探讨动态增强MRI强化曲线对椎管内肿瘤的诊断价值及其病理基础

摘要

Objective To study the significance of curve types of dynamic contrast-enhanced MRI in diagnosising different intraspinal tumors and its pathological basis. Methods The dynamic contrast-enhanced MR imaging of 62 patients with intraspinal tumors (including 12 intramedullary tumors, 49 intradural extramedullary tumors, 1 epidural tumor) proved by surgery and pathology were prospectively studied. And the correlation analysis among a variety of pathological parameters and curve were analysed in 16 patients with intraspinal tumors (including 10 schwannomas, 3 meningiomas, 1 astrocytoma, 1 ependymoma and 1 hemangioblastoma). Results The CER-time curve types of intraspinal tumor were divided into four types: I fast-rise and fast-fall (hemangioblastoma), II fast-rise and slow down (osteoblastoma/primitive neuroectodermal tumor). III relatively fast-rise and persistent (meningioma/ ependymoma), IV slow rise (astrocytoma, schwannoma, neurofibroma, ganglion cell tumor). The correlation analysis showed strengthen curve type and large blood vessels number 30 sCER was negatively correlated with 8 min CER was a positive correlation) 30 s CER the proliferation of small blood vessels, endothelial proliferation, a large blood vessel number was positively correlated to 16 cases of intraspinal tumor pathology indicators and dynamic enhance the results of correlation analysis; 8 min CER and the proliferation of small blood vessels, blood vessel number was negatively correlated; maximum enhancement rate and bleeding, small blood vessels in the number of positive correlation. n the curves of CER-Time, Hemangioblastoma showed a rapid rise and gradual decline with peak in 45 s. Neuromas, Neurofibromas and malignant gangliocytoma showed a slow steady increase with no peak in 8 minute. Meningiomas showed a relatively rapid increase with peak in 165 s. then kept flat and decline after about 5 minute. Conclusion Dynamic contrast-enhanced MRI can differentiate almostly all kinds of intraduralextramedullary tumors and provide the microeconomic situation of the tumor's blood supply and a more reliable basis forrnclinical treatment and prognosis.%目的 探讨动态增强MRI(DCE-MRD)强化曲线对各种椎管内肿瘤的诊断价值及其病理学基础.方法 用DCE-MRI方法对已手术和病理证实的62例椎管内肿瘤(包括髓内肿瘤12例;髓外硬膜下肿瘤49例;硬膜外肿瘤1例)进行前瞻性研究,并对16例椎管内肿瘤(包括神经鞘瘤10例,脊膜瘤3例,星形细胞瘤、室管膜瘤及血管母细胞瘤各1例)的多种病理指标与强化曲线进行相关性分析.结果 将椎管内肿瘤CER-Time曲线分为快升快降型、快升慢降型、较快升持续型、缓慢上升型4型,其中血管母细胞瘤属于快升快降型;骨母细胞瘤、原始神经外胚层肿瘤属于快升慢降型;脊膜瘤、室管膜瘤属于较快升持续型;星形细胞瘤、神经鞘瘤、神经纤维瘤、神经节细胞瘤属于缓慢上升型.对16例椎管内肿瘤病理指标与动态增强结果的相关性分析显示强化曲线类型与大血管数、30sCER呈负相关,与8minCER呈正相关;30sCER与小血管增生、内皮增生、大血管数呈正相关;8minCER与小血管增生、大血管数呈负相关;最大增强率与出血、小血管数呈正相关.结论 DCE-MRI不仅有助于各类椎管内肿瘤的鉴别诊断,还能提供肿瘤的血供等微观情况,为临床选择治疗方案及估计预后提供较为可靠的依据.