摘要
目的 进一步了解高级别脑胶质瘤脑膜转移患者的临床特征，以帮助临床诊断。方法 回顾2010年7月至2015年9月吉林大学第一医院放疗科诊断的16例WHO分类Ⅲ～Ⅳ级脑胶质瘤发生脑膜转移的患者。病理类型包括间变星形细胞瘤（1），间变少突星形细胞瘤（1），胶质母细胞瘤（12），小细胞胶质母细胞瘤（1），胶质肉瘤（1）。回顾其相关临床特征，进一步比较同期收治的163例系统性肿瘤脑膜转移患者的主要临床表现。结果 初始肿瘤诊断距脑膜转移中位时间为13个月（2～19个月）。全部患者行MRI检查，特征性影像学表现包括室管膜强化（11）、柔脑膜强化（3）、椎管内种植性转移结节（1）、颅神经强化（2）、脑室扩张（1）。8例患者行脑脊液检查。15/16患者诊断主要依据神经影像学检查。与同期收治的系统性肿瘤脑膜转移患者相比，脑胶质瘤脑膜转移患者头痛发生率较低（分别为6/16、81.6%（133/163）；χ2＝16.3，P〈0.01），颅神经症状发生率亦较低[分别为4/16、56.4%（92/163）; χ2＝5.79，P＝0.016 1]，脊神经症状发生率低，但差异无统计学意义[分别为2/16、26.4%（43/163）；χ2＝1.49，P＝0.222]。9例患者分别接受替莫唑胺化疗，鞘注化疗或鞘注化疗联合全脑放射治疗。中位生存期4.5个月（0.7～13.3个月）。结论 影像学检查在高级别脑胶质瘤脑膜转移的诊断中具有重要意义；胶质瘤脑膜转移较系统性肿瘤脑膜转移，具有相对独特的临床特点。
Objective To further understand the clinical manifestations and improve clinical diagnosis of patients with leptomeningeal metastasizing high-grade glioma. Methods Sixteen patients with leptomeningeal metastasizing high-grade glioma （WHO classification： grade ]lI - IV ） in Department of Radiotherapy, the First Hospital of Jilin University from July 2010 to September 2015 were respectively analyzed. The pathological types included anaplastic gliomas （1）, anaplastic oligodenastrocytoma （1）, gfioblastoma （ 12 ）, small-cell glioblastoma （ 1 ）, gliosarcoma （ 1 ） . We reviewed the relative clinical manifestations of the patients, and further compared them with 163 patients with systemic malignant solid tumors at corresponding period. Results The median time from initial diagnosis to the diagnosis of leptomeningeal metastasis was 13.0 months （range 2 -19 months）. Plain and enhanced magnetic resonance imaging was obtained in all patients. The main radiographic characteristics included ependymaJ enhancement （ 11 ）, leptomeningeal enhancement （ 3 ）, nodules of implantation metastasis in spinal canal （ 1 ）, cranial nerve enhancement （2）, and ventricular dilatation （1）. Eight patients received cerebrospinal fluid examination. The diagnosis of leptomeningeal metastasis in 15/16 patients was determined by radiographic findings. Comparing with leptomeningeal metastasis from systemic malignant tumors at the corresponding period, the incidence of headache in patients with high-grade glioma was significantly lower （6/16 vs 81.6% （133/163） ; X2 = 16. 3, P 〈0. O1 ） ; and the incidence of cranial nerve paralysis was also significantly lower （4/16 vs 56. 4% （92/163）; X2 =5. 79, P =0. 016 1 ）. The incidence of nerve root symptoms was lower than that of systemic malignant tumors, though without statistically significant difference （ 2/16 vs 26. 4% （43/163） ; X2 -- 1.49, P = 0. 222） . Nine patients respectively received chemotherapy, intrathecal chemotherapy or i
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2016年第8期625-629,共5页
Chinese Journal of Neurology
关键词
高级别脑胶质瘤
复发
脑膜转移
诊断
鉴别
治疗
High grade glioma
Recurrence
Leptomeningeal metastasis
Diagnosis,differential
Treatment
