients had different kinds of complications before and after chemotherapy. Brain atrophy was observed in 13 patients. Leukoenphalopathy was found in 9 patients who presented high signal in white matter of double periventricular and/or semi-oval center on T2WI; the lesions of 4 patients were reduced or disappeared after withdrawal. Infectious diseases were diagnosed in 3 patients, including viral encephalitis in 2 cases, tuberculous meningitis combined with tuberculoma in 1 case. The other complications included intracranial tumor (n=2), sinus thrombosis (n=1), posterior reversible encephalopathy syndrome (n=1) after chemotherapy. Conclusion The MRI findings of brain complications in childhood leukemia are various and demonstrate significantly different features before and after chemotherapy. The major complications before treatment include meningopathy and intra-cerebral hemorrhage;while after chemotherapy the main complications are brain atrophy, leukoencephalopathy and infectious diseases. MRI proves to be a valuable method to detect, observe and follow up these complications.