CT或MRI占位效应及强化不明显胶质瘤诊治探讨

目的：探讨CT或MRI显示占位效应及强化不明显胶质瘤的有效诊治方法。方法：19例CT或MRI检查显示无明显占位效应,并且强化均不明显,CT平扫及增强,呈低密度,MRI T1WI呈低信号,T2WI呈稍高或高信号的局限性病变。结果：10例不排除非胶质瘤,宜先观察或保守治疗半月至1月,病灶无变化,诊断仍不明确者,手术治疗;9例拟诊胶质瘤者,均作剖颅探查。19例术中发现均为实性肿瘤。其中,14例病变肉眼几乎难与正常脑组织区别,切除时感觉质地较韧,血供差;5例病变呈鱼肉状,淡肉红色,质软,血供较差,为较典型胶质瘤。位于中央沟附近3例,该3例中2例采用立体定向开颅手术,1例采用CT定位开颅手术。后者术中肉眼确定病变困难,导致术后肢体活动障碍加重,余18例疗效满意。病理检验为星形细胞瘤Ⅰ～Ⅱ级12例,少枝胶质细胞瘤2例,星形细胞瘤Ⅲ～Ⅳ级5例。结论：对于CT或MRI显示占位效应及强化不明显脑内病变,保守治疗无效者,尤位于非功能区病变者,应积极考虑开颅手术切除。对位于功能区病灶或小病灶,应采用立体定向开颅手术,避免因寻找病变困难而导致术后神经功能废损症状加重,或造成不能获得准确病检结果的不良后果。

Diagnosis and Treatment of the Glioma without Significant Contrast Enhancement and Mass Effect on CT or MRI

Objective： To investigate the effective diagnosis and treatment methods for the glioma with absence of significant enhancement and mass effect on CT or MRI.Methods： Nineteen cases with no significant enhancement and mass effect on CT or MRI showed hypo-density/low-signal structures on axial view,T1WI low-sigal intensity on MR or hyperdense unenhanced on CT scan and caused no significant enhancement.Results： Nine cases diagnosed as glioma accepted operation,while 10 suspected non-glioma cases were observed or/and received conservative treatment first.If the lesions did not change or the diagnosis was not clear after half or one month,surgical management was taken.Solid tumors were found during operation in all those 19 cases.Lesions of 14 cases among them were tough and poor-blood-supplied,which can be hardly distinguished from normal brain tissue.Lesions of the other 5 cases were typical glioma with a fish-like and poor-blood-supplied appearance.In 3 cases,lesions were closed to the central sulcusff,among which 2 cases took stereotactic surgery,and the other one use CT localization surgery.The lesion of the latter case was difficult to find,resulting in motor difiency became worse postoperatively.The other 18 cases gained satisfactory outcome.Pathological examination revealed 12 cases with Astrocytoma ⅠⅡ,2 cases with oligodendroglioma,5 cases with Astrocytoma ⅢⅣ.Conclusion： For lesions with no significant enhancement or mass effect showed on CT or MRI,surgical management should be considered aggressively when conservative treatment is ineffective,especially in the non-functional brain area.Lesions in functional area or small lesions should be managed via stereotactic surgery to avoid postoperative neurological deficiency becoming worse for difficulties in finding lesions,or causing inaccurate pathology results.