摘要
目的分析颅内粒细胞肉瘤(granulocytic sarcoma,GS)CT及MRI影像学表现特点,提高该病诊断率。方法回顾分析经临床证实的颅内GS 9例的影像学及其他临床资料。结果本组CT及MRI检查主要表现为脑实质浸润伴出血4例,颅内肿瘤伴骨质破坏3例,脑膜侵犯2例。2例影像学检查诊断为GS;7例误诊,误诊为高血压脑出血及转移瘤各2例,脑肿瘤、颅底软骨肉瘤及颅内低压综合征各1例。9例经骨髓穿刺细胞学检查确诊为急性淋巴细胞白血病4例,急性粒细胞白血病3例,慢性粒单细胞白血病2例;3例先确诊白血病,后诊断GS,6例因颅神经症状首发经脑脊液检查发现典型GS细胞确诊GS。经相应治疗疾病进展死亡1例,缓解8例。结论颅内GS CT与MRI检查具有特征性表现,主要表现为脑实质浸润伴出血、颅内肿瘤伴骨质破坏及脑膜侵犯伴梗阻性脑积水等征象,CT和MRI联合检查有助于GS确诊,且对预后评价有一定帮助。
Objective To improve the understanding of intracranial granulocytic sarcoma（ GS） and reduce misdiagno-sis by evaluating the CT and MRI findings. Methods The CT and MRI findings and other clinical data of 9 patients with GS proved by clinical features or pathology were retrospectively analyzed. Results CT and MRI imaging showed parenchymal in-filtration with hemorrhage in 4 cases, intracranial tumors with bone destruction in 3 cases, and 2 cases were showed meningeal involvement. Among of 9 cases, only 2 cases were diagnosed as GS initially. However, 7 cases were misdiagnosed：hyperten-sive intracerebral hemorrhage in 2 cases, metastases in 2 cases;brain tumors, skull base chondrosarcoma and intracranial hy-potension syndrome in one each. Through bone marrow aspiration cytology, 4 cases were diagnosed as acute lymphoblastic leu-kemia, 3 cases were diagnosed as acute myeloid leukemia, and 2 cases were diagnosed with chronic myelomonocytic leukemia. 3 cases of them were diagnosed as leukemia at first and confirmed as GS finally. Because of initial neurological symptoms and typical GS cells by examination of cerebrospinal fluid, 6 cases were diagnosed as GS correctively. After appro-priate treatment, 8 cases were cured and 1 case died. Conclusion Intracranial GS may mainly perform as parenchymal infil-tration （ hematoma） , intracranial tumor formation associated with bone destruction and meningeal involvement with obstructive hydrocephalus. Combined CT and MRI may be helpful for diagnosis and can provide valuable assistance to early treatment and prognostic evaluation.
出处
《临床误诊误治》
2014年第8期51-54,共4页
Clinical Misdiagnosis & Mistherapy
关键词
肉瘤
髓样
白血病
磁共振成像
体层摄影术
螺旋计算机
误诊
颅内出血
高血压性
Sarcoma,myeloid
Leukemia
Magnetic resonance imaging
Tomography,spiral computed
Diagnostic errors
Intracranial hemorrhage,hypertensive
