目的:探討CT或MRI顯示占位效應及強化不明顯膠質瘤的有效診治方法。方法:19例CT或MRI檢查顯示無明顯占位效應,并且強化均不明顯,CT平掃及增強,呈低密度,MRI T1WI呈低信號,T2WI呈稍高或高信號的局限性病變。結果:10例不排除非膠質瘤,宜先觀察或保守治療半月至1月,病灶無變化,診斷仍不明確者,手術治療;9例擬診膠質瘤者,均作剖顱探查。19例術中發現均為實性腫瘤。其中,14例病變肉眼幾乎難與正常腦組織區別,切除時感覺質地較韌,血供差;5例病變呈魚肉狀,淡肉紅色,質軟,血供較差,為較典型膠質瘤。位于中央溝附近3例,該3例中2例采用立體定向開顱手術,1例采用CT定位開顱手術。后者術中肉眼確定病變困難,導致術后肢體活動障礙加重,余18例療效滿意。病理檢驗為星形細胞瘤Ⅰ～Ⅱ級12例,少枝膠質細胞瘤2例,星形細胞瘤Ⅲ～Ⅳ級5例。結論:對于CT或MRI顯示占位效應及強化不明顯腦內病變,保守治療無效者,尤位于非功能區病變者,應積極考慮開顱手術切除。對位于功能區病灶或小病灶,應采用立體定向開顱手術,避免因尋找病變困難而導致術后神經功能廢損癥狀加重,或造成不能獲得準確病檢結果的不良后果。
Citation：
GAO Limin,LUO Li.. Diagnosis and Treatment of the Glioma without Significant Contrast Enhancement and Mass Effect on CT or MRI. West China Medical Journal, 2009, 24(6): 1345-1346. doi:
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| 1. |
GUSBURG L E, RULLER G N, HASHIMI M, et al. The significance of lack of MRI cantrast enhancement of supratentorial brain tumors in adults:histopathological evaluation of a series[J]. Surg Neural,1998,429–436.
|
| 2. |
OSBORN A G. Diagnostic neuropathology[M]. St Luis: Minsby,1994:529–578.
|
| 3. |
CHAMBERLIAN M C, MUROVIC J A, LEVIN V A. Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas[J]. Neurology,1998,38:1371.
|
| 4. |
RECHT L D, LEW R, SMITH T W. Suspected lowgrade glioma:deferring treatment save[J]? Ann Neurol,1992,31:431.
|
- 1. GUSBURG L E, RULLER G N, HASHIMI M, et al. The significance of lack of MRI cantrast enhancement of supratentorial brain tumors in adults:histopathological evaluation of a series[J]. Surg Neural,1998,429–436.
- 2. OSBORN A G. Diagnostic neuropathology[M]. St Luis: Minsby,1994:529–578.
- 3. CHAMBERLIAN M C, MUROVIC J A, LEVIN V A. Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas[J]. Neurology,1998,38:1371.
- 4. RECHT L D, LEW R, SMITH T W. Suspected lowgrade glioma:deferring treatment save[J]? Ann Neurol,1992,31:431.
