MR and CT imaging of 24 pleomorphic xanthoastrocytomas (PXA) and a review of the literature

INTRODUCTION: The aim of our study was to review the imaging appearance of PXA, a rare and usually low-grade, astrocytic tumor that typically occurs in young adults. METHODS: The clinical presentation, location and imaging findings on CT (n = 15) and MR (n = 18) of 24 pathologically confirmed PXA were retrospectively reviewed. Two morphologic patterns were defined according to imaging features. The Mann-Whitney U-test was used for statistical analysis of the data. RESULTS: All the neoplasms were supratentorial and superficial in location with obvious leptomeningeal contact in 22 patients, although leptomeningeal enhancement was demonstrated in only 3. Common locations were temporal (42%), frontal (33%) and parietal (21%), and more than one lobe was involved in 21% of patients. On CT without contrast enhancement, PXA was an iso- or hypoattenuating mass, and calcification was seen in six tumors and inner table remodeling was seen in three patients younger than 12 years. On MR, the solid component of PXA was isointense relative to gray matter on T1-weighted images, hyperintense on T2-weighted images in more than 90% and enhanced intensely following intravenous contrast material administration. Cystic areas showed hyperintensity relative to CSF. Two imaging patterns were differentiated: first a cystic mass containing a mural nodule (70%) and second a predominantly solid mass that may show cystic changes (30%). CONCLUSION: The most consistent imaging features of PXA were a superficial location, leptomeningeal contact, and enhancement of the solid component. Apart from the classical PXA appearance of a cystic lesion with an enhancing mural nodule, a second pattern consisting of a predominantly solid mass was recognized.     

Supratentorial ectopic cortical ependymoma occurring with intratumoral hemorrhage

We report here a rare case of supratentorial ectopic cortical ependymoma. This tumor was localized in the left angular gyrus, occurred with intratumoral hemorrhage, was attached to the dura mater, exhibited no continuity with the ventricular system, showed distinctive pathological features (perivascular pseudo-rosette formations and firework-like giant rosette formations), and finally transformed to a glioblastoma-like high-grade lesion. A cortical ependymoma should be considered in the differential diagnosis of supratentorial cortical tumors with intraparenchymal hemorrhage and high vascularity, even if not in contact with the ventricular system. Although malignant transformation is unusual in cortical ependymoma, close observation and adjunctive radiotherapy are strongly recommended after the excision.     

幕上肿瘤病人应用自控镇痛泵留置尿管拔除时机的探讨

目的:探讨应用自控镇痛泵的幕上肿瘤病人手术后留置尿管的拔除时机。方法:将123例幕上肿瘤手术后病人,根据是否应用静脉自控镇痛泵,分为试验组与对照组,均在术后次日晨即尿管留置24 h后拔除留置尿管,观察两组间尿潴留的发生情况。结果:经χ2检验,两组病人发生尿潴留情况比较无显著性差异(χ2=2.856,P>0.05)。结论:应用自控镇痛泵的病人术后次日即可拔除尿管,以降低泌尿系统感染,增加病人舒适度。     

Therapeutic Difficulty in a Case of Supratentorial Primitive Neuroectodermal Tumor Diagnosed during Pregnancy

We report a supratentorial primitive neuroectodermal tumor (sPNET) in 17-year-old primipara in the second trimester her pregnancy. Magnetic resonance imaging revealed a left frontoparietal mass with solid and cystic component. Gross-total resection was achieved via a left frontoparietal craniotomy. It was decided to suspend the radiotherapy and chemotherapy until the 30 weeks of gestation. But, a sudden uncal herniation was developed due to the reccurrence of the tumor and bleeding into the tumor at the 25 weeks of gestation and the patient died after urgent decompressive surgery. sPNETs is an extremely rare brain tumor in pregnancy and only two cases were reported in the literature to date. There is no universally agreed treatment protocol for sPNETs during pregnancy and a multidisciplinary approach is required in treatment. In the present study, the clinical, histopathological features and therapeutical difficulties of sPNETs diagnosed during pregnancy was discussed with the literature review.     

成人幕上原始神经外胚层肿瘤的MRI表现

目的:探讨成人幕上原始神经外胚层肿瘤(PNET)的MRI表现,提高对本病的诊断水平。方法:回顾分析10例经手术和病理证实的幕上PNET的MRI资料(其中3例为术后复发而再次手术的病例)。结果:病灶多数位于额叶及额顶叶,病灶普遍较大,病灶绝大多数信号不均匀,病灶内可见囊变/坏死(9例)、出血(3例)、钙化(2例)、流空小血管影(5例),增强后病灶呈明显不均匀强化(9例),2例显示肿瘤脑脊液通路播散,1例显示肿瘤侵犯上矢状窦和颅骨。结论:PNET的MRI表现无特异性,一些MR特征对本病的诊断有一定的帮助,最后的确诊依赖于病理学诊断。     

利多卡因对幕上肿瘤切除术患者血浆S100β蛋白的影响

目的 观察利多卡因对幕上肿瘤切除术患者血浆S100β蛋白的影响.方法 选择30例择期行幕上肿瘤切除术患者,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为利多卡因组和对照组,每组15例.利多卡因组麻醉诱导后单次静脉注射2％利多卡因1.5 mg/kg,随后以2 mg/（kg＆#183;h）的速度持续输注至术毕;对照组按照相同的剂量和速度给予0.9％氯化钠.分别在术前、术毕和术后1d抽取颈静脉球血液检测血浆S100β蛋白水平.结果 利多卡因组术前、术毕、术后1d血浆S100β蛋白分别为（21.03±11.67）、（32.63±10.14）、（34.16±17.59） ng/L,对照组分别为（23.04±13.32）、（44.98±16.63）、（39.85±21.99） ng/L.两组术前和术后1d血浆S100β蛋白比较差异无统计学意义（P＞0.05）,但术毕血浆S100β蛋白比较差异有统计学意义（P＜0.05）.结论 幕上肿瘤切除术患者术中给予利多卡因能降低术毕时血浆S100β蛋白水平.     

脑室出血量对幕上自发性脑出血患者预后的影响

目的研究脑室出血（IVH）对幕上自发性脑出血（ICH）患者预后的影响。方法前瞻性收集幕上自发性ICH合并IVH患者105例,运用IVH评分系统量化IVH体积,采用多因素Logistic回归分析消除混杂因素的影响。结果发病后30 d,根据改良Rankin量表（mRS）评估患者预后,本组预后较好45例（42.9%;mRS 0-2分）,预后较差60例（57.1%;mRS 3-6分）。预后较差患者IVH体积[（26.5±14.1）ml]明显大于预后较好的患者[（5.1±5.3）ml;P〈0.01]。多因素Logistic回归分析显示,IVH体积是ICH患者预后不良的独立危险因素（OR=2.17;95%置信区间为1.39-3.92;P〈0.05）。结论IVH体积是幕上自发性ICH患者预后不良的独立危险因素;合并IVH体积越大,患者预后越差。     

Rapidly Enlarging Pediatric Cortical Ependymoma

We report a 10-year-old boy with supratentorial cortical ependymoma that rapidly grew in the course of 3 years. He suffered generalized seizures when he was 5 years old; MRI showed a small cortical lesion in the right postcentral gyrus. MRI performed 2 years later revealed no changes. For the next 3 years he was free of seizures. However, at the age of 10 he again suffered generalized seizures and MRI disclosed a large parietal tumor. It was resected totally and he remains free of neurological deficits. The histopathological diagnosis was ependymoma. Pediatric supratentorial cortical ependymomas are extremely rare. We recommend including cortical ependymoma as a differential diagnosis in pediatric patients with cortical mass lesions presenting with seizures and careful follow-up even in the absence of symptoms because these tumors may progress.     

成人幕上原始神经外胚层肿瘤的MRI表现及病理特点分析

目的 探讨成人幕上原始神经外胚层肿瘤(SPNET)的MRI表现与病理联系,提高诊断水平.方法 搜集10例经手术病理证实的成人SPNET的临床病理及MRI资料,回顾性分析其影像学特点,并结合病理归纳其联系.男女比例为7∶3,中位年龄45.0岁,7例以头痛、呕吐首发,2例头痛伴晕厥,1例面部及舌根部麻木.均采用GE 1.5 T MRI扫描仪行MRI平扫+增强检查.结果 病灶均单发,其中额叶5例、颞叶3例、顶叶2例,1例累及胼胝体膝部,无一例术前发生转移.病灶体积大,边界清,占位效应显著,3例无水肿,5例伴轻度水肿,2例伴明显水肿,2例伴出血,未见钙化.囊实性为主6例,表现为大囊小结节,壁结节多位于大脑凸面,囊变常靠近中线,实性为主4例,可伴灶性坏死,MRI上呈等或低T1WI、高或稍高T2WI信号,增强后呈“印戒”样或“蜂窝”样强化.结论 成人SPNET的MRI表现与组织学特点密切相关,MRI表现具有特征性,仍依靠病理学确诊.     

幕上原始神经外胚层肿瘤的CT、MRI和病理分析

目的探讨幕上原始神经外胚层肿瘤（PNET）的CT及MRI特点，以提高影像学诊断的准确性。资料与方法分析经手术病理证实的8例PNET的CT及MRI表现。结果8例PNET分别位于幕上大脑半球的额顶、额颞、枕叶、胼胝体区，病灶普遍较大，多为偏实性肿瘤，边界清晰，瘤周水肿较轻，其中病灶内囊变4例，合并出血3例，肿瘤T1WI呈稍低信号，T2WI呈稍高信号4例，T1WI、T2WI呈混杂信号3例，2例DWI显示呈高信号。增强检查肿瘤可表现为不均一强化、不规则“印戒”样强化，2例显示沿室管膜播散。结论PNET影像学表现有一定特征，影像学表现结合临床症状有助于与其他肿瘤区分。