颅内血管外皮细胞瘤的MR影像诊断(附3例报告)

目的总结颅内血管外皮细胞瘤(hemangiopericytoma,HPC)的影像表现,提高其诊断准确性。资料与方法回顾性分析3例经手术病理证实的颅内HPC的MRI表现,均行MRI平扫及增强,其中女2例,男1例,年龄44~62岁,平均52.7岁。结果 3例HPC呈类圆形或不规则形肿块,均位于硬膜。2例边界清晰,1例边界不清。MRI表现为T1WI呈等、略低信号,T2WI呈稍高信号,信号均匀或混杂。3例均可见血管流空信号。增强扫描显著强化。2例病理表现为WHOⅡ级,1例为WHOⅢ级。结论颅内HPC的MRI表现有一定特点,多位于硬膜,总结其影像表现可提高其诊断准确性。     

颅内血管外皮细胞瘤MRI特征

目的 回顾分析颅内血管外皮细胞瘤(hemangiopericytomas,HPC)及脑膜瘤的MRI表现,以获得对颅内HPC的诊断及鉴别诊断具有价值的MRI特征.资料与方法 选取经病理证实的颅内HPC患者11例及脑膜瘤患者107例.用X2检验,Fisher确切概率法对比分析两组之间差异是否存在统计学意义.结果 颅内HPC的MRI 表现:肿瘤呈分叶状9例(81.8%),7例(63.6%)肿瘤以窄基底附着硬膜上,7例(63.6%)肿瘤内部呈迂曲的血管信号,8例(72.7%)肿瘤内囊变、坏死,7例(63.6%) T2WI呈等高信号,8例(72.7%)扩散加权成像(DWI)呈高信号;增强扫描肿瘤明显强化11例(100%),5例(45.5%)可见瘤周水肿.肿瘤形态(P<0.01)、肿瘤内部迁曲的血管信号(P<0.01),T2WI信号强度(P<0.05)及DWI信号强度(P<0.01)在两组之间差异有显著统计学意义.结论 颅内HPC的MRI表现具有一定特征性.肿瘤形态、T2WI及DWI信号、肿瘤内部迂曲的血管信号是鉴别颅内HPC及脑膜瘤的重要征象.     

颅内血管外皮细胞瘤MRI分叶征与P73表达相关性的研究

目的 探讨颅内血管外皮细胞瘤(HPC)的MRI分叶征与P73因子表达的相关关系.方法 采用免疫组织化学法(S-P法),用抗P73抗体对33例颅内血管外皮细胞瘤及27例血管瘤型脑膜瘤、6例正常脑膜组织标本进行标记并分析,对肿瘤MRI图像上分叶征情况进行评分,对照做相关分析.结果 33例颅内血管外皮细胞瘤P73均呈阳性表达,与对照组血管瘤型脑膜瘤组之间具有统计学意义(P＜0.01);随着肿瘤MRI分叶征评分的增高,P73阳性表达水平也升高(P＜0.05).结论 颅内血管外皮细胞瘤MRI表现分叶征与肿瘤P73蛋白的表达程度相关,可做为临床分析肿瘤治疗和预后的参考.     

颅内血管外皮细胞瘤MRI影像学特征与ki67因子表达相关性研究

目的探讨颅内血管外皮细胞瘤(HPC)的MRI影像学特征与瘤组织中ki67因子表达的相关性。方法选取陕西中医药大学第二附属医院自2013年2月至2017年2月收集的HPC标本39例(HPC组)、血管瘤型脑膜瘤标本24例(脑膜瘤组)及颅脑外伤手术获取的正常脑膜标本10例(正常组),采用免疫组化法检测3组标本中ki67因子的表达水平;同时回顾性分析HPC患者术前的MRI影像学资料,分析MRI影像学特征与ki67因子表达水平的相关性。结果 HPC组ki67因子的高表达率显著高于脑膜瘤组和正常组,差异有统计学意义(P<0.05)。ki67因子高表达的HPC患者的瘤体出血概率、瘤体周围中重度水肿发生率、肿瘤不均匀增强概率、骨质破坏概率均显著高于ki67因子低表达患者,差异均有统计学意义(P<0.05)。结论 HPC患者瘤组织中ki67因子表达的增强与患者的脑水肿、瘤体出血及骨质破坏等相关,其表达程度还与MRI影像学表现密切相关,可作为患者临床治疗和预后判断的重要参考指标。     

颅内孤立性纤维瘤/血管外皮瘤瘤内血管流空特征研究

目的 探讨瘤内血管流空在颅内孤立性纤维瘤/血管外皮瘤(SFT/HPC)鉴别诊断中的价值。方法 选取经过手术病理证实的颅内SFT/HPC组13例,脑膜瘤(脑膜瘤组) 57例作为对照。观察并记录“蛇形流空征”和“光芒征”在两种不同肿瘤内部的分布情况。结果在SFT/HPC组中13例均表现出“蛇形流空征”;在脑膜瘤组中54例(95%)出现“光芒征”,3例(5%)出现“蛇形流空征”;两组间的血管流空信号特点差异具有统计学意义(P <0.05)。结论 SFT/HPC瘤内血管流空模式常表现为“蛇形流空征”,了解这一影像学征象,有助于提高SFT/HPC术前诊断准确性。     

颅内血管周细胞瘤的MRI诊断

目的血管周细胞瘤(Hemangiopericytoma,HPC)较少发生于颅内,分析颅内HPC的MRI表现特征,有利于提高对此种肿瘤的认识。方法分析6例经手术病理证实的颅内HPC的临床和影像资料,6例均行MRI平扫及增强扫描,其中男性4例,女性2例,年龄32~58岁,平均41岁。结果本组6例中2例肿瘤发生于桥小脑角区,3例发生于脑实质,1例发生于脑室内,肿瘤体积均大于3cm,边界清,均呈多分叶状,脑外病灶T1WI、T2WI信号均匀,增强明显均匀强化,脑内病灶T1WI呈稍高信号、T2WI呈稍高混杂信号,脑室内病灶接近或稍低于脑白质。注射对比剂后,6例均表现明显强化,内见点片及条状低强化灶,其中2例脑实质肿瘤内见弯曲条状低强化灶。结论颅内HPC少见,MRI形态及增强表现较有特征性,总结MRI表现,可提高术前诊断准确性。     

普通型COVID-19与轻症甲型H1N1流感肺炎病人的临床特征和CT表现比较

目的分析普通型新型冠状病毒肺炎(COVID-19)和轻症甲型H1N1流感病人临床特征和CT表现的异同。方法回顾性分析25例普通型COVID-19病人(COVID-19组)[平均(36.44±14.68)岁]和20例轻症甲型H1N1流感肺炎病人(H1N1组)[平均(51.45±22.72)岁]的临床和CT影像特征,包括病变密度、直径、部位及受累肺叶,以及病变内部特征、肺外表现的发生率及数量。采用卡方检验或Fisher确切概率法或t检验比较2组间临床资料和CT影像特征的发生率;采用Mann-Whitney U检验比较2组间不同特征的病灶数量。结果 COVID-19组病人首次CT检查时间较H1N1组短(分别为2.52±2.40、4.20±3.14 d,P0.05),平均年龄、体温、外周血中性粒细胞计数及C反应蛋白(CRP)均低于H1N1组(均P0.05)。2组病人CT影像均以GGO或GGO伴实变影表现为主,COVID-19胸部CT显示肺内实变影发生率及数量均低于H1N1组(均P0.05),但外周混合磨玻璃影、直径为1～3 cm的病灶数量多于H1N1组(均P0.05)。2组病人其他临床及CT影像特征的差异均无统计学意义(均P0.05)。结论普通型COVID-19和甲型轻症H1N1流感病人的发病年龄和发热温度有一定差异,普通型COVID-19的CT影像上更多见1～3 cm的病变,多见分布于肺野外周的混合GGO,实变影少见。     

腰椎间孔MRI和CT三维测量的对比分析

目的对比分析腰椎间孔MRI和CT三维数据,提高腰椎间孔三维测量的准确性。方法收集2013年8月—2016年8月间的56例腰椎退变病人[男24例、女32例,年龄39～72岁,平均(56.5±7.6)岁]和41名体检腰椎正常者[男18名、女23名,年龄25～36岁,平均(31.4±5.2)岁]的MRI和CT影像资料。采用Mimics19.0软件构建腰椎间孔MRI和CT三维模型,分别测量腰椎间孔容积、矢状面最小面积及冠状面长径,测量数据间的比较采用配对样本t检验。采用组内相关系数(ICC)评价不同测量者之间的一致性。结果不同测量者之间存在较高的一致性(均ICC0.9)。腰椎正常者MRI上测得的L_1～S_1各节段椎间孔容积及L_1/L_2、L_2/L_3、L_3/L_4、L_4/L_5节段的矢状面最小面积均小于CT测量结果(均P0.05);腰椎退变病人MRI上测得的L_1～S_1各节段的椎间孔容积以及L_1/L_2和L_2/L_3节段的椎间孔矢状面最小面积均小于CT测量结果(均P0.05)。腰椎退变病人及腰椎正常者其余测量值差异均无统计学意义(均P0.05)。结论腰椎间孔MRI和CT三维测量数据之间存在差异,主要是由于CT成像尚不能精确识别未发生显著退行性改变的椎间孔后壁软组织。     

普通型与重型/危重型COVID-19病人的CT表现及临床特征比较

目的探讨新型冠状病毒肺炎(COVID-19)不同临床分型的CT影像表现及临床特征。方法回顾性分析2020年1月24日—2月17日确诊的189例COVID-19病人的临床及首诊CT影像资料,男91例,女98例,平均(46.5±16.6)岁。全部病人分为普通组(普通型,153例)和重症组(重型/危重型,36例)。采用卡方检验或t检验比较2组临床特征及CT影像表现间的差异。结果与普通组相比,重症组的男性占比(72.2%)、平均年龄[(55.9±15.4)岁]更高(均P0.05),合并高血压、糖尿病的比例以及头晕、头痛、全身酸痛、气促及高热的发生率也更高(均P0.05),白细胞、淋巴细胞及中性粒细胞异常的比率均高于普通组(均P0.05)。重症组病人全部表现为双肺受累,累及范围达10个肺段以上,人均病灶数量大于普通组(24.8±13.5∶12.3±8.8,P0.05)。重症组出现单纯实变影、胸膜下线的比例高于普通组(均P0.05)。结论普通型与重型/危重型COVID-19病人的临床症状、实验室检查及CT影像表现方面均存在差异,了解和掌握这些差异性,有助于临床及影像科医生对COVID-19病人进行病情评估。     

MRI对颅内孤立性纤维瘤/血管外皮细胞瘤与血管瘤型脑膜瘤的鉴别诊断价值

目的 探讨MRI对颅内孤立性纤维瘤/血管外皮细胞瘤(SFT/HPC)与血管瘤型脑膜瘤(AM)的鉴别诊断价值.方法 选取并分析经手术病理证实的SFT/HPC与AM患者的临床特征及MRI征象,应用ROC曲线、多因素Logistic回归模型,分析其对SFT/HPC及AM的独立预测因素及鉴别诊断效能.结果 计量资料进行￡检验表...     

脑室脑膜瘤的影像诊断

目的　探讨脑室脑膜瘤的影像学表现,以提高对脑室脑膜瘤的认识和诊断正确率。方法　经手术病理证实的脑室脑膜瘤 22例,其中男 8例,女 14例,年龄 17~72岁(平均 45岁 )。行MRI检查 21例,其中增强 17例;行CT检查 11例,其中增强 4例;同时行CT和MRI检查 10例,结合手术和病理结果进行分析。结果　脑室脑膜瘤以纤维型多见,主要位于侧脑室三角区,多数表现为实质性肿块,边界清晰,明显强化。可见钙化,出血及囊变少见。结论　脑室脑膜瘤有特殊的影像学表现,CT和MRI在诊断中具有一定的价值,尤其是MRI。     

Magnetic resonance imaging of cutis verticis gyrata

OBJECTIVE: To describe the magnetic resonance imaging (MRI) findings in cutis verticis gyrata (CVG) and familiarize the interpreters of neuroimaging studies with its characteristic appearance and intracranial and systemic associations. METHODS: The MRI examinations of 12 patients (7 men and 5 women; age range, 16 to 66 years; mean, 40.3 years) with CVG were retrospectively evaluated for distribution, orientation, number of folds, and the associated intracranial or calvarial abnormalities. RESULTS: Eleven patients had bilateral involvement. The number of folds was 3 to 8 (average, 6), and the direction was anterior-posterior (longitudinal) in 9 patients. Transverse and longitudinal folds coexisted in 3 patients. The subcutaneous tissues underneath CVG were thickened in all patients, whereas skin was thickened in 7. Intracranial abnormalities identified included meningioma, schwannoma, glioma, and prolactin-secreting pituitary microadenoma. There were no skull abnormalities. CONCLUSIONS: Cutis verticis gyrata CVG has a typical appearance on MRI characterized by scalp undulations due to thickening of the skin and subcutaneous tissues.     

前颅凹底脑膜瘤的影像诊断与病理对照研究

目的:探讨前颅凹底脑膜瘤的影像学和病理组织学之间的关系.材料和方法:病理证实的前颅凹底脑膜瘤27例,男8例,女19例.年龄13～79岁,平均62岁.均行MRI检查(增强16例);15例行CT检查(增强8例).分析CT、MRI影像,并与手术病理对照.结果:27例前颅凹底脑膜瘤,起源于嗅沟15例,前颅凹底6例,眶顶4例,鞍结节向前生长2例.多数水肿明显,均匀增强;少数不均匀增强,并出现脑膜尾征,少数伴钙化、坏死、囊变和出血.累及邻近颅骨时引起骨质增生.结论:前颅凹底脑膜瘤具有典型的影像学表现.CT和MRI具有诊断价值,MRI优于CT ,但CT观察钙化和骨质改变优于MRI.     

Calcifying pseudoneoplasms of the neuraxis (CAPNON): The great tumor mimicker

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are very rare intracranial lesions with less than 50 cases reported in literature. These are non-neoplastic in etiology and despite having unique imaging characteristics, are often misdiagnosed as a neoplastic condition like meningioma, chordoma and gliomas. These do not have any predilection for any age, gender or intracranial location and can be seen in a wide range of age groups. Despite having an imaging overlap with neoplastic conditions, CAPNONs have classic histopathologic findings including chondromyxoid matrix, palisading spindle cells and calcific or ossific metaplasia. As more cases are being described in literature the imaging features are also being better defined. We discuss the clinical, imaging and histopathological findings of 2 cases of CAPNON mimicking posterior fossa meningioma and glial neoplasm.     

钙化性砂粒体型脑膜瘤的CT与MRI诊断

目的探讨钙化性砂粒体型脑膜瘤的CT与MRI特征及病理学表现,以提高对其诊断准确性。资料与方法搜集经手术病理证实的钙化性砂粒体型脑膜瘤患者资料7例,男2例,女5例,年龄39～66岁(平均56岁)。行CT检查者3例,增强扫描2例;行MRI检查者6例,均行平扫加增强扫描;同时行MRI与CT检查者2例。结果 7例中,全瘤钙化者2例,厚环状钙化者1例,多发散在点条状钙化者4例。CT平扫肿瘤呈高密度为主的混杂密度,增强扫描高密度区无强化。MRIT1WI呈明显低信号、稍低信号或等信号,T2WI呈低信号、等信号或稍高信号;增强扫描肿瘤明显不均匀强化,低信号区亦有强化,可见脑膜尾征者3例。结论 CT与MRI结合能更全面显示钙化性砂粒体型脑膜瘤的特征,可提高其诊断准确性。     

MRI扩散加权成像在非小细胞肺癌靶向治疗早期疗效评价中的应用价值

目的评价磁共振扩散加权成像(MRI-diffusion weighted imaging,MRI-DWI)在非小细胞肺癌靶向治疗早期疗效评价中的应用价值。 方法选择32例病理证实非小细胞肺癌患者,于治疗前、1周期靶向治疗后行胸部常规MRI检查、DWI检查及CT增强检查,以第2周期靶向治疗后相对于治疗前的肿瘤最大径变化率为标准,将患者分为有效组（19例）和无效组（13例）,比较两组治疗前后肿瘤表观扩散系数(ADC)值及最大径的差异。同时比较MRI-DWI与增强CT对肿瘤及阻塞性肺不张的显像效果。 结果肿瘤最大径在两组内不同时间及组间的差异均无统计学意义（P>0.05）。第1周期靶向治疗后,有效组肿瘤平均ADC值明显升高（×10^-3 mm²/s：1.48±0.23 vs. 1.23±0.21,t=-15.45,P<0.01）,而无效组治疗后ADC值变化不大（×10^-3 mm²/s：1.20±0.27 vs.1.15±0.32,t=-1.69,P>0.05）,并且有效组ADC值的升高率明显高于无效组（%：17.7±5.7 vs. 4.6±2.1,t=6.72,P<0.01）。CT图像可显示清楚肿瘤与不张肺组织边界6例（37.5%）,MRI-DWI图像可显示肿瘤与肺不张组织边界13例（81.3%）,高于CT图像,差异有统计学意义（χ²=6.35,P<0.05）。 结论MRI-DWI较增强CT可更清晰地显示肺不张与肺肿瘤边界,便于肿瘤大小测量及疗效评估,ADC值可以对非小细胞肺癌靶向治疗疗效做出早期监测。     

Imaging features of unusual intracranial cystic meningiomas.

OBJECTIVE: To describe the imaging features of unusual intracranial cystic meningiomas in infants and adults. METHODS: We retrospectively reviewed the magnetic resonance and computed tomography findings for 2 female patients and 3 male patients, ranging in age from 1 to 73 years (median 41 years), with histopathologically proven cystic meningioma. RESULT: Although cystic meningiomas usually appear as solid and cystic masses, they may present as a mainly multicystic lesion. The wall of a cystic part of the meningioma may include both enhancing and unenhancing areas at imaging. The cystic portion of a meningioma is hypointense on diffusion-weighted images and markedly hyperintense on corresponding apparent diffusion coefficient maps. CONCLUSION: Cystic meningiomas may vary in appearance at imaging. They can be very challenging when present in infants. Knowledge of imaging findings and awareness of variability in the differential diagnosis can help to avoid preoperative diagnostic pitfalls.     

Pneumosinus dilatans in anterior skull base meningiomas

Introduction

Skull base meningiomas are often missed on non-contrast CT or MR examinations due to their close proximity to bone and low lesion to brain contrast. The purpose of this study is to illustrate that pneumosinus dilatans can be an indicator of anterior skull base meningiomas.

Methods

A retrospective search of the radiology information system and picture archiving and computing system database was performed. Search terms were “meningioma” in association with “pneumosinus dilatans.” Medical records and imaging studies were reviewed independently by two experienced neuroradiologists and were read in consensus. We recorded the patient age at the time of discovery of the meningioma, main presenting symptom(s), location of the tumor, and imaging characteristics. We also performed a comparative literature search for pneumosinus dilatans and its association with meningiomas.

Results

Ten patients (six women; four men) were identified in whom a meningioma of the anterior skull base was associated with a pneumosinus dilatans. Three patients had multiple meningiomas, so a total of 14 intracranial tumors were identified. Mean age at discovery was 59 years with an age range of ±20 years. All meningiomas were diagnosed by MRI and/or CT.

Conclusion

Pneumosinus dilatans can be a helpful sign to indicate the presence of a meningioma of the anterior skull base.     

乳腺X线摄影及MRI结合临床特征对乳腺高危病变诊断价值

目的探讨乳腺X线摄影及MRI征象结合临床特征预测乳腺高危病变恶性升级的价值。方法回顾性分析复旦大学附属肿瘤医院2017年1月至2018年3月经病理证实为乳腺高危病变,且活检前行乳腺X线摄影和MRI检查的230例患者。分析乳腺病变X线摄影及MRI征象,并以病理结果为金标准,评估高危病变升级率与临床及影像特征的关系。采用独立样本t检验与χ2检验比较升级组与未升级组患者临床及影像特征的差异,采用受试者操作特征(ROC)曲线比较乳腺X线和MRI对乳腺高危病变升级率的诊断效能,采用Binary logistic回归分析比较高危病变升级率与临床、影像学征象之间的关系。结果230例患者病灶均为单发。47例在后续再手术中升级为恶性病变,升级率为20.4%(47/230)。未升级组与升级组乳腺高危病变患者的年龄、病灶最大径以及绝经状态差异有统计学意义(P<0.05)。未升级组和升级组患者间的乳腺X线摄影征象的差异无统计学意义(P>0.05),乳腺MRI征象和MRI背景实质强化的差异有统计学意义(P<0.05)。乳腺X线摄影和MRI评估高危病变升级为恶性病变的ROC曲线下面积分别为0.606、0.913,MRI诊断优于乳腺X线摄影(Z=6.919,P<0.01)。单因素分析结果显示,年龄、病灶最大径、中重度背景强化为预测高危病变升级的正相关因素,已绝经、MRI诊断阴性为预测高危病变升级的负相关因素(P<0.05);多因素分析显示,年龄以及MRI背景实质强化是预测乳腺高危病变升级的独立因素(P<0.01)。结论MRI对高危病变升级的诊断效能优于乳腺X线,年龄越大,MRI背景实质强化中重度可提示高危病变的恶性升级。