Department of Neurosurgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India.
J Cancer Res Ther. 2024 Jan 1;20(1):112-117. doi: 10.4103/jcrt.jcrt_1456_22. Epub 2023 May 2.
Multiple ring-enhancing lesions are commonly experienced group of brain pathologies which we come across in day-to-day practice. Clinical symptoms in these lesions are quite non-specific, and hence, it is difficult to reach a final diagnosis. However, these lesions have a varied group of differential diagnosis and it is sometimes difficult to have an accurate diagnosis on conventional MRI. This article was written with the objective of discussing the demographical study and etiology, clinical diagnosis and management for these patients.
It is a prospective study carried out at the Department of Neurosurgery, Dr. D Y Patil Medical College and Hospital, Pune, from September 2019 to August 2022 and included 50 patients who presented to us multiple ring-enhancing brain lesions.
In our study, 50 patients between age (1-70 years) with multiple ring-enhancing lesions were analyzed. Majority of the patients were between age group 30-39 years. Males (76%) were majority in our study than females (24%). Most common pathology was primary neoplasm (glioma) and metastasis, followed by nine patients of pyogenic abscess and tuberculosis each. Neurocysticercosis was seen in eight patients and three patients were diagnosed with CNS lymphoma. Most of our patients presented with headache (38 patients) and a subset of patients had associated seizures (28 patients). Two patients with primary neoplasm were diagnosed to have WHO grade 3 glioma and seven patients were diagnosed to have WHO grade 4 glioma. Glioblastoma multiforme presented as multifocal and multicentric lesions. Among the patients with primary neoplasm, three patients underwent stereotactic biopsy for diagnosis and the rest of seven patients underwent maximum safe resection followed by chemotherapy and radiotherapy. Ten patients were diagnosed with metastatic lesions, among them six patients underwent stereotactic biopsy for histopathological diagnosis and immunohistochemistry, and rest of the patients were managed on the basis of the primary lesion. Five patients were immune-compromised, among them two patients presented with abscess and three patients presented with primary neoplastic lesion. Thirty-six patients underwent biopsy, among them seven patients underwent frameless, seven patients underwent frame stereotactic biopsy, and the rest 22 patients underwent excision biopsy.
Multiple ring-enhancing lesions of brain pose a challenge in terms of achieving an accurate diagnosis and planning further treatment. It is of utmost importance to have a diagnosis in mind based on radiological investigations, so that surgical intervention can be planned accordingly be it by invasive or minimal invasive techniques. An idea toward the diagnosis also helps in prognosticating these patients which could avoid costly whole-body scans and unnecessary surgical intervention.
多发环形增强病变是我们在日常实践中经常遇到的一组脑部病变。这些病变的临床症状相当不特异，因此难以做出最终诊断。然而，这些病变有一组不同的鉴别诊断，有时在常规 MRI 上很难做出准确的诊断。本文旨在讨论这些患者的人口统计学研究和病因、临床诊断和治疗。
这是一项在浦那的 Dr. D Y Patil 医学院和医院神经外科进行的前瞻性研究，从 2019 年 9 月至 2022 年 8 月期间，共纳入了 50 名出现多发性环形增强脑部病变的患者。
在我们的研究中，分析了 50 名年龄在 1-70 岁之间的多发性环形增强病变患者。大多数患者年龄在 30-39 岁之间。男性（76%）多于女性（24%）。最常见的病理是原发性肿瘤（胶质瘤）和转移瘤，其次是每个 9 例化脓性脓肿和结核。神经囊尾蚴病在 8 例患者中可见，3 例患者诊断为中枢神经系统淋巴瘤。我们的大多数患者表现为头痛（38 例），少数患者伴有癫痫发作（28 例）。两名原发性肿瘤患者被诊断为 3 级胶质瘤，7 名患者被诊断为 4 级胶质瘤。多形性胶质母细胞瘤表现为多灶性和多中心性病变。在原发性肿瘤患者中，3 名患者接受立体定向活检以明确诊断，其余 7 名患者接受最大安全切除，然后进行化疗和放疗。10 名患者被诊断为转移性病变，其中 6 名患者接受立体定向活检进行组织病理学诊断和免疫组化检查，其余患者根据原发性病变进行治疗。5 名患者免疫功能低下，其中 2 名患者出现脓肿，3 名患者出现原发性肿瘤病变。36 名患者接受了活检，其中 7 名患者接受了无框架、7 名患者接受了框架立体定向活检，其余 22 名患者接受了切除活检。
脑多发环形增强病变在获得准确诊断和制定进一步治疗计划方面构成挑战。根据影像学检查得出诊断至关重要，以便可以相应地计划手术干预，无论是采用侵入性还是微创技术。对诊断的认识也有助于预测这些患者的预后，从而避免昂贵的全身扫描和不必要的手术干预。
