Intracranial Meningeal Carcinomatosis and Non-neoplastic Meningeal Diseases: Evaluation with Contrast-Enhanced MR Imaging

顱內腦膜腫瘤轉移與非腫瘤腦膜疾病：以注射顯影劑的磁振造影評估

周春平(Chen-Pin Chou) ； 賴炳宏(Ping-Hong Lai) ； 陳威良(Wei-Liang Chen) ； 潘慧本(Huay-Ben Pan) ； 陳坤煌(Clement Chen) ； 楊建芳(Chien-Fang Yang)

《中華放射線醫學雜誌》 26卷2期 (2001/04) Pp. 51-60

摘要

本文在討論腦膜腫瘤轉移與非腫瘤轉移腦膜疾病，在注射顯影劑後不正常磁振造影影像之分析。
從1993年至1998年間，共收集48例有臨床診斷且有不正常腦膜磁振造影影像的病人。注射顯影劑後區分為軟腦膜及硬腦膜增強並觀察增強之分佈及形狀。同時我們將病人疾病歸納為6項分類：腫瘤轉移，感染，發炎性反應，腦血管疾病，反應性病變，化學性反應。
48位病人中，19例腦膜腫瘤轉移。其他29例非腫瘤疾病有10例腦膜感染，5例腦膜發炎性反應，8例腦血管疾病（7例早期腦梗塞，1例Sturge-Weber疾病），5例反應性腦膜病變，1例化學性腦膜炎。
結果顯示呈現硬腦膜增強的共有11例腦膜腫瘤轉移，1例阿米巴腦膜炎，4例腦膜發炎性反應，7例腦梗塞，5反應性腦膜病變及1例化學性腦膜炎。而呈現軟腦膜增強的共有8例腦膜腫瘤轉移，9例腦膜感染，2例腦膜發炎性反應及2例腦血管疾病（1例早期腦梗塞及1例Sturge-Weber疾病）。同時出現兩種腦膜增強的有一例腦膜發炎性反應（Wegener granulomatosis）及一例早期腦梗塞。
分析結果認為廣泛線型的軟腦膜增強較偏向非腫瘤腦膜疾病。結節狀軟腦膜造影增強可以是腫瘤的轉移或其他疾病，如結核腦膜炎，中樞系統的結節病。局部結節狀硬腦膜增強大部份為腫瘤轉移。廣泛線型的硬腦膜增強則要考慮腫瘤轉移或反應性腦膜病變。

關鍵字

腦膜 ； 磁振造影 ； 腦膜炎 ； 腦膜腫瘤轉移

並列摘要

This study was performed to correlate meningeal enhancement patterns with intracranial meningeal carcinomatosis and non-neoplastic meningeal diseases.
From 1993 to 1998, 48 patients with a clinical diagnosis of meningeal carcinomatosis and non-neoplastic enhancement on MR imaging were reviewed. Two enhancement patterns of the meninges were characterized: pachymeningeal and leptomeningeal. The distribution and shape of the enhancement were also inspected. The meningeal enhancement was classified into six etiologic subgroups: carcinomatosis, infection, inflammation, cerebrovascular disease, reactive meningitis, and chemical meningitis. Nineteen of the 48 patients with enhanced meninges had carcinomatosis of the meninges. The other 29 patients without neoplasms included 10 with infectious meningitis, 5 with inflammatory disease, 8 with cerebrovascular disease (7 with early brain infarction and 1 with Sturge-Weber disease), 5 with reactive changes and 1 with chemical meningitis.
Pachymeningeal enhancement occurred in 11 patients with meningeal metastasis, 1 with amebic meningitis, 4 with inflammatory meningeal disease, 7 with early infarction, 5 with reactive meningeal disease, and 1 with chemical meningitis while leptomeningeal enhancement was shown in 8 meningeal metastases, 9 with infectious meningitis, 2 with inflammatory changes and 2 with vascular disease (1 with early brain infarction and 1 with Sturge-Weber disease). Both enhancement patterns were noted in 1 with inflammatory changes (Wegener granulomatosis) and 1 with early brain infarction.
Diffuse linear leptomeningeal enhancement favored non-neoplastic etiologies while enhanced leptomeningeal nodules indicated meningeal metastasis and some non-neoplastic disease such as tuberculosis and neuro-sarcoidosis. Focal nodular pachymeningeal enhancement presented mostly due to meningeal carcinomatosis. Diffuse linear pachymeningeal enhancement could be meningeal carcinomatosis or reactive meningeal change.

並列關鍵字

Meninges ； Magnetic resonance imaging ； Meningitis ； Meningeal metastasis