出血性脑转移瘤

出血性脑转移瘤

病史：

Middle-aged man with no relevant medical history presents with headaches and a possible new onset seizure 中年男性，出现头痛和可能的癫痫发作，既往无相关的临床病史。

影像改变：

Noncontrast enhanced CT of the brain reveals multiple high-density brain lesions with surrounding vasogenic edema, suggestive of hemorrhagic metastases (green arrows inFigure 1 and Figure 2). Post-contrast images demonstrate enhancement of several of the lesions (yellow arrows in Figure 1 and Figure 4).平扫CT显示颅内多发性高密度病灶，周围环绕以血管源性水肿，提示出血性脑转移瘤（绿色箭头）。增强扫描，显示数个病灶有明显强化（黄色箭头）

Medialstinal and lung windows from the CT of the chest demonstrate the primary lung carcinoma (red arrows inFigure 5 and Figure 6）胸部CT纵隔及肺窗显示原发性肺癌（红色箭头）

诊断：

Multiple hemorrhagic intracranial metastases from primary lung carcinoma 肺癌颅内多发性出血性脑转移

要点：

Metastatic lesions are frequently centered at the gray-white junction.转移性肿瘤多见于灰白质交界区。

The most common cause of multiple hemorrhagic metastasis to the brain is lung carcinom

最常见的引起出血性脑转移瘤是肺癌。

讨论：

Metastatic spread to the brain is usually arterial, although less commonly spread via the Batson venous (pelvic, GI tumors) may occur. Most metastatic lesions are well-demarcated and tend to cluster at the gray-white matter junction.

转移播散至颅内通常是通过动脉系统，虽然有少数是经由Batson静脉播散（盆腔、胃肠道肿瘤），大多数转移性病灶是边界清楚，多位于灰白质交界区。

Most of the brain metastases originate either from a primary lung tumor or from metastatic lesions in the lungs, since most large aggregates of tumor cells are filtered by the lung capillary network. Single tumor cells, however, can pass through the lung capillary network, and larger tumor emboli can pass from the venous to arterial circulation through a patent foramen ovale or a right to left shift.

The most likely malignancies to produce hemorrhagic metastases are melanoma, renal cell carcinoma, choriocarcinoma, thyroid, lung, breast, and germ cell tumors. Due to their increased prevalence, however, bronchogenic lesions are the most common source of hemorrhagic lesions.

可以导致出血性脑转移瘤的常见恶性肿瘤有黑色素瘤、肾细胞癌、绒毛膜癌、甲状腺癌、肺癌、乳腺癌、以及生殖细胞癌。然而由于不同的发病率，支气管源性肿瘤是最常导致出血性脑转移瘤。

Up to 20% of patients with metastases to the brain present with seizures.

超过20％的脑转移瘤患者会出现癫痫发作。

Mnemonic MR CT BB 记忆法：MR CT BB

M – Melanoma 黑色素瘤

R – Renal cell carcinoma 肾细胞癌

C – Choriocarcinoma 绒毛膜癌

T – Thyroid, terratoma 甲状腺癌

B – Bronchogenic carcinoma 支气管肺癌

B – Breast carcinoma. 乳腺癌

病例来源：ACR Thursday, April 6, 2006