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MRI诊断中枢神经系统炎性脱髓鞘性假瘤的价值

作者:阎守芳 高 慧 钟文新 张 凯 褚千琨

所属单位:深圳市南山人民医院放射科(广东 深圳 518051)

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摘要

目的分析MRI诊断中枢神经系 统炎性脱髓鞘性假瘤的价值。方法 通过 数字表法选取2015年2月-2017年4月期间 本院就诊中枢神经系统炎性脱髓鞘性假 瘤诊断检查患者50例为本次探究对象, 探究分析MRI诊断的MRI影像表现及其诊 断价值。结果 4.00%的患者为DWI弥散轻 度受限或边缘受限、18.00%的患者为不均 匀长T1长T2信号、等T1长T2信号、52.00% 的患者病变信号为均匀长T1长T2;结果 表明,单发局限性肿块在病变形态中占 40.00%。病变周围水肿以及伴有多发病变 分别占26.00%,18.00%;大脑半球在病变 部位中占比最大,为58.00%,均大于其他 病变部位;增强扫描所见的26例患者中, 有34.00%的患者为半环形强化,结节状强 化、环形强化、不规则斑片状强化分别占 比为8.00%,4.00%,6.00%。以上差异在 统计学上有意义(P<0.05);本组患者共4 例被误诊为为胶质瘤,占比8.00%,具有 较低的误诊率,诊断效果良好。结论 中 枢神经系统炎性脱髓鞘性假瘤的诊断对于 指导疾病治疗具有重要意义,MRI具有较 高的可靠性,为疾病的有效治疗提供相对 可靠的依据,应用价值显著,可进行进一 步的推广应用。

Objective To investigate and analyze the value of MRI in the diagnosis of inflammatory demyelinating pseudotumor of the central nervous system. Methods A total of 50 cases of central nervous system inflammatory demyelinating pseudotumor diagnosed in our hospital during February 2015-2017 April were selected by the digital table method as the objects, to explore the MRI manifestations and diagnostic value of MRI diagnosis. Results A total of 4% of patients with DWI diffusion limited or restricted, mild edge in 18% of the patients were non-uniform long T1 long T2 signals and equal T1 long T2 signals. 52% of the patients had homogeneous T1 and long T2 signal. The lesion edema and with multiple lesions accounted for 26%, 18%, cerebral hemisphere lesion in the largest proportion, 58% were higher than that of other lesions. 26 cases of enhanced scan findings in patients, 34% had semi annular enhancement, nodular enhancement, ring enhancement, irregular spot patchy enhancement were accounted for 8%, 4%, 6%. The above differences were statistically significant (P<0.05). In this group, 2 cases were misdiagnosed as glioma, accounting for 4%, which had a lower rate of misdiagnosis, and the diagnosis was satisfactory. Conclusion The diagnosis of inflammatory demyelinating pseudotumor of the central nervous system is of great significance in guiding the treatment of diseases. MRI has high reliability, and provides reliable evidence for effective treatment of diseases. It has significant application value and can be further applied.

【关键词】中枢神经系统;脱髓鞘性假瘤;MRI诊断

【中图分类号】R445.2;R745.4

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.09.019

前言

中枢神经系统脱髓鞘假瘤是一种发生于脑部或脊髓内的特定疾 病,这一疾病的主要病理特征为神经纤维的髓鞘破坏、脱失,这类疾 病常常发病于青壮年,临床上的发病病因各异,病症表现也不完全相 同[1]。中枢神经系统脱髓鞘假瘤并不是在脑内形成肿瘤肿块,由于病 变较大、最大处有两厘米,并且周边组织具有与肿瘤相似的表现,导 致和中枢神经系统胶质瘤很难区分[2]。大部分患者患病后的症状有眩 晕,四肢乏力,上呼吸道感染,头痛等主要病症,与脑部肿瘤疾病的 临床表现相似,常常会造成误诊,进行脑部肿瘤的切除手术,但是手 术后不仅不会改善患者的病情,反而会延误其最佳治疗时间[3-4]。因 此,中枢神经系统炎性脱髓鞘性假瘤的准确诊断是非常必要的,为提 高对脱髓鞘假瘤的诊断水平,避免由于误诊和手术而导致的不可逆性 损伤[5],特选取本院2015年2月-2017年4月期间来本院就诊,并诊断为 中枢神经系统炎性脱髓鞘性假瘤患者50例为本次探究对象,现汇报如 下。