脑膜瘤瘤周水肿的CT与手术病理对照观察

目的：研究脑膜瘤瘤周水肿的发生机制及相关因素。材料和方法：结合手术病理观察，分析３２例脑膜瘤患者的ＣＴ资料。结果：ＣＴ所示的脑膜瘤瘤周水肿程度与手术所见的瘤脑界面有关联性，脑膜瘤瘤脑界面有三种类型：光滑型、移行型和侵蚀型。光滑型不伴有瘤周水肿，移行型多伴有晕带状瘤周水肿，侵蚀型多伴有指状瘤周水肿。脑膜瘤的瘤周水肿与肿瘤的发生部位、大小及病理亚型无显著关联性。结论：根据脑膜瘤瘤周水肿的ＣＴ表现可推测脑实质受侵蚀的程度，为手术方案的制定提供依据     

非典型脑膜瘤的MRI诊断

目的:分析非典型脑膜瘤的MRI表现及病理基础,以提高对该肿瘤的认识.方法:回顾性分析经手术病理证实的15例非典型脑膜瘤的MRI表现,探讨肿瘤的部位、形态、有无出血囊变、瘤体占位效应、瘤周水肿、瘤体信号及强化特点,并行病理对照分析.结果:本组15例非典型脑膜瘤,部位典型者13例(86.7%),典型部位以大脑镰、矢状窦旁、...     

脑膜瘤的CT诊断

目的：提高脑膜瘤CT诊断的准确性。方法：回顾分析42例经手术病理证实为脑膜瘤患者的CT表现。肿瘤位于大脑镰旁10例，大脑凸面12例，矢状窦旁8例，蝶骨嵴7例，嗅沟4例，桥小脑角1例。结果：增强后多为均匀增强。边界清晰，呈圆形或椭圆形。不典型CT表现为肿瘤混杂有低密度区，且无明显强化，或呈环形强化或有壁结节的强化。结论：脑膜瘤的CT表现具有特征性，而且临床表现与CT某些征象有关。临床症状的轻重与瘤周水肿的程度有相关性。     

复发性脑膜瘤的临床影像与病理分析(附52例报告)

目的 探讨脑膜瘤的复发规侓,提高对脑膜瘤复发的预测可能性.方法 回顾性分析52例复发性脑膜瘤的临床及影像资料.结果 46例单发,6例多发.4例多次复发.41例良性I级,其中21例为上皮型;11例II～III级脑膜瘤.单发者平均直径4～6 cm,35例不规则分叶覃菌形,伴钙化2例.24例不均匀强化.46例血供(或极)丰富.19例矢状窦旁及凸面者均有中或重度瘤周水肿,20例镰旁、天幕及颅底者无水肿;5例镰旁者均包膜完整,4例大脑凸面者均包膜不完整;9例矢状窦旁及凸面者侵及脑组织,20例颅底、凸面及矢状窦旁者侵犯颅骨,13例矢状窦旁者静脉窦受累.结论 脑膜瘤的复发受多因素影响,主要取决于病理类型、发病部位、肿瘤的血供、脑组织及颅骨的受侵以及静脉窦的累及.     

双源CT静脉造影对上矢状窦旁脑膜瘤显微手术的价值探讨

目的 探讨脑双源CT静脉造影(CTV)显示上矢状窦旁脑膜瘤与上矢状窦关系、显示中央沟静脉和代偿回流静脉情况,从而为神经外科制定手术方案提供重要信息.方法 32例上矢状窦旁脑膜瘤患者行脑CTV检查,在工作站重建三维图像,术前判断肿瘤与静脉窦关系、显示中央沟静脉和代偿回流静脉并与术中情况对照.结果 根据CTV显示的窦腔狭窄程度,将上矢状窦旁脑膜瘤分为三型:Ⅰ型,瘤体与一侧静脉窦壁外层附着,静脉窦壁正常或轻度受压,窦腔通畅;Ⅱ型,肿瘤沿静脉窦壁生长,窦壁不规则增厚,窦腔变窄但尚通畅;Ⅲ型,瘤体长人静脉窦内或跨越生长,静脉窦腔内形成充盈缺损,窦腔闭塞,同时有静脉侧支循环建立.本组Ⅰ型8例,Ⅱ型15例,Ⅲ型9例.术中观察到代偿扩张的浅静脉以及肿瘤与中央沟静脉、上矢状窦的关系均与CTV结果相符.本组无术后严重神经功能受损和死亡病例.结论 上矢状窦旁脑膜瘤患者术前行CTV检查可以明确肿瘤部位、矢状窦阻塞程度及引流静脉代偿情况,为手术人路的选择及手术方案的制定提供重要信息,在全切肿瘤的同时减少并发症的发生,提高患者的生活质量.     

恶性脑膜瘤CT与病理对照分析及CT诊断

复习了２０例资料完整经手术和病理证实的恶性脑膜瘤，综合分析其ＣＴ表现为：（１）肿瘤外形不规则，有分叶结节状凸起，边界不清；（２）肿瘤内低密度区及脑膜瘤的非均一强化或环状强化；（３）明显的瘤周水肿；（４）肿瘤侵犯颅骨及颅外软组织。讨论了恶性脑膜瘤的ＣＴ表现与病理组织学关系以及诊断与鉴别诊断。     

脑膜瘤瘤周水肿的MR与手术病理对照研究

目的：分析脑膜瘤瘤周水肿的发生机制及MR表现。方法：搜集81例经手术、病理证实脑膜瘤，分析其瘤周水肿的MR表现。结果：①无水肿区．瘤周无明显异常信号。②圆晕状水肿，瘤周弧形晕带状异常信号。③不规则水肿，瘤中斑片状不规则异常信号。④指压迹状水肿，白质内指压迹状异常信号。结论：脑膜瘤瘤周水肿有一定特点，对其影像学诊断及手术方案的制定提供依据。     

脑膜瘤和星形细胞瘤瘤周水肿的MRI对照研究

目的：比较脑膜瘤和星形细胞瘤瘤周水肿的MRI特点。材料和方法：对88例星形细胞瘤MRI和51例脑膜瘤MRI进行统计学分析。结果：（1）51％脑膜瘤伴瘤周水肿，其中月晕型水肿11例（42．3％），指样型水肿10例（38．5％），混合型5例（19．2％）；86．4％星形细胞瘤伴瘤周水肿，均为指样型水肿。（2）当瘤体超过64cm3时，87％脑膜瘤和87．5％星形细胞瘤伴水肿，脑膜瘤轻度水肿占61．5％，星形细胞瘤重度水肿占78．6％；瘤体为8～64cm3时，44．4％脑膜瘤伴水肿，91．5％星形细胞瘤伴水肿；体积小于8cm3时，11．1％脑膜瘤伴水肿，且为轻度水肿，而61．5％星形细胞瘤伴不同程度水肿。（3）脑膜癌中，血管母细胞型水肿发生率较高（100％），纤维细胞型最低（25％）；星形细胞瘤中，Ⅲ～Ⅳ级水肿发生率最高。结论：MRI不同的水肿形态与肿瘤的来源有关，对此进一步研究将有助脑内、外肿瘤的鉴别诊断及瘤-脑界面的评价。     

非典型脑膜瘤的CT诊断(附14例报告)

笔者报告14例经手术与病理证实的非典型CT表现的脑膜瘤,其中有:瘤体呈混杂密度;肿瘤内有不规则不强化的低密度区;肿瘤呈环形强化或弧形强化;肿瘤有壁结节出现;全瘤以囊性为主要表现及以瘤周大范围脑水肿为主要表现的各种非典型CT表现。认为脑膜瘤病程较长;增强时瘤体实质部分强化较其他肿瘤显著;窟周水肿位于瘤体一侧的脑质内;有白质塌陷征;部位位于脑膜旁;有局部颅骨骨质改变等特点可有助于鉴别诊断。     

脑膜瘤伴瘤周水肿的MRI特征分析

目的:探讨脑膜瘤伴瘤周水肿的机制。方法:49例经手术病理证实的脑膜瘤,回顾性分析伴有瘤周水肿脑膜瘤的MRI特征,用Fisher′s检验比较肿瘤大小、部位、边缘、假包膜征及肿瘤T2WI信号与瘤周水肿发生的关系。结果:肿瘤边缘、假包膜征和肿瘤T2WI信号与脑膜瘤瘤周水肿发生明显相关,P值分别是0.016,0.004 和0.041。结论:脑膜瘤脑界面侵袭性模式和T2WI高信号是提示脑膜瘤发生瘤周水肿的因素。     

Lymphoplasmacyte-rich meningioma: A rare histologic variant of benign meningioma with atypical bone invasion

Meningiomas are the most common primary intracranial brain tumor and have been divided into 15 histologic subtypes, which are further classified into 3 grades according to biological behavior. Lymphoplasmacyte-rich meningioma is a rare histologic subtype of benign (grade 1) meningiomas characterized by prominent infiltration of plasma cells and lymphocytes, with a variable proportion of meningothelial elements. These benign meningioma variants usually cause significant peritumoral brain edema and mimic higher-grade lesions, which is believed to represent inflammatory cell infiltration rather than true neoplastic invasion. Bone invasion in these tumors is exceedingly rare and its clinical significance remains elusive. We describe the case of a lymphoplasmacyte-rich meningioma with skull invasion and peritumoral brain edema in a 57-year-old female patient presenting with left hemiparesis. Gross total resection of the lesion and adjacent skull were performed and histophatological examination disclosed a lymphoplasmacyte-rich meningioma. Gradual decrease of the parenchymal edema was seen on postoperative imaging studies and the patient showed progressive improvement of the motor deficit. This case report depicts rare bone invasion by lymphoplasmacyte-rich meningioma and highlights the other imaging features of this rare histologic subtype of benign meningioma. Due to the paucity of cases, gross total resection, and long-term follow-up are warranted as the prognosis of these tumors is still not fully understood.Kewyords: Lymphoplasmacyte-rich meningioma, WHO grade 1 tumor, Vasogenic edema, Magnetic resonance imaging     

脑膜瘤瘤周水肿的64层螺旋CT灌注成像定量研究

目的:应用64层螺旋CT灌注成像定量估计脑膜瘤瘤周水肿的灌注状况.方法:对15例脑肿膜瘤伴瘤周水肿患者进行MSCT灌注成像,经灌注软件处理分别计算近瘤周水肿区及远瘤周水肿区局部脑血流量(rCBF)、局部脑血容量(rCBV)、表面通透性(PS),并与对侧脑白质灌注参数进行比较;测量并计算水肿指数EI[(V水肿+V肿瘤)/V肿瘤],并与rrCBV(rCBV水肿平均/rCBV对侧脑白质)的进行相关性分析.结果:脑膜瘤近瘤周水肿区、远瘤周水肿区的rCBF和rCBV明显低于对侧脑白质(rCBF:t=5.78和4.34,P=0.001,0.005; rCBV:t=6.46和8.46,P=0.001,0.003),近瘤周水肿区的rCBF和rCBV低于远瘤周水肿区(rCBF:t=3.49,P=0.013;rCBV:t=4.10,P=0.006),三组间PS值的差异均没有统计学意义(P值均＞0.05);水肿指数跟瘤周水肿区的rrCBV值呈负相关(r=-0.72,P＜0.01);2例恶性脑膜瘤近瘤周水肿区的rCBV、rCBF、PS值的均数明显高于良性脑膜瘤近瘤周水肿区.结论:脑膜瘤瘤周水肿区的灌注具有一定特征,有助于鉴别肿瘤良恶性,优化手术方案及相关辅助治疗、评价手术疗效、鉴别肿瘤复发和坏死.     

CT灌注成像对脑肿瘤瘤周水肿的评价

目的　应用CT灌注成像半定量估计脑肿瘤瘤周水肿的灌注状况。方法　应用SomatomPlus4螺旋CT机,对21例脑肿瘤瘤周水肿患者[脑膜瘤4例,胶质瘤(Ⅲ~Ⅳ级)7例、转移瘤10例]进行CT灌注成像,经灌注软件处理分别计算瘤周水肿区局部脑血流量(rCBF)、局部脑血容量(rCBV)、对比剂平均通过时间(MTT),并与对侧脑白质和不同肿瘤瘤周水肿间的灌注参数进行比较。结果　脑膜瘤和转移瘤瘤周水肿的rCBF和rCBV明显低于对侧脑白质(rCBF:t=2 .92和3 .82,P值均<0. 05, 0. 005;rCBV:t=2 .42和3. 53, P<0 .05, 0 .01),胶质瘤瘤周水肿的rCBF和rCBV与正常脑白质无明显差别(t=1 .00和1 .33, P值均>0 .05)。瘤周水肿区与对侧正常脑白质rCBF、rCBV比值,脑膜瘤和转移瘤之间差异无统计学意义(t=0 .23和0. 73, P值均>0 .05),胶质瘤明显大于脑膜瘤和转移瘤(t=3 .05和3. 37, P<0 .01, 0 .005)。结论　脑膜瘤和转移瘤瘤周水肿区的rCBF、rCBV显著降低,而胶质瘤瘤周水肿区接近或高于对侧脑白质,CT灌注能定量脑肿瘤瘤周水肿血流灌注状况,有助于肿瘤的鉴别和随访。     

Alterations in diffusion and perfusion in the pathogenesis of peritumoral brain edema in meningiomas

Magnetic resonance perfusion and diffusion studies were undertaken to clarify the significance of ischemia in the pathogenesis of peritumoral brain edema in patients with meningiomas. Included in this study were 26 patients with 27 meningiomas and 5 gliomas. Perfusion-weighted imaging (PWI) was performed using a gradient-echo, echo-planar-imaging (EPI) sequence for calculation of the relative regional cerebral blood volume (rrCBV) and the relative regional cerebral blood flow index (rrCBFi). Furthermore, multi-slice spin-echo EPI sequences were applied in order to obtain anisotropic and isotropic diffusion-weighted imaging (DWI). Apparent diffusion coefficient (ADC) values were then calculated for peritumoral brain parenchyma from tumors, with and without edema, using various diffusion sensitivities. Meningiomas without edema demonstrated a minimal increase of perfusion parameters in the peritumoral brain tissue. In contrast, cases with brain edema had highly significant ( p<0.0005) lower rrCBV and rrCBFi. The edema index (EI) correlated strongly with the rrCBV. A fitting procedure resulted into the following mathematical relation: EI=0.1/rrCBV(2). The DWI showed a significantly larger ADC value within areas of brain edema, compared with the normal white matter (0.74 x 10(-3) vs 1.55 x 10(-3) mm(2)/s; p<0.0001). Increases in EI correlated with increases in ADC values. In 31% of the meningiomas associated with edema, areas with increased signal, probable ischemia, demonstrated significantly lower ADC values, in comparison with the rest of the edematous areas. These areas were confined to tissue immediately adjacent to the tumor. In general, the decrease in rrCBV in brain edema represents a consequence from, rather than a cause of, vasogenic edema. Ischemic alterations can be regarded as secondary, facultative phenomena in the pathogenesis of meningioma-related brain edema.     

Peritumoral brain edema in intracranial meningiomas evaluated by dynamic perfusion-weighted MR imaging: a preliminary study

Our objective was to semi-quantitatively evaluate the cerebral perfusion in the peritumoral brain edema of meningiomas using dynamic perfusion-weighted MR imaging. Six patients with intracranial meningiomas accompanied by peritumoral brain edema were prospectively examined by perfusion-weighted MR imaging. One patient was examined twice, once before and once 5 months after the surgical resection. The relative regional cerebral blood volume (rrCBV), the relative regional cerebral blood flow (rrCBF), and the relative regional mean transit time (rrMTT) were calculated for peritumoral brain edema and the contralateral white matter. These parameters were compared between peritumoral brain edema and the contralateral white matter. The time–concentration curve of the peritumoral brain edema was less prominent than that of the contralateral white matter, resulting in a significantly lower rrCBV (mean 46%) and rrCBF (mean 45%) in peritumoral brain edema than those of contralateral white matter. The serial perfusion-weighted MR imaging also demonstrated the recovery of these parameters after the removal of meningioma by means of surgical resection. Perfusion-weighted MR imaging can demonstrate significantly decreased rrCBV and rrCBF in peritumoral brain edema compared with those in normal white matter. Electronic Publication     

DTI多参数值及DTT技术在颅内肿瘤中的应用研究

目的 探讨MR扩散张量成像(DTI)多参数值在脑肿瘤中的诊断和鉴别诊断价值;评价扩散张量纤维柬成像(DTT)在显示脑肿瘤与周围脑白质纤维束关系中的应用.资料与方法 搜集经手术病理证实的星形细胞瘤(低级别、高级别)、脑膜瘤、转移瘤患者资料(低级别星形细胞瘤15例,高级别星形细胞瘤18例,脑膜瘤16例,转移瘤10例)共59例.行常规T_1WI、T_2WI、增强T_1WI及DTI.测量病灶肿瘤实质区、瘤周水肿区、囊变坏死区、水肿邻近正常白质区及对侧正常白质区的平均扩散系数(DCavg)值、部分各向异性分数(FA)值、1-容积比(1-VR)值及相对各向异性(RA)值,分析各测量值在肿瘤的诊断及良恶性鉴别诊断中的作用.利用DTI数据进行DTT重组病变周围脑白质纤维束,观察肿瘤与脑白质纤维束的关系.结果 低级别星形细胞瘤、高级别星形细胞瘤、脑膜瘤及转移瘤的肿瘤实体、瘤周水肿区的FA值、1-VR值及RA值差异均具有统计学意义(P<0.05);对侧正常白质区DCavg值、FA值、1-VR值及RA值差异均具有统计学意义(P<0.5).FA图、FA彩色编码图、DTT图均能显示脑白质纤维受累情况,而常规MRI难以显示;脑白质纤维束与脑肿瘤的位置关系可分为四型,即推挤型、水肿型、浸润型和破坏型.低级别星形细胞瘤及脑膜瘤良性肿瘤周围的白质纤维束多呈推挤水肿改变,而高级别星形细胞瘤及转移瘤恶性肿瘤周围的白质纤维束多表现为以浸润破坏为主.结论 DTI较常规MRI能更确切、直观地显示脑内肿瘤与周围脑白质的关系,结合FA值、1-VR值及RA值能为肿瘤的诊断及鉴别诊断提供更多的依据;DTT可以为临床提供更多的肿瘤及其周围白质纤维束的信息,指导术前计划的制定和术后的评估.     

The characteristics of cerebral meningiomas and surrounding tissues on dynamic CT

Summary Dynamic CT was utilized to evaluate 11 patients with histologically benign meningiomas. While it was found that all demonstrated macroscopic neovascularity, subtle differences in the dynamic perfusion curves were identified both between different meningiomas and from region to region within the same tumor. Other than basic anatomic differences, these changes may reflect intratumoral ischemia and hypothetically herald cystic/necrotic alteration within the neoplasm. The dynamic calculations over the surrounding brain showed areas of gross hyper- and hypoperfused cerebral cortex, and hypoperfused white matter in regions of peritumoral edema. These latter findings are of uncertain clinical importance. The dynamic examination also confirmed cases of dural venous sinus invasion and calvarial permeation by tumor. In addition, the dynamic series showed macroscopic neovascularity in one case with a completely negative selective cerebral arteriogram. It is felt that certain cases which have previously been evaluated by static CT may benefit from further study utilizing the dynamic method.     

MRI of primary meningeal tumours in children

Childhood meningeal tumours are uncommon and mostly meningiomas. We reviewed the histological and radiological findings in meningeal tumours in six children aged 12 years or less (four benign meningiomas, one malignant meningioma and one haemangiopericytoma). Compared to the adult counterpart, childhood meningiomas showed atypical features: cysts, haemorrhage, aggressiveness and unusual location. MRI features varied according to the site of the tumour, histology, haemorrhage, and presence of intra- or peritumoral cysts. Diagnosis of the extra-axial tumour was relatively easy in two patients with meningiomas, one malignant meningioma and one haemangiopericytoma. MRI findings strongly suggested an intra-axial tumour in two patients with benign meningiomas, because of severe adjacent edema. Awareness of the variable findings of childhood meningiomas and similar tumours may help in differentiation from brain tumours. Received: 22 September 1998 Accepted: 18 November 1998     

Meningiomas with brain edema: radiological characteristics on MRI and review of the literature

OBJECT: Despite their benign characteristics, meningiomas are often accompanied by perifocal brain edema. The aims of this study are to determine what kind of characteristics on magnetic resonance (MR) image are indicative of a meningioma that produces brain edema and to investigate the mechanism responsible for brain edema accompanying meningiomas. METHODS: Fifty-one patients with meningioma were examined by magnetic resonance imaging (MRI), and tumor size, tumor location, shape of tumor margin, peritumoral rim, and signal intensity of tumor on T2-weighted image (T2WI) were compared and correlated with the presence versus absence of brain edema. Surgical histopathology was also examined and correlated with the MRI findings and brain edema. RESULTS: Shape of tumor margin, peritumoral rim, and signal intensity of tumor on T2WI correlated with brain edema on multivariate analyses. CONCLUSION: Invasive pattern of brain-tumor interface and hyperintensity on T2WI were indicative factors of meningiomas producing brain edema.     

脑膜瘤瘤周水肿的MRI表现与手术病理对照研究

目的：分析脑膜瘤瘤周水肿的MRI表现与手术、病理的关系。材料和方法：对51例磁共振图像中脑膜瘤的瘤周水肿特点进行分析，并与手术、病理对照。结果：51％脑膜瘤伴瘤周水肿，磁共振T2WI瘤周水肿有月晕型（50％）和指样型（50％）两种，该分型与显微外科手术界面相对应。结论：MRI有助于脑内、外肿瘤的鉴别诊断。