99例幕上累及脑室的胶质瘤MRI特征与病理对照分析

doi:10.19854/j.cnki.1008-2425.2026.03.0001

摘要/Abstract

摘要： 目的探讨幕上累及脑室的胶质瘤(Supratentorial Ventricle-Involved Glioma,SVIG)的常规及多模态MRI特征,为临床诊断、鉴别诊断及术前评估提供依据。方法回顾性分析2020年1月至2024年12月中国科学技术大学附属第一医院(安徽省立医院)99例SVIG患者的临床及MRI资料。所有患者术前均行MRI平扫及增强扫描,76例行DWI检查,52例行MRS检查。由2名资深放射科医师盲法独立分析肿瘤的部位、形态、信号特征、强化方式、瘤周水肿、侵袭性及多模态参数,结合病理结果进行对照分析。结果 99例SVIG患者均累及侧脑室,以三角区最常见;肿瘤多呈类圆形、不规则形或分叶状,T1WI以低/低-等信号为主,T2WI/FLAIR以高/稍高信号为主,易伴囊变/坏死(72例)、出血(13例)、钙化(9例)。增强扫描以明显不均匀强化为主(76例),轻度强化19例,4例无明显强化;DWI示41例弥散受限,35例无明显受限;MRS示42例Cho峰升高、NAA峰降低,部分高级别胶质瘤患者病灶可见Lip峰。病理以高级别胶质瘤为主(89例,89.9%),其中胶质母细胞瘤77例;GFAP阳性率98.0%,IDH1突变24例,H3K27M突变4例。术后随访52例复发、4例远处转移,高级别胶质瘤复发及死亡率高于低级别,复发及死亡病例多伴明显强化、较重瘤周水肿、较低ADC值及较高Cho/NAA比值。结论 SVIG的MRI表现具有一定特征性,结合肿瘤的部位、形态、信号、强化方式、病理亚型及多模态参数,可有效辅助术前诊断、病理级别预判及预后评估,为临床治疗方案制定提供重要参考。

关键词: 幕上累及脑室的胶质瘤, 多模态MRI, 病理分级, 预后, 鉴别诊断

Abstract: Objective To investigate the conventional and multimodal MRI features of supratentorial ventricle-involved glioma (SVIG),so as to provide evidence for clinical diagnosis,differential diagnosis and preoperative evaluation. Methods The clinical and imaging data of 99 patients with SVIG confirmed by surgery and pathology at the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2020 to December 2024 were retrospectively analyzed.All patients underwent preoperative conventional MRI (T1WI,T2WI,FLAIR) with and without contrast enhancement,76 underwent DWI,and 52 underwent MRS.Two senior radiologists independently analyzed the location,morphology,signal characteristics,enhancement pattern,peritumoral edema,invasiveness and multimodal parameters in a blind manner,and the results were compared with pathological findings.Pathological types and grades were determined according to the 2021 WHO Classification of Tumors of the Central Nervous System. Results All 99 lesions involved the lateral ventricle,most commonly in the trigone.Tumors were mostly round,irregular or lobulated.The lesions were predominantly hypo- to isointense on T1WI,and hyper- to slightly hyperintense on T2WI/FLAIR,frequently accompanied by cystic degeneration/necrosis (72 cases),hemorrhage (13 cases) and calcification (9 cases).On contrast-enhanced scans,marked heterogeneous enhancement was seen in 76 cases,mild enhancement in 19 cases,and no obvious enhancement in 4 cases.On DWI,41 cases showed restricted diffusion and 35 cases showed no obvious restriction.On MRS,42 cases showed elevated Cho peak and decreased NAA peak,and Lip peak was detected in some high-grade gliomas.Pathologically,high-grade gliomas accounted for the majority (89 cases,89.9%),including 77 cases of glioblastoma.The positive rate of GFAP was 98.0%,IDH1 mutation was found in 24 cases,and H3K27M mutation in 4 cases.During postoperative follow-up,52 cases recurred and 4 had distant metastasis.The recurrence and mortality rates of high-grade gliomas were higher than those of low-grade gliomas.Recurrent and deceased cases mostly presented with marked enhancement,severe peritumoral edema,lower ADC values and higher Cho/NAA ratio. Conclusion SVIG demonstrates certain characteristic MRI findings.Combined with tumor location,morphology,signal intensity,enhancement pattern,pathological subtype and multimodal parameters,MRI can effectively assist preoperative diagnosis,pathological grade prediction and prognosis evaluation,providing important reference for clinical treatment planning.

Key words: Supratentorial ventricle-involved glioma, Multimodal MRI, Pathological grading, Prognosis, Differential diagnosis

中图分类号:

R739.4

吴家星, 储柱权, 牛万祥, 计颖, 牛朝诗, 邱俊, 程传东. 99例幕上累及脑室的胶质瘤MRI特征与病理对照分析[J]. 立体定向和功能性神经外科杂志, 2026, 39(3): 129-137.

Wu Jiaxing, Chu Zhuquan, Niu Wanxiang, Ji Ying, Niu Chaoshi, Qiu Jun, Cheng Chuandong. Comparative analysis of MRI features and pathology in 99 cases of supratentorial gliomas involving the ventricles[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2026, 39(3): 129-137.

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