MRI在鞍旁海绵状血管瘤与脑膜瘤鉴别诊断中的应用

目的 分析MRI在鉴别鞍旁海绵状血管瘤与脑膜瘤的表现特点.方法 回顾性分析经手术病理证实的20例鞍旁肿瘤MRI影像表现,观察MR影像特征.结果 鞍旁海绵状血管瘤与脑膜瘤均可同时侵犯鞍内及鞍旁,但两者MRI信号有特征性,海绵状血管瘤T1WI呈等或稍低于脑灰质信号,T2WI信号强度类似脑脊液信号,增强扫描病变强化显著,可见延迟强化.脑膜瘤呈等T1、T2信号,T2WI信号强度与脑灰质信号近似,增强扫描病变呈中等度弥漫性强化,相应部位可见脑膜线样强化.结论 MRI平扫加增强能明确显示鞍旁海绵状血管瘤及脑膜瘤的不同信号改变、强化特点及内部结构特点,其MRI信号特点对诊断有价值.     

鞍旁肿瘤的MR诊断及鉴别诊断

目的:探讨鞍旁肿瘤的MR影像学表现,提高诊断准确率.方法:回顾性分析64例经手术病理证实的鞍旁肿瘤MR影像学表现,所有病例均行MR平扫及增强扫描.结果:64例中脑膜瘤17例,侵袭性垂体瘤14例,神经鞘瘤9例,海绵状血管瘤6例,转移瘤6例,表皮样囊肿6例,脊索瘤4例,淋巴瘤2例.鞍旁脑膜瘤信号和强化表现与颅内其他部位脑膜瘤类似;侵袭性垂体瘤累及鞍旁,颈内动脉海绵窦段被包绕;神经鞘瘤以三叉神经鞘瘤多见,呈哑铃形跨颅中、后窝生长;海绵状血管瘤呈鞍内向鞍旁生长的哑铃形肿块,增强后强化显著,均匀强化或不均匀周边强化逐渐向内充填;鞍旁转移瘤多为双侧性,常见于鼻咽癌颅内侵犯;表皮样囊肿T1WI信号高于脑脊液,DWI上呈高信号改变;脊索瘤为不均匀信号,伴斜坡骨质破坏;鞍旁淋巴瘤可为双侧性,伴颅中窝底骨质破坏.结论:鞍旁肿瘤M R表现各有特点,把握其特征可作出正确诊断.     

鞍旁海绵状血管瘤与脑膜瘤的MR鉴别诊断

目的探讨鞍旁海绵状血管瘤与脑膜瘤的MR鉴别诊断要点。方法收集我院经手术病理证实的6例鞍旁海绵状血管瘤和15例鞍旁脑膜瘤的影像资料,比较两者MRI平扫及增强扫描表现的不同之处。结果鞍旁海绵状血管瘤以稍长T1、长T2为主要表现,DWI呈等信号,ADC值约为1.63×10-3 mm2/s,增强扫描3例早期明显均匀强化,3例延迟后均匀强化,邻近颞叶无水肿,颈内动脉海绵窦段包绕或被推压。鞍旁脑膜瘤表现为等T1、等T2信号常见,DWI呈等或略高信号,ADC值约为0.93×10-3 mm2/s,病变明显强化,12例可见"脑膜尾征"。结论鞍旁海绵状血管瘤T2WI呈明显高信号、ADC值高,脑膜瘤可见"脑膜尾征"。     

鞍旁海绵状血管瘤的CT和MRI诊断

目的总结7例鞍旁海绵状血管瘤CT、MRI和磁共振波谱（MRS）表现,探讨其诊断和鉴别诊断。资料与方法7例均经手术病理证实,均行CT和MR平扫,2例行CT增强扫描,7例行MR增强扫描,5例行MR扩散加权成像（DWI）,6例行^1H MRS检查。结果鞍旁海绵状血管瘤体积大,并同时伸入到鞍内。CT平扫病变呈等或稍高密度,密度均匀,MR T1WI呈等或稍低于脑灰质信号,T2WI呈类似脑脊液高信号。增强扫描病变呈非常显著强化。DWI呈等或稍低信号,但表观扩散系数（ADC）值明显高于正常脑实质。。HMRS表现为NAA峰、Cr峰和Cho峰消失。可出现Lip峰。结论CT检查时鞍旁海绵状血管瘤与脑膜瘤和垂体瘤鉴别困难,MRI表现很有特点,T2WI呈极高信号,增强扫描非常显著强化,ADC值明显升高而DWI接近等信号,MRS检查无NAA峰、Cr峰和Cho峰,MRI可以对海绵窦海绵状血管瘤作出定性诊断。     

鞍上病变的MR诊断

目的　分析探讨鞍上病变的MR诊断和鉴别诊断。方法　 13 6例鞍上病变均经手术病理证实。年龄 3～ 70岁。均行MR平扫检查 ,其中 10 2例行MR增强扫描。分析病变的MR表现。结果　颅咽管瘤 49例 ,脑膜瘤 18例 ,表皮样囊肿 15例 ,生殖细胞瘤13例 ,胶质瘤 8例 ,蛛网膜囊肿 8例 ,错构瘤 5例 ,脂肪瘤 5例 ,Rathke囊肿 5例 ,转移瘤 3例 ,皮样囊肿 3例 ,畸胎瘤 2例 ,组织细胞X1例 ,结节病 1例。通过分析MR表现 ,提出可根据病变信号和组织学特点将鞍上病变分为囊实性病变、T1 WI呈高信号的病变、囊性病变和实质性病变 4大类。结论　将鞍上病变进行分类对其鉴别诊断有重要意义     

鞍区脑膜瘤的MR影像及鉴别诊断

目的 分析鞍区脑膜瘤的MR影像特点，提高诊断水平。方法经手术及病理证实的鞍区脑膜瘤50例，对其临床和MR影像资料进行回顾性分析。结果47例为单发，3例为多发。位于鞍区的病灶数为52个，22个病灶中心位于鞍上，30个位于鞍旁。肿瘤多呈椭圆形或圆形，边界清晰，包膜完整，T1WI为等信号，T2WI为等、略高或低信号，41例行Gd-DTPA增强呈明显强化。结论MR对鞍区脑膜瘤的诊断与鉴别诊断具有重要临床价值。     

颅底脊索瘤的CT和MRI影像诊断与鉴别诊断

目的探讨颅底脊索瘤CT与MR影像学诊断与鉴别诊断。方法回顾性分析13例经病理证实的颅底脊索瘤的CT与MR影像学资料。结果13例脊索瘤中,发生在斜坡5例,鞍区4例,颅中凹2例,鼻咽部1例,蝶窦1例。肿瘤的形态以不规则形最多8例,圆形3例,椭圆形2例。病灶边界清楚9例,边缘模糊4例。MR表现为T1WI呈低、等、高混杂信号,T2WI则以高、低混杂信号为主。增强后病灶呈轻到中度强化,强化信号不均匀。CT见病灶呈不均匀等或稍高密度肿块,7例可见不同程度的骨质破坏。结论颅底脊索瘤的CT和MR表现有一定的特征性,结合临床大多可以确诊,但需与脑膜瘤、垂体瘤、鼻咽癌、软骨类肿瘤等鉴别。     

MRI对海绵窦病变的诊断价值

目的分析海绵窦(cavernous sinus,CS)病变的MRI表现及其临床价值。方法回顾性分析经临床或/和病理证实的海绵窦病变患者59例(男30例,女29例,年龄范围6~69岁,平均45.3岁)MRI资料。59例海绵窦病变患者均行MRI平扫及增强检查,分析病变形态、信号及累及范围。结果海绵窦原发肿瘤(脑膜瘤8例,三叉神经鞘瘤5例,多发性神经纤维瘤病1例,胶质瘤1例);海绵窦继发肿瘤(鼻咽癌18例,侵袭性垂体瘤8例,脊索瘤6例);非肿瘤性病变(颈内动脉瘤6例,颈内动脉海绵窦瘘3例,海绵状血管瘤2例,鼻咽部动静脉瘘累及海绵窦1例)。主要MRI征象:1)47例肿瘤性病变,一侧海绵窦受累29例,双侧海绵窦受累18例,其中13例包绕双侧颈内动脉,22例包绕一侧颈内动脉;2)非肿瘤性疾病12例,海绵窦内见异常血管流空信号,其中3例颈内动脉海绵窦瘘同侧眼上静脉扩张扭曲,6例动脉瘤表现为颈内动脉扩张呈类圆形流空信号,2例海绵状血管瘤呈稍长T1、长T2信号,增强扫描明显不均匀强化,延时扫描强化范围增大。结论 MRI能清楚显示海绵窦区病变及其累及范围,了解颈内动脉海绵窦段是否被包绕,对海绵窦病变的诊断及鉴别诊断具有重要意义,为临床治疗方案的选择提供理论依据。     

海绵窦海绵状血管瘤的MRI表现(2例及文献复习)

目的:探讨海绵窦海绵状血管瘤(cavernous sinus hemangiomas,CSHAs)的MRI表现特征。方法:回顾性分析经手术病理证实的2例CSHAs的MRI表现,并复习文献资料。结果:海绵状血管瘤位于左、右侧海绵窦各1例,MRI呈分叶状,边缘清晰,呈长T1长T2信号,信号均匀,未见出血及钙化。增强扫描病变明显强化,强化程度高于垂体,并表现出渐进性、向心性强化的特点。结论:CSHAs的MR表现具有特征性,MR检查有助于作出正确的定位和定性诊断。     

鞍旁肿瘤及肿瘤样病变的MRI表现

目的探讨鞍旁肿瘤及肿瘤样病变的MRI表现,以提高认识及诊断正确性。方法搜集41例病理证实鞍旁病变的术前MRI并对其进行回顾性分析,分析内容包括病变部位、形态、最大径、信号特点及增强表现等。结果 41例鞍旁病变中,脑膜瘤24例,信号均匀(22/24)或不均匀(2/24),增强扫描常可见脑膜尾征(18/24),6例包绕颈内动脉,11例侵入鞍内生长;神经鞘瘤5例,其中三叉神经鞘瘤2例,肿瘤内囊变多见(2/5);海绵状血管瘤4例,增强后均呈不均匀渐进性强化(4/4);表皮样囊肿3例,DWI序列上均呈高信号,而增强后无强化;颗粒细胞瘤1例,信号不均匀,内见多发小囊变,并见液平影;淋巴瘤1例,信号均匀,增强后亦呈均匀强化;黑色素瘤1例,T1WI高信号,T2WI呈低信号;脊索瘤1例,鞍旁肿块伴有右侧斜坡骨质信号异常;转移瘤1例,为转移性神经内分泌癌,增强后呈不均匀强化。结论鞍旁肿瘤及肿瘤样病变常有其典型的MRI表现,MRI很大程度上可于术前作出准确诊断。     

Cavernous sinus lesions

The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.     

鞍区少见病变的MR诊断及鉴别诊断

目的:通过分析探讨鞍区少见病变的MR表现特点及其鉴别诊断,提高MR对鞍区病变的诊断准确性。方法:手术病理证实的病例6例,年龄18～61岁。均行MR平扫和增强检查。分析其MR信号特点与周围解剖结构的关系。结果:累及鞍内及鞍上病变1例为下视丘胶质瘤;鞍旁病变2例,为中颅窝鞍旁硬膜型海绵状血管瘤。鞍上病变3例,1例为垂体柄的生殖细胞瘤,2例为胆脂瘤。以上6例病例,5例术前均误诊,1例术前未能正确定性。结论:为提高诊断准确性,减少误诊,应认真分析鞍区病变的MR信号特点及与周围结构的关系,同时加强对少见病的认识。     

垂体大腺瘤的MRI影像分析

目的:探讨垂体大腺瘤的MRI影像特征。方法:回顾性分析过去10年经临床病理证实17例垂体大腺瘤的MRI平扫及增强表现。结果:垂体大腺瘤表现为鞍区肿块,T1WI呈等或略低信号,T2WI呈等或略高信号,正常垂体未见显示。海绵窦侵袭性垂体腺瘤3例,2例伴有出血,“腰身”显示6例。结论:MR对垂体大腺瘤有定性诊断价值.术前可有效地观察其形态大小信号及与周围组织关系。     

MR imaging of Tolosa-Hunt syndrome

The Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by cavernous sinus inflammation, which is responsive to steroid therapy. The MR features of 11 patients with the clinical diagnosis of Tolosa-Hunt syndrome were studied. Two patients had normal MR studies of the orbit and cavernous sinuses. In nine patients, abnormal signal and/or mass lesions were seen in the cavernous sinuses; in eight cases, the abnormality was hypointense relative to fat and isointense with muscle on short TR/TE images and isointense with fat on long TR/TE scans. Extension into the orbital apex was seen in eight cases. In six of nine cases the affected cavernous sinus was enlarged; in five of nine it had a convex outer margin. One patient had a thrombosed cavernous sinus and superior ophthalmic vein in addition to a cavernous sinus soft-tissue mass. The signal intensity of Tolosa-Hunt syndrome in this limited series was similar to that of orbital pseudotumor and is confined to a limited differential diagnosis, which includes meningioma, lymphoma, and sarcoidosis.     

慢性侵袭性真菌性鼻窦炎的CT和MRI诊断

目的探讨慢性侵袭性真菌性鼻窦炎的CT和MRI表现及诊断价值。方法回顾性分析经手术、组织病理学证实的10例慢性侵袭性真菌性鼻窦炎的影像学资料。结果慢性侵袭性真菌性鼻窦炎发生于蝶窦5例，上颌窦3例，筛窦2例。CT表现：受累窦腔内充以软组织影，其中1例伴斑点状钙化；窦壁骨质破坏，同时伴周围骨质增生肥厚。MRI表现：T1WI为低信号（与脑实质比较，以下相同）2例，等信号7例；T2WI信号不均匀，7例以低信号为主，2例以高信号为主；增强后病变明显强化。侵犯邻近结构：眼眶9例，其中6例累及眶尖区，可见不规则软组织肿块影，与邻近眼外肌分界不清楚，7例包绕视神经；6例侵犯海绵窦，可见形态不一的软组织影；脑膜增厚、强化5例，3例侵犯脑实质，表现为水肿1例，肉芽肿2例；4例侵犯翼腭窝及颞下窝；3例鼻咽部软组织增厚；2例上颌神经和1例下颌神经明显增粗、强化；3例面颊部软组织肿胀；1例硬腭骨质破坏。结论窦壁骨质破坏伴硬化、MR T2WI低信号、易侵犯眶尖及海绵窦为本病特征性影像学表现。结合CT和MRI2种检查方法能够对本病的诊断、鉴别和治疗提供更可靠的信息。     

The value of paramagnetic contrast agent gadolinium-DTPA in the diagnosis of pituitary adenomas

Summary The purpose of this study was to assess the role of MR imaging and the paramagnetic contrast agent Gadolinium-DTPA(Gd-DTPA) in the diagnosis of pituitary macroadenomas. 44 macroadenomas were examined with MRI before and after intravenous application of Gd-DTPA. Gd-DTPA produced excellent enhancement of solid adenoma. The best contrast between adenoma and surrounding structures could be gained on post-Gd T1-weighted images. Post-Gd images were equivalent to pre-Gd images in the evaluation of supra-and infrasellar extensions of macroadenomas. Post-Gd images had advantages in the evaluation of cavernous sinus invasion by adenoma. The difference in degree of contrast enhancement between adenoma and cavernous sinus facilitated the exact evaluation of lateral extension by adenoma in 18 cases. Almost equal degree of enhancement of both structures impaired tumor-sinus contrast in 2 cases. In the other 24 cases the tumor filled the cavernous sinus completely. It is our opinion that Gd-DTPA can be used on a widespread basis because of its excellent capability to highlight and delineate pituitary adenomas.     

垂体脓肿的MRI和CT诊断

目的总结5例垂体脓肿的Mill和CT表现,并复习相关文献,探讨垂体脓肿的影像学诊断和鉴别诊断。资料与方法5例垂体脓肿均经手术病理证实。5例术前均行MR平扫和增强,2例行CT平扫和增强。结果5例均表现为垂体腺增大,向鞍上突出。2例CT平扫呈低密度;3例MR平扫T1WI呈低信号,T2WI呈脑脊液样高信号,2例T1WI与脑实质信号类似,T2WI呈稍高信号。2例CT增强扫描未显示明显强化征象;5例MR增强扫描均呈环形强化,4例环壁薄且均匀,1例环壁较厚。结论环形强化是垂体脓肿的影像学表现特点,MR增强扫描显示这种环形强化比CT增强扫描更优越。