CLINICAL AND RADIOLOGICAL PICTURES OF HEPATOCELLULAR-CARCINOMA WITH INTRACRANIAL METASTASIS
CLINICAL AND RADIOLOGICAL PICTURES OF HEPATOCELLULAR-CARCINOMA WITH INTRACRANIAL METASTASIS
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DOI：
10.1111/j.1440-1746.1995.tb01593.x
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发表时间：
1995-07-01
影响因子：
4.1
通讯作者：
LEE, SD
中科院分区：
文献类型：
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作者：
YEN, FS;WU, JC;LEE, SD
肝细胞癌（HCC）肝外扩散并不罕见。为了描绘颅内转移 HCC 的临床和放射学图像，对 33 个记录的病例进行了分析。 18 例有脑实质转移，但未累及颅骨；其余15例发现颅骨转移伴脑侵犯。基础HCC主要为扩展型（13/33，39.4%）和多灶性（13/33，39.4%）型。 18例（18/33，54.5%）有与低血糖或肝性脑病无关的精神变化。 18 例（18/20，90%）通过非增强 CT 扫描发现高密度肿块病变，17 例通过增强 CT 图像显示均匀强化（17/22，77.3%）。非颅骨受累组5例（5/12，41.7%）出现环形强化，14例（14/16，87.5%）出现灶周水肿，而颅骨受累组未见此现象。 8例（8/33，24.2%）表现为脑出血。十二人（12/33，36.4%）死于脑疝。大多数（14/18，77.8%）非颅骨受累病例同时有肺转移，无骨转移，而颅骨受累组常（10/15，66.7%）有颅外骨转移，无肺转移。颅外转移差异有统计学意义（P < 0.05）。多变量生存分析显示，较低的乳酸脱氢酶水平（小于或等于 316 Un，P = 0.029）和治疗（手术或放射，P = 0.001）与较长的生存期呈正相关。总之，伴有颅内转移的 HCC 是有症状且危及生命的。一半病例可能来自肺转移，另一半可能来自骨转移。脑部照射或手术可以延长他们的生存期。
Hepatocellular carcinoma (HCC) with extrahepatic spreading is not uncommon. In order to delineate the clinical and radiological pictures of HCC with intracranial metastasis, 33 documented cases were analysed. Eighteen had brain parenchymal metastasis without skull involvement; the other 15 cases disclosed skull metastasis with brain invasion. The underlying HCC are mainly of expanding (13/33, 39.4%) and multifocal (13/33, 39.4%) types. Eighteen cases (18/33, 54.5%) had mental changes not related to hypoglycaemia or hepatic encephalopathy. Eighteen cases (18/20, 90%) disclosed hyperdense mass lesions by non-contrast computed tomography (CT) scans and 17 cases showed homogeneous enhancement (17/22, 77.3%) by post-contrast CT images. In the non-skull involved group, five cases (5/12, 41.7%) disclosed ring-shape enhancement and 14 cases (14/16, 87.5%) had perifocal oedema, which were not seen in the skull involved group. Eight cases (8/33, 24.2%) presented as intracerebral haemorrhage. Twelve (12/33, 36.4%) died of brain herniation. Most (14/18, 77.8%) non-skull involved cases had simultaneous lung metastasis without bony metastasis, while the skull involved group often (10/15, 66.7%) disclosed extracranial bony metastasis without lung metastasis. The difference in extracranial metastasis was statistically significant (P < 0.05). The multivariate survival analysis disclosed that lower lactate dehydrogenase level (less than or equal to 316 Un, P = 0.029) and treatments (surgery or radiation, P = 0.001) were positively associated with longer survival. In conclusion, HCC with intracranial metastasis is symptomatic and life-threatening. Half the cases may come from pulmonary metastasis and the other half may be from bony metastasis. Brain irradiation or surgery can prolong their survival.