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弥漫性中线胶质瘤伴H3K27M突变的磁共振成像特征及其表观弥散系数的定量研究 被引量:4

Magnetic resonance imaging features and apparent diffusion coefficient of diffuse midline gliomas with H3K27M mutation
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摘要 目的分析伴H3K27M突变的弥漫性中线胶质瘤的磁共振成像(MRI)特征,并定量分析肿瘤表观弥散系数(ADC)值的变化情况。方法回顾性分析于2017年4月至2019年11月在青岛大学附属医院行手术治疗的14例弥漫性中线胶质瘤伴H3K27M突变患者的MRI图像,观察其病灶的部位、边缘、信号、瘤周水肿及强化特点,并分析其ADC值的变化特点。结果在14例患者中,肿瘤主体位于丘脑4例,脑桥6例,延髓2例,脊髓2例。7例肿瘤仅局限于中线区,其中6例边界清楚;7例肿瘤主体位于中线区,但同时向非中线区浸润,其中6例边界不清。6例肿瘤位于脑桥的患者均出现基底动脉包绕征。5例患者的肿块内见多发较大囊变,4例肿块内见多发小囊变,5例无囊变。7例累及非中线区的肿瘤均出现囊变,其中6例囊变区仅位于非中线区域;7例局限于中线区的肿瘤只有2例出现小囊变。4例肿瘤内部伴出血。增强扫描后5例患者的肿瘤为轻度不均匀强化,6例中度不均匀强化,2例明显强化,1例无强化。9例患者的肿瘤周围无水肿,5例有轻度水肿,平均水肿指数为1.13。12例患者肿瘤实质的ADC值为(7.83±0.88)×10^(-4) mm^(2)/s,而对侧及周围正常脑组织的ADC值为(9.28±0.69)×10^(-4) mm^(2)/s,差异有统计学意义(t=-6.336,P<0.05)。结论伴H3K27M突变的弥漫性中线胶质瘤发病年龄较小,肿瘤好发于丘脑、脑干、脊髓等部位,瘤周水肿多数较轻或无水肿。局限于中线区的肿块多形态规则,边界清楚,累及非中线区的肿块易囊变坏死。位于脑桥的伴H3K27M突变的弥漫性中线胶质瘤易出现基底动脉包绕征。ADC值可以为肿瘤的术前分级提供一定的定量依据。 Objective To analyze the magnetic resonance imaging(MRI)features of diffuse midline gliomas with H3K27M mutation,and to quantitatively analyze the changes of apparent diffusion coefficient(ADC).Methods The MRI images of 14 cases of diffuse midline gliomas with H3K27M mutation were retrospectively analyzed in the Affiliated Hospital of Qingdao University from April 2017 to November 2019.The location,edge,signal,peritumoral edema and enhancement characteristics of the lesions were observed,and the changes of ADC values were analyzed.Results The tumors were located in thalamus in four cases,pons in six cases,medulla oblongata in two cases and spinal cord in two cases.In seven cases,the tumor was confined to the midline region,of which six cases had clear boundary,seven cases were located in the midline area,but infiltrated into the non midline area at the same time,and six cases had unclear boundary.Basilar artery entrapment was found in all six patients located in pons.Multiple large cystic changes were found in five cases,multiple small cysts in four cases and no cystic changes in five cases.Cystic changes were found in all seven cases of tumors involving the non midline region,of which six cases were located only in the non midline region,and only two of the seven tumors localized in the midline region had small cysts.Hemorrhage was found in four cases.Five cases showed mild heterogeneous enhancement,six cases showed moderate heterogeneous enhancement,two cases showed obvious enhancement,and one case showed no enhancement.There was no edema around the tumor in nine cases and mild edema in five cases.The average edema index was 1.13.The average ADC value of tumor parenchyma in 12 patients was(7.83±0.88)×10^(-4) mm^(2)/s,which was 15.6%lower than that of the contralateral side[(9.28±0.69)×10^(-4) mm^(2)/s,t=-6.336,P<0.05].Conclusions Diffuse midline gliomas with H3K27M mutation have a younger onset age and are more likely to occur in thalamus,brainstem and spinal cord.Most of the tumors have no peritumoral edem
作者 赵继平 王家臣 崔春晓 马文帅 刘学军 刘芳 Zhao Jiping;Wang Jiachen;Cui Chunxiao;Ma Wenshuai;Liu Xuejun;Liu Fang(Department of Radiology,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)
出处 《中华神经科杂志》 CAS CSCD 北大核心 2021年第4期376-383,共8页 Chinese Journal of Neurology
关键词 胶质瘤 磁共振成像 突变 Glioma Magnetic resonance imaging Mutation
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