Rogers L R, Weinstein M A, Estes M L, Cairncross J G, Strachan T
Department of Neurology, Cleveland Clinic Foundation, Ohio.
J Neurosurg. 1994 Dec;81(6):817-21. doi: 10.3171/jns.1994.81.6.0817.
The authors describe the clinical behavior of eight patients with cerebral astrocytomas, in whom computerized tomography (CT) or magnetic resonance (MR) imaging of the brain was characterized by diffuse bilateral cerebral hemisphere tissue density abnormalities and minimal focal mass effect. Five patients were newly diagnosed, and three others had been treated for focal low-grade astrocytoma. Histological diagnoses included anaplastic astrocytoma (three patients), low-grade astrocytoma (three patients), glioblastoma (one patient), and gliosis with later development of glioblastoma (one patient). In five patients, brain tumor was not suspected from the neuroimaging studies, the findings of which were mistaken for radiation leukoencephalopathy, vasogenic edema, or multiple sclerosis. Serial CT scans or MR images undertaken over intervals of 3 to 184 weeks showed progression of abnormal tissue densities in seven patients and multifocal contrast-enhancing masses developed on CT scan in two patients. An autopsy in each of four patients showed diffuse cerebral infiltration by astrocytoma. It is concluded that neuroimaging studies in some patients with diffusely infiltrating cerebral astrocytoma are atypical for neoplasm and can be mistaken for other diseases, especially those that predominantly affect cerebral hemisphere white matter.
作者描述了8例脑星形细胞瘤患者的临床行为，这些患者的脑部计算机断层扫描（CT）或磁共振成像（MR）表现为双侧大脑半球组织密度弥漫性异常，且占位效应轻微。5例为新诊断患者，另外3例曾接受过局灶性低级别星形细胞瘤治疗。组织学诊断包括间变性星形细胞瘤（3例）、低级别星形细胞瘤（3例）、胶质母细胞瘤（1例）以及伴有胶质母细胞瘤后期发展的胶质增生（1例）。5例患者的神经影像学检查未怀疑有脑肿瘤，其检查结果被误诊为放射性白质脑病、血管源性水肿或多发性硬化症。在3至184周的间隔时间内进行的系列CT扫描或MR图像显示，7例患者异常组织密度有所进展，2例患者CT扫描出现多灶性强化肿块。4例患者均进行了尸检，结果显示星形细胞瘤弥漫性浸润大脑。结论是，一些弥漫性浸润性脑星形细胞瘤患者的神经影像学检查结果对肿瘤来说不典型，可能会被误诊为其他疾病，尤其是那些主要影响大脑半球白质的疾病。
