Onda K, Tanaka R, Takahashi H, Takeda N, Ikuta F
Department of Neurosurgery, Niigata University, Japan.
Neuroradiology. 1990;32(2):146-50. doi: 10.1007/BF00588565.
Computed tomography (CT) findings in eleven patients with symptomatic cerebrospinal fluid (CSF) dissemination from cerebral glioblastoma were analyzed and, in seven cases subsequently autopsied, they were compared with histological observations. Each patient had multiple CT abnormalities including periventricular enhancement (5/11), subarachnoid enhancement (10/11) and progressive hydrocephalus (7/9) by cranial CT, and small filling defects with or without block (5/5) by CT myelography. The areas that showed periventricular or subarachnoid enhancement on CT were confirmed to have macroscopically detectable seeding at autopsy. On the other hand, microscopic deposits were more widely distributed than the enhancement suggested, and were hardly visualized on CT. In association with subarachnoid seeding, we found low-density lesions on CT which had resulted from ischemia or reinvasion of adjacent structures by disseminated glioblastoma and resulting parenchymal edema. By cranial CT, subarachnoid enhancement seems to be a very reliable sign of CSF seeding, whereas periventricular enhancement due to CSF metastases should be carefully distinguished from that due to periventricular tumor infiltration. CT myelography is capable of revealing minute metastatic spinal deposits and may be helpful for ruling out spinal seeding as well as its precise evaluation.
对11例有症状的脑胶质母细胞瘤脑脊液（CSF）播散患者的计算机断层扫描（CT）结果进行了分析，并对其中7例随后进行尸检的患者，将其CT结果与组织学观察结果进行了比较。每位患者通过头颅CT均有多种CT异常表现，包括脑室周围强化（5/11）、蛛网膜下腔强化（10/11）和进行性脑积水（7/9），通过CT脊髓造影可见有或无梗阻的小充盈缺损（5/5）。CT上显示脑室周围或蛛网膜下腔强化的区域在尸检时证实有肉眼可见的种植转移。另一方面，显微镜下的沉积物分布比强化所提示的范围更广，在CT上很难显示。与蛛网膜下腔种植转移相关，我们在CT上发现了低密度病变，这是由于播散性胶质母细胞瘤对邻近结构的缺血或再侵犯以及由此导致的实质水肿所致。通过头颅CT，蛛网膜下腔强化似乎是CSF播散的一个非常可靠的征象，而由于CSF转移引起的脑室周围强化应与由于脑室周围肿瘤浸润引起的强化仔细区分。CT脊髓造影能够显示微小的脊髓转移沉积物，可能有助于排除脊髓播散以及对其进行精确评估。
