本文選題：磁共振成像 + 增強(qiáng)掃描　； 參考：《內(nèi)蒙古醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的顱腦是各種惡性腫瘤常見(jiàn)的轉(zhuǎn)移部位之一,如能及早發(fā)現(xiàn)并選擇合理的治療方案,就可以最大限度的延長(zhǎng)患者生命,提高生存質(zhì)量。而對(duì)于不同原發(fā)腫瘤的顱內(nèi)轉(zhuǎn)移,臨床治療方案的選擇有所不同。一些很難通過(guò)穿刺活檢確定原發(fā)腫瘤類型以及部分先于原發(fā)腫瘤發(fā)現(xiàn)的腦轉(zhuǎn)移瘤患者,若能通過(guò)腦轉(zhuǎn)移瘤的影像學(xué)表現(xiàn)推斷出原發(fā)腫瘤的類型,就可以對(duì)臨床治療方案的選擇提供一定的指導(dǎo)作用。本文收集從2011年6月~2013年7月行MRI檢查、經(jīng)臨床確診為腦轉(zhuǎn)移瘤且已明確原發(fā)腫瘤類型的病例210例,回顧性分析其MRI的特征性表現(xiàn)。材料及方法收集內(nèi)蒙古醫(yī)科大學(xué)附屬醫(yī)院2011年6月~2013年7月間行MRI檢查、經(jīng)臨床確診為腦轉(zhuǎn)移瘤且已明確原發(fā)腫瘤類型的病例210例。將顱內(nèi)轉(zhuǎn)移常見(jiàn)的原發(fā)腫瘤進(jìn)行分組(不包括病例總數(shù)≤4的原發(fā)腫瘤),分為肺腺癌64例,肺小細(xì)胞癌60例,肺鱗癌27例,乳腺癌19例,結(jié)直腸癌15例。所有患者均接受MRI平掃及增強(qiáng)掃描,并由兩位長(zhǎng)期從事MRI診斷的資深副主任或以上醫(yī)師雙盲讀片并結(jié)合臨床、病理結(jié)果取得一致意見(jiàn)后獲得MRI結(jié)果。記錄常見(jiàn)惡性腫瘤顱內(nèi)轉(zhuǎn)移的數(shù)目、大小、發(fā)生部位、信號(hào)特點(diǎn)、強(qiáng)化方式及瘤周水腫程度等,并繪制表格。統(tǒng)計(jì)學(xué)方法采用SPSS13.0軟件,χ2檢驗(yàn)的統(tǒng)計(jì)學(xué)方法,以P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果MRI掃描中,肺癌、乳癌等常見(jiàn)惡性腫瘤顱內(nèi)轉(zhuǎn)移多表現(xiàn)為長(zhǎng)T1、長(zhǎng)T2信號(hào),結(jié)直腸癌轉(zhuǎn)移灶中有20個(gè)(71.4%)呈混雜/短T2信號(hào),DWI上170個(gè)(69.4%)轉(zhuǎn)移灶邊界清楚。顱內(nèi)轉(zhuǎn)移的數(shù)目、大小、強(qiáng)化形態(tài)、瘤周水腫均與原發(fā)腫瘤相關(guān)(P0.05)。45例(70.3%)肺腺癌腦轉(zhuǎn)移、33例(55.0%)肺小細(xì)胞癌及15例(78.9%)乳腺癌,MRI表現(xiàn)以多發(fā)轉(zhuǎn)移灶居多;16例(59.3%)肺鱗癌以單發(fā)轉(zhuǎn)移灶居多。72個(gè)(57.1%)肺小細(xì)胞癌的轉(zhuǎn)移灶為Ⅱ型大小,22個(gè)(59.5%)肺鱗癌的轉(zhuǎn)移灶為Ⅰ型大小;肺鱗癌有27個(gè)(72.9%)轉(zhuǎn)移灶為環(huán)形強(qiáng)化;18個(gè)(48.6%)肺鱗癌轉(zhuǎn)移灶的瘤周水腫為輕度,重度水腫中有21個(gè)(52.5%)轉(zhuǎn)移灶為肺腺癌。顱內(nèi)轉(zhuǎn)移病灶的分布與原發(fā)腫瘤無(wú)關(guān),但與顱內(nèi)血供分布有關(guān),以幕上病灶288個(gè)居多(占79.3%),多分布于額、頂、顳葉,幕下為61個(gè),小腦半球占90.2%(55/61)。結(jié)論不同惡性腫瘤顱內(nèi)轉(zhuǎn)移可有不同的MRI特征;MRI平掃、增強(qiáng)及DWI綜合運(yùn)用對(duì)腦轉(zhuǎn)移瘤的診斷及鑒別有重要價(jià)值。
[Abstract]:Objective craniocerebral brain is one of the most common metastatic sites in malignant tumors. If we can find and choose reasonable treatment plan early, we can prolong the life of patients and improve the quality of life.For different primary tumors, the choice of clinical treatment is different.It is difficult to determine the type of primary tumor by puncture biopsy and some patients with brain metastases found before the primary tumor, if the type of primary tumor can be inferred from the imaging findings of brain metastases.It can provide some guidance to the choice of clinical treatment plan.From June 2011 to July 2013, 210 cases with brain metastases diagnosed as brain metastases and whose types of primary tumors have been confirmed by MRI were collected and analyzed retrospectively the characteristic features of MRI.Materials and methods 210 cases of brain metastases confirmed by MRI from June 2011 to July 2013 in affiliated Hospital of Inner Mongolia Medical University were collected.The primary tumors with common intracranial metastasis (excluding the total number of cases 鈮，

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