目的:探讨CT或MRI显示占位效应及强化不明显胶质瘤的有效诊治方法。方法:19例CT或MRI检查显示无明显占位效应,并且强化均不明显,CT平扫及增强,呈低密度,MRI T1WI呈低信号,T2WI呈稍高或高信号的局限性病变。结果:10例不排除非胶质瘤,宜先观察或保守治疗半月至1月,病灶无变化,诊断仍不明确者,手术治疗;9例拟诊胶质瘤者,均作剖颅探查。19例术中发现均为实性肿瘤。其中,14例病变肉眼几乎难与正常脑组织区别,切除时感觉质地较韧,血供差;5例病变呈鱼肉状,淡肉红色,质软,血供较差,为较典型胶质瘤。位于中央沟附近3例,该3例中2例采用立体定向开颅手术,1例采用CT定位开颅手术。后者术中肉眼确定病变困难,导致术后肢体活动障碍加重,余18例疗效满意。病理检验为星形细胞瘤Ⅰ～Ⅱ级12例,少枝胶质细胞瘤2例,星形细胞瘤Ⅲ～Ⅳ级5例。结论:对于CT或MRI显示占位效应及强化不明显脑内病变,保守治疗无效者,尤位于非功能区病变者,应积极考虑开颅手术切除。对位于功能区病灶或小病灶,应采用立体定向开颅手术,避免因寻找病变困难而导致术后神经功能废损症状加重,或造成不能获得准确病检结果的不良后果。
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.
