Gururangan Sridharan, McLaughlin Colleen A, Brashears James, Watral Melody A, Provenzale James, Coleman R Edward, Halperin Edward C, Quinn Jennifer, Reardon David, Vredenburgh James, Friedman Allan, Friedman Henry S
The Brain Tumor Center at Duke, Duke University Medical Center, Durham, NC 27710, USA.
J Neurooncol. 2006 Apr;77(2):207-12. doi: 10.1007/s11060-005-9029-5.
We performed a retrospective study of patients with diffuse pontine glioma (DPG) who suffered neuraxis metastasis (NM) and characterized the incidence, clinical features, radiologic findings, and patterns of disease dissemination.
Magnetic resonance imaging (MRI) of brain and spine was used to assess NM. Some patients also underwent magnetic resonance spectroscopy (MRS) (6 patients) and fluorodeoxyglucose positron emission tomography (FDG-PET) scans (13 patients) to further evaluate areas of metastatic disease. Three patients had histologic confirmation of disease at the site of NM.
Between 1986 and 2003, 18 of 96 patients (17.3%) with DPG developed NM. The median age at diagnosis was 8 years (range, 4-17). All patients had adjuvant chemotherapy and/or focal radiotherapy at diagnosis. The NM occurred at a median of 15 months from diagnosis of DPG (range, 3-96). Three patterns of NM were seen on MRI of brain and spine in these patients; 8 (39%) had parenchymal (PM), 4 (22%) leptomeningeal (PM), 2 (11%) subependymal, and in 5 a combination of two or more patterns. The MRS and FDG-PET scan of suspected areas of metastatic disease was consistent with tumor in 6 of 6 and 12 of 13 patients who underwent these procedures respectively. Three patients also had histologic confirmation of malignant glioma at the site of NM. Despite salvage therapy, all 18 patients have died of disease at a median of 5 months (range, 0.5-20) from diagnosis of neuraxis spread.
Our study emphasizes the need for screening patients with DPG for NM at the time of recurrence.
我们对患有弥漫性脑桥胶质瘤（DPG）并发生神经轴转移（NM）的患者进行了一项回顾性研究，以确定其发生率、临床特征、影像学表现及疾病播散模式。
采用脑部和脊柱的磁共振成像（MRI）评估NM。部分患者还接受了磁共振波谱分析（MRS）（6例患者）和氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）（13例患者），以进一步评估转移病灶区域。3例患者在NM部位有疾病的组织学确诊。
1986年至2003年间，96例DPG患者中有18例（17.3%）发生了NM。诊断时的中位年龄为8岁（范围4 - 17岁）。所有患者在诊断时均接受了辅助化疗和/或局部放疗。NM发生在DPG诊断后的中位时间为15个月（范围3 - 96个月）。在这些患者的脑部和脊柱MRI上可见三种NM模式；8例（39%）为实质型（PM），4例（22%）为软脑膜型（LM），2例（11%）为室管膜下型，5例为两种或更多模式的组合。分别接受这些检查的6例和13例患者中，可疑转移病灶区域的MRS和FDG-PET扫描结果分别与6例中的6例和13例中的12例肿瘤情况相符。3例患者在NM部位也有恶性胶质瘤的组织学确诊。尽管进行了挽救性治疗，所有18例患者均在神经轴扩散诊断后的中位时间5个月（范围0.5 - 20个月）死于该疾病。
我们的研究强调在复发时对DPG患者进行NM筛查的必要性。
