Colosimo C, Celi G, Settecasi C, Tartaglione T, Di Rocco C, Marano P
Istituto di Radiologia, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Roma.
Radiol Med. 1995 Oct;90(4):386-95.
In the last thirty years much progress has been made in the treatment of brain tumors in children, thanks to modern diagnostic imaging techniques, together with neurosurgery and radiotherapy, for the diagnosis and follow-up of these lesions. MRI and paramagnetic contrast agents have revolutionized the imaging of intracranial conditions, especially in the posterior cranial fossa. The superiority of MRI over CT is well known and reported in the literature, but the adequacy of the two methods has rarely been compared. Therefore, this study was aimed at assessing and quantitating the accuracy of MRI and CT relative to two essential parameters: preoperative "histologic" diagnosis and local and distant intracranial tumor extent. In 52 selected patients the final histologic diagnosis was cerebellar medulloblastoma in 20 cases, cerebellar astrocytoma in 12 cases, brain stem glioma in 12 cases and ependymoma in 8 cases. CT allowed the correct diagnosis to be made in 25 patients (48%), with questionable findings in 21 patients (40%) and 6 misdiagnoses (12%). MRI allowed the correct diagnosis to be made in 43 patients (83%), with questionable findings in 9 patients (17%) and no misdiagnoses. MRI depicted local and distant tumor spread in 34 patients while CT showed it in 22 patients only. The analysis of the results confirmed the superiority of MRI over CT, relative to the parameters considered, i.e. histology and the assessment of tumor spread. In the clinical suspicion of brain tumors of the posterior cranial fossa in children, MRI--if available--should be the examination of choice if the patient's clinical status does not prevent its use. CT should be used only in emergency cases (acute intracranial hypertension) to identify hydrocephalus and intratumoral hemorrhages. Unenhanced CT also yields useful pieces of information for lesion "histology" and may be used to integrate MR findings in selected cases.
在过去三十年里，儿童脑肿瘤的治疗取得了很大进展，这得益于现代诊断成像技术以及神经外科手术和放射疗法，用于这些病变的诊断和随访。磁共振成像（MRI）和顺磁性造影剂彻底改变了颅内疾病的成像，尤其是在后颅窝。MRI相对于计算机断层扫描（CT）的优越性是众所周知的，并且在文献中也有报道，但这两种方法的充分性很少被比较。因此，本研究旨在评估和量化MRI和CT相对于两个基本参数的准确性：术前“组织学”诊断以及颅内肿瘤的局部和远处范围。在52例选定患者中，最终组织学诊断为小脑髓母细胞瘤20例，小脑星形细胞瘤l2例，脑干胶质瘤l2例，室管膜瘤8例。CT使25例患者（48%）得到正确诊断，21例患者（40%）结果存疑，6例误诊（12%）。MRI使43例患者（83%）得到正确诊断，9例患者（17%）结果存疑，无误诊。MRI显示34例患者有局部和远处肿瘤扩散，而CT仅显示22例患者有此情况。结果分析证实，相对于所考虑的参数，即组织学和肿瘤扩散评估，MRI优于CT。在临床怀疑儿童后颅窝脑肿瘤时，如果患者的临床状况不阻止使用，MRI（如果可用）应是首选检查。CT仅应在紧急情况（急性颅内高压）下用于识别脑积水和肿瘤内出血。平扫CT也能提供有关病变“组织学”的有用信息，并且可用于在特定病例中补充磁共振成像的结果。
