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目的提高对临床和影像学表现不典型的脑肿瘤的认识,减少诊疗失误。方法回顾性分析9例貌似非肿瘤病变,但最终经病理证实的脑肿瘤,总结其临床和影像学特点。结果9例患者的临床表现:8例无前驱感染和发热,1例有前驱感染;6例非急性起病,3例急性起病;7例呈亚急性或慢性病程,1例呈急性病程;5例行血液免疫炎性指标检测,其中3例有异常。6例行头颅CT平扫:5例呈低密度灶,1例高密度灶。9例患者病灶分布多样,头颅MRI表现:T1WI呈低信号5例,等信号2例,混合信号3例,T2WI和Flair相均呈高信号;4例有强化;5例有占位效应;9例均无灶周水肿。2例行正电子发射计算机断层显像(positron emission tomography,PET),其中1例提示肿瘤;3例行磁共振波谱分析(magnetic resonance spectroscopy,MRS)均提示为肿瘤。3例早期抗炎有效,但9例抗炎最终疗效均不佳;病理结果:星形细胞瘤4例,胶质瘤病2例,节细胞胶质瘤1例,淋巴瘤2例。结论不典型脑肿瘤的临床和影像学表现复杂多变。对于貌似非肿瘤的不典型颅内病变,需考虑肿瘤可能,当抗炎治疗效果不佳时,应行病理活检以尽快明确诊断。
Objective To improve the understanding of brain tumors with atypical clinical and radiological manifestations and to reduce errors in diagnosis and treatment. Methods Retrospective analysis of 9 cases of seemingly non-neoplastic lesions, but eventually confirmed by pathological brain tumors, to summarize the clinical and imaging features. Results The clinical manifestations of 9 patients were: no prodromal infection and fever in 8 cases, prodromal infection in 1 case, 6 cases of non-acute onset and 3 cases of acute onset, 7 cases of subacute or chronic disease course and 1 case of acute disease course. 5 cases of blood test for immune inflammatory markers, of which 3 were abnormal. 6 cases of skull CT scan: 5 cases showed low-density lesions, 1 case of high-density lesions. The distribution of lesions in 9 patients were diverse. The manifestations of head MRI were as follows: T1WI showed low signal in 5 cases, equal signal in 2 cases, mixed signal in 3 cases, T2WI and Flair showed high signal; 4 cases had enhancement; 5 cases had mass effect; 9 Cases were no focal edema. Two cases were positron emission tomography (PET), of which 1 showed tumor and 3 cases showed tumor by magnetic resonance spectroscopy (MRS). Three were early anti-inflammatory effective, but the final anti-inflammatory effect of 9 patients was poor. The pathological results were as follows: 4 astrocytomas, 2 gliomas, 1 ganglion glioma and 2 lymphoma. Conclusion The clinical manifestations and radiological findings of atypical brain tumors are complex and changeable. For seemingly non-tumor atypical intracranial lesions, need to consider the tumor may be, when the anti-inflammatory treatment ineffective, biopsy should be performed to confirm the diagnosis as soon as possible.