摘要
目的白血病颅脑并发症严重影响患儿的治疗和生存质量。本文探讨白血病儿童化疗前后颅脑并发症的差异及MRI表现,指导临床治疗。资料与方法回顾性分析37例白血病颅脑并发症患儿的临床及MRI资料,34例行2次以上MRI检查,其中28例行增强扫描。结果 22例化疗前发生并发症,2例存在2种并发症:脑膜浸润7例,表现为脑膜广泛或局限性增厚,其中5例化疗后减轻或消失;颅内多发小、微出血灶7例,其中2例合并血肿;肿块3例,均为颞骨肿块,1例合并颞叶肿块,1例化疗后肿块消失;脑白质病变及硬膜下积液各2例,真菌感染、脑膜脑实质浸润及脑梗死各1例。17例化疗后发生并发症,2例化疗前后存在不同并发症,8例存在2种以上并发症:脑萎缩13例;脑白质病变9例,表现为双侧脑室旁和(或)半卵圆中心脑白质对称性长T2信号,其中4例停药后减轻或消失;感染性病变3例,其中病毒性脑炎2例,结核性脑膜炎并结核瘤1例;肿块2例,确诊静脉窦血栓及可复性后部脑病综合征各1例。结论儿童白血病颅脑并发症MRI征象多样,化疗前后存在明显差异,化疗前并发症主要为脑膜浸润及颅内出血,化疗后并发症主要为脑萎缩、脑白质病变及感染性病变。MRI检查对白血病并发症的诊断、进展及疗效观察有重要价值。
Purpose Brain complications severely threaten the treatment and survival of children with leukemia. This paper aims to investigate the MRI manifestations and differences of brain complications in leukemia before and after chemotherapy for a clinical guidance.Materials and Methods The clinical data and MRI findings of 37 children with leukemia and brain complications were retrospectively analyzed. Thirty-four of them underwent MRI scan twice or more, among whom 28 received contrast-enhanced MRI scan.Results Twenty-two patients were discovered with brain complications before chemotherapy, 2 of whom were with two kinds of complications. Meningopathy was found in 7 patients who showed widespread or localized meningeal thickening. Among them, 5 patients＆#39;＆#39; lesions reduced or disappeared after chemotherapy. Intracerebral multiple small and micro bleed was found in these 7 patients, 2 of them combined with hematoma. Three patients were found with intracranial tumor which all proved to be temporal bone tumor, 1 of whom combined with temporal lobe tumor and 1 had tumor disappeared after chemotherapy. The other complications before chemotherapy included leukoencephalopathy （n=2）, subdural collection of fluid （n=2）, meninges and parenchymal infiltration of leukemia （n=1）, fungal infection （n=1） and cerebral infarction （n=1）. On the contrary, 17 patients were discovered with brain complications after chemotherapy, 8 of whom were with two or more complications. Two patients had different kinds of complications before and after chemotherapy. Brain atrophy was observed in 13 patients. Leukoenphalopathy was found in 9 patients who presented high signal in white matter of double periventricular and/or semi-oval center on T2WI; the lesions of 4 patients were reduced or disappeared after withdrawal. Infectious diseases were diagnosed in 3 patients, including viral encephalitis in 2 cases, tuberculous meningitis combined with tuberculoma in 1 case. The other complications included intracranial tumor （n=2）, sinus thrombosis （n=1）, posterior reversible encephalopathy syndrome （n=1） after chemotherapy. Conclusion The MRI findings of brain complications in childhood leukemia are various and demonstrate significantly different features before and after chemotherapy. The major complications before treatment include meningopathy and intra-cerebral hemorrhage;while after chemotherapy the main complications are brain atrophy, leukoencephalopathy and infectious diseases. MRI proves to be a valuable method to detect, observe and follow up these complications.
出处
《中国医学影像学杂志》
CSCD
北大核心
2015年第8期578-581,586,共5页
Chinese Journal of Medical Imaging
关键词
白血病
药物疗法
脑疾病
并发症
磁共振成像
儿童
Leukemia
Drug therapy
Brain diseases
Complication
Magnetic resonance imaging
Child
