脑膜瘤临床、MRI与病理特征

脑膜瘤是颅内常见肿瘤之一 ,约占颅内原发肿瘤的 13%～ 19%。多数为良性 ,生长缓慢 ;少数可发生恶变或转移。部分脑膜瘤虽经手术全切且证实为良性 ,但术后仍可复发。本文对 6 3例脑膜瘤 MRI表现及病理特征作了回顾性分析 ,以期为脑膜瘤的手术治疗提供依据。临　床　资　料1、一     

常规MRI纹理分析鉴别WHO Ⅱ级与Ⅲ级胶质瘤的 价值

目的 探讨常规MRI纹理分析在WHO Ⅱ级与Ⅲ级胶质瘤鉴别中的临床价值。方法 回顾性分析经病理证实的40例WHO Ⅱ级和46例WHO Ⅲ级胶 质瘤的常规MRI影像。在MaZda上勾画肿瘤最大层面进行纹理分析,选出与肿瘤级别显著相关的特征纹理参数并统计分析各特征纹理参数的诊断效能。 结果 四种MRI序列（包括T1WI、T2WI、FLAIR、T1WI增强）鉴别WHO Ⅱ级和Ⅲ级胶质瘤的最小误判率为9.30%,出现在T2WI序列中。多元Logistic回归 分析显示,T2WI序列中熵（OR=2.497;P=0.009 ）及游程长非均匀度因子（OR=1.844;P=0.011）与胶质瘤级别独立相关。根据ROC曲线分析结果,以 熵=2.46为阈值鉴别WHO Ⅱ级和Ⅲ级胶质瘤的曲线下面积为0.843,敏感性、特异性分别为0.814、0.767;以游程长非均匀度因子=363.22为阈值鉴别 WHO Ⅱ级和Ⅲ级胶质瘤的曲线下面积为0.808,敏感性、特异性分别为0.794、0.778。结论 常规MRI纹理分析有助于鉴别WHO Ⅱ级与Ⅲ级胶质瘤, T2WI纹理参数中熵及游程长非均匀度因子的鉴别诊断价值最高。     

MRI纹理分析在脑脓肿与胶质母细胞瘤鉴别诊断中的应用价值

目的探讨MRI纹理分析在鉴别脑脓肿与胶质母细胞瘤的应用价值。方法回顾性分析徐州医科大学附属医院经临床或手术、病理证实的25例脑脓肿和37例胶质母细胞瘤患者的MRI资料。通过Fire Voxel软件在MRI增强扫描T_1WI的轴位、矢状位及冠状位,选取明显强化部分范围最大层面(感兴趣区,ROI),提取病灶的纹理特征进行分析。结果脑脓肿脓肿壁和胶质母细胞瘤囊变坏死的MRI表现有明显差异;脑脓肿组的偏度、峰度参数显著高于胶质母细胞瘤组,两者的差异有统计学意义(均P 0. 05)。结论纹理分析可以提供客观、可量化的信息特征,对脑脓肿与胶质母细胞瘤的鉴别有一定的临床价值。     

脑膜瘤临床病理分析

目的：探讨脑膜瘤的临床与组织学类型、复发、预后的关系。方法：对38例脑膜瘤的临床和病理资料进行回顾性分析。结果：病理见脑侵润的26例，且其比率与瘤周水肿程度成正比：复发5例。为合体型及血管型。结论：可以通过对脑膜瘤的临床、病理学表现认识、指导临床治疗。     

WHO脑膜瘤分级分型的病理及影像学观察

目的 探讨经2007年WHO神经系统肿瘤分类修改后脑膜瘤分级中各级脑膜瘤的病理及影像学特征.方法 回顾性分析了2007年以来经手术及病理证实的295例脑膜瘤组织病理切片及影像资料.结果 295例脑膜瘤中WHOⅠ级脑膜瘤255例,Ⅱ级脑膜瘤34例,Ⅲ级脑膜瘤6例.影像学表现:①Ⅰ、Ⅱ、Ⅲ级脑膜瘤肿瘤最大径平均为4.2 cm、4.5 cm及4.6 cm.②Ⅰ级脑膜瘤多为类球形,Ⅱ级脑膜瘤中分叶状比率高于Ⅰ级,Ⅲ级大部分为分叶状.③Ⅰ、Ⅱ、Ⅲ级脑膜瘤边界不清者所占比率为23.9％、55.8％及100％.④硬膜尾征在Ⅰ、Ⅱ、Ⅲ级脑膜瘤中发生率为67.8％、55.9％及66.6％.⑤Ⅰ、Ⅱ、Ⅲ级脑膜瘤均有不同程度的周边组织侵润.随访152例,8例复发,其中Ⅰ级1例、Ⅱ级4例、Ⅲ级3例.结论 脑膜瘤以Ⅰ级脑膜瘤多见,其中纤维型、上皮型、过渡型较常见,而分泌性、化生型、微囊型及淋巴细胞丰富型少见;Ⅱ级脑膜瘤以非典型性脑膜瘤居多,透明细胞型、脊索样型少见,且均有不同程度的核分裂像;Ⅲ级脑膜瘤少见,呈明显恶性性生长方式且均有明显的核分裂像及坏死区.Ⅰ、Ⅱ、Ⅲ级脑膜瘤肿瘤直径及硬膜尾征无明显差异性,Ⅱ、Ⅲ级脑膜瘤分叶状比率较Ⅰ级高,且边界多不清,各级脑膜瘤均表现为不同程度的侵袭性生长.术后复发率与脑膜瘤分级有关.     

颅内脑膜瘤的分级与临床治疗的相关研究

目的 提出颅内脑膜瘤的分级方案以判断预后,方法 通过对２１０例颅内脑膜瘤的统计分析,供血情况及肿瘤部位３项指标进行评分分级,结果 级别越高,全切除率越低,而死亡率越高,预后越差。结论 此发级法对判断脑膜瘤预后有一定参考价值。     

脑膜瘤MRI诊断及鉴别诊断

目的 总结分析脑膜瘤的影像学表现,以期提高脑膜瘤的MRI诊断水平.方法 回顾性分析经病理证实的脑膜瘤52例,男20例,女32例.52例均行MRI检查,其中31例行增强扫描.结果 脑膜瘤的MRI信号特点:T1WI为灰质等信号或略低信号,T2WI为等或略高信号.增强扫描显示大多为均匀强化.结论 MRI检查对脑膜瘤定位、定性准确,平扫基本可以确诊.特殊病例增强扫描能提供更多信息,提高诊断准确率.     

非典型性脑膜瘤与良性脑膜瘤MRI征象的对比分析

目的 对比分析非典型性脑膜瘤与良性脑膜瘤的MRI征象特点,提高对非典型性脑膜瘤的认识。方法 回顾性分析经病理证实的37例非典型性脑膜瘤与288例良性脑膜瘤的MRI征象。结果 非典型性脑膜瘤直径>6.5 cm比例、肿瘤呈分叶型比例、瘤脑界面不清晰比例、重度瘤周水肿比例、邻近骨质改变比例均明显高于良性脑膜瘤（P<0.05）。多因素Logistic回归分析显示,肿瘤较大及瘤脑界面不清晰为非典型性脑膜瘤的可能性显著增加,肿瘤大小每增加1.5 cm,非典型性脑膜瘤的概率是良性脑膜瘤的1.507倍,瘤脑界面不清晰为非典型性脑膜瘤的概率是良性脑膜瘤的2.605倍。结论 肿瘤大小及瘤脑界面对于非典型性脑膜瘤与良性脑膜瘤的鉴别诊断具有重要价值。     

脑膜瘤"脑膜尾征"(MRI)形成机制探讨:肿瘤细胞侵蚀硬膜血管

目的探讨WHO（2000）I级脑膜瘤“脑膜尾征”（MRI）形成的组织病理基础及临床意义。方法切除46例脑膜瘤及其周围硬膜，对比脑膜瘤周围硬膜MRI特点进行病理学和免疫组织化学（VEGF）观察。结果46例硬脑膜标本组中有肿瘤浸润者32例，14例无肿瘤侵袭。在35例MRI（增强）显示存在“脑膜尾征”（MRI）的标本中有15例肿瘤侵入硬脑膜血管内。距肿瘤边缘1．0cm范围内硬膜标本肿瘤存在几率为100．00％，1．5cm、2．0cm处分别为35．00％和25．00％。VEGF在脑膜瘤中表达程度与其侵袭性行为之间具有统计学意义（P〈0．05）。脑膜瘤向其毗邻硬脑膜组织浸润最明显部位VEGF表达最强。结论“脑膜尾征”形成机制是由肿瘤细胞侵入硬脑膜血管所引起的。脑膜瘤对周围至少2．0cm范围内的硬脑膜存在浸润的可能性。VEGF在脑膜瘤侵袭行为中有着重要作用。     

恶性脑膜瘤22例临床分析

临床上，脑膜瘤作为良性肿瘤，人们对它的认识已有近200年的历史了，但是，直到1938年人们才清楚地认识到也存在恶性脑膜瘤。恶性脑膜瘤是指既具有良性脑膜瘤的一般表现，又有生长快、侵袭性强、易复发和转移等恶性肿瘤特征的脑膜瘤，它是一种临床病理诊断；由于目前恶性脑膜瘤还没有统一的诊断标准，所以，文献中报道恶性脑膜瘤占颅内脑膜瘤的比例悬殊较大，在0．9％～20％之间，平均2．8％。按照1999年WHO新的脑膜瘤三级分类标准，作者于1986年1月至2005年1月收治22例恶性脑膜瘤（不包括不典型脑膜瘤和脑膜肉瘤），均经手术病理证实，结合文献报告如下。     

Suprasellar cystic meningioma: unusual presentation and review of the literature

We report on a case of suprasellar cystic meningioma. The magnetic resonance imaging of this tumor resembled that of a craniopharyngioma. The definitive diagnosis of meningioma was made only after histopathological confirmation. We conclude that preoperative studies are often equivocal. The possibility of meningioma should be considered in the diagnosis of any intracranial neoplasms with radiological and surgical evidence of a cystic lesion.     

Clinical analysis for an unusual large cystic meningioma: case report and review of the literature

The authors report the case of a 17-year-old boy with an unusual large cystic meningioma (Nauta type II) in the right hemisphere. The imaging appearances of this patient were very unusual. The shape of the huge cyst was crescentic and similar to subdural hematoma. It lay between the dura and the solid tumor parts. In addition there was a small intracystic nodule attached to the cyst wall. The patient underwent a right hemisphere craniotomy. At surgery it was found that the cyst contained a large amount of xanthochromic fluid and some semitransparent serumlike sediment. The intracystic nodule was proved to be necrotic substance without tissue and cell structure. Histological examination displayed an anaplastic meningioma, of which the cyst wall also consisted of meningioma tissue. To the best of the authors' knowledge, such an unusual case of cystic meningioma has not been reported. The authors review the literature with reference to intratumoral cyst associated with meningiomas, analyze the unusual imaging appearances of this patient, and explore the mechanism of cyst formation. The mechanism of cyst formation associated with meningiomas is not perfectly understood. Intratumoral cyst formation may be attributed to microcystic degeneration, ischemic necrosis, intratumoral hemorrhage, transudation and secretory changes within the tumor.     

术前超选择栓塞富血运脑膜瘤的临床疗效分析

目的 探讨在术前对富血运脑膜瘤进行介入经动脉超选择栓塞的安全性、疗效及应用价值。方法 回顾性分析在本院治疗的34例脑膜瘤患者,术前均经全脑血管造影(DSA)证实为富血运脑膜瘤,其中12例使用明胶海绵栓塞,15例使用PVA颗粒栓塞,7例未经栓塞直接手术,栓塞3～5 d后进行开颅手术切除肿瘤,记录患者的栓塞程度、开颅切除肿瘤的出血量及肿瘤切除程度。结果 栓塞术后明胶海绵组肿瘤染色完全消失3例,大部分消失9例; PVA颗粒组肿瘤染色完全消失9例,大部分消失6例; 2组比较有明显差异(P<0.05); 2组无与介入栓塞相关的严重并发症发生。PVA组出血量为(350±135)mL,明胶海绵组出血量为(475±265)mL,未栓塞组出血量为(660±350)mL,3组间两两比较均有明显差异(P<0.05)。PVA组肿瘤全切14例,次全切除1例; 明胶海绵组全切11例,次全切除1例; 未栓塞组全切7例,次全切0例。结论 富血运脑膜瘤在术前进行介入栓塞能减少术中出血,降低全切难度,但并未能明显提高全切率,对于栓塞材料而言,PVA颗粒的栓塞效果比明胶海绵颗粒更好,两者均可作为富血运脑膜瘤切除术前栓塞的材料使用,术前的介入栓塞能作为富血运脑膜瘤的一项可行的辅助措施。     

非典型脑膜瘤的临床分析

目的探讨非典型脑膜瘤的诊断、治疗及预后相关影响因素。方法回顾性分析2001~2011年首都医科大学附属北京天坛医院收治的89例经病理证实的非典型脑膜瘤,应用Log-rank法和Cox回归进行统计分析,并结合文献对本病的特点、治疗方法和预后进行分析。结果 89例非典型脑膜瘤中72例肿瘤全切除,40例术后行放疗;中位PFS 72.6个月(2~102个月),2年、5年PFS率为74.5%、67.5%,OS率为93.6%、89.1%。单因素分析显示,继发肿瘤、女性、肢体瘫痪、KPS80的非典型脑膜瘤患者复发的风险增加(均P0.05)。多因素分析显示,继发肿瘤、肢体瘫痪患者的复发风险增加(均P0.05),KPS≥80患者有更长的存活时间(P0.05)。结论手术全切除是改善非典型脑膜瘤患者预后的重要手段;对未全切除者,术后推荐放疗。对于全切除的非典型脑膜瘤,首发症状为偏瘫、继发肿瘤、肿瘤存在骨侵袭、肿瘤存在脑侵袭。核有丝分裂象高、MIB-1指数高的患者为高危患者,存在这些危险因素中1项及以上者,推荐术后放疗。     

Presurgical differentiation between malignant haemangiopericytoma and angiomatous meningioma by a radiomics approach based on texture analysis

PurposeTo assess whether a machine-learning model based on texture analysis (TA) could yield a more accurate diagnosis in differentiating malignant haemangiopericytoma (HPC) from angiomatous meningioma (AM).Materials and methodsSixty-seven pathologically confirmed cases, including 24 malignant HPCs and 43 AMs between May 2013 and September 2017 were retrospectively reviewed. In each case, 498 radiomic features, including 12 clinical features and 486 texture features from MRI sequences (T2-FLAIR, DWI and enhanced T1WI), were extracted. Three neuroradiologists independently made diagnoses by vision. Four Support Vector Machine (SVM) classifiers were built, one based on clinical features and three based on texture features from three MRI sequences after feature selection. The diagnostic abilities of these classifiers and three neuroradiologists were evaluated by receiver operating characteristic (ROC) analysis.ResultsMalignant HPCs were found to have larger sizes, slighter degrees of peritumoural oedema compared with AMs (P < 0.05), and more serpentine-like vessels. The AUC of the enhanced T1WI-based classifier was 0.90, significantly higher than that of T2-FLAIR-based or DWI-based classifiers (0.77 and 0.73). The AUC of the SVM classifier based on clinical features was 0.66, slightly but not significantly lower than the performances of 3 neuroradiologists (AUC = 0.69, 0.70 and 0.73).ConclusionMachine-learning models based on clinical features alone could not provide a better diagnostic performance than that of radiologists. The SVM classifier built by texture features extracted from enhanced T1WI is a promising tool to differentiate malignant HPC from AM before surgery.     

恶性脑膜瘤CT与MRI表现

目的分析恶性脑膜瘤CT与MRI影像学表现,以提高其术前诊断准确率。方法回顾性分析18例经手术病理证实的恶性脑膜瘤CT与MRI影像学表现。结果 18例肿瘤中,大脑镰旁5例,大脑凸面4例,海绵窦旁3例,鞍上2例,鞍旁2例,小脑半球2例;边缘规整者4例,边缘分叶状者14例,肿瘤边缘清晰者2例,边缘模糊者16例;CT密度、T2WI信号不均匀者15例,内部可见囊变、坏死、出血。肿瘤强化显著,15例表现为不均匀强化,3例均匀强化,13例表现为短、粗不规则硬膜尾征;轻度水肿8例,中度水肿5例,重度水肿5例;临近颅骨破坏5例,2例形成软组织肿块并突向颅外,6例颅骨增生、硬化。结论恶性脑膜瘤具有特殊的影像学特征,正确分析其表现,有助于提高其术前诊断率。     

Magnetic resonance diffusion tensor imaging-based evaluation of optic-radiation shape and position in meningioma

Employing magnetic resonance diffusion tensor imaging, three-dimensional white-matter imaging and conventional magnetic resonance imaging can demonstrate the tumor parenchyma, peritumoral edema and compression on surrounding brain tissue. A color-coded tensor map and three-dimensional tracer diagram were applied to clearly display the optic-radiation location, course and damage. Results showed that the altered anisotropy values of meningioma patients corresponded with optic-radiation shape, size and position on both sides. Experimental findings indicate that the magnetic resonance diffusion tensor imaging technique is a means of tracing and clearly visualizing the optic radiation.     

Study of Haralick’s and GLCM texture analysis on 3D medical images

Purpose of the study: Medical field has highly evolved with advancements in the technologies which prove to be beneficial for radiologists and patients for better diagnosis. The era of medical science provides best healthcare solutions with the help of medical images. Till now, 2D MRIs played a prominent role in early detection of disease but with latest technologies taking over the charge, 3D MRIs are highly effective and great in demand nowadays. With the aid of advanced techniques such as edge detection, segmentation and texture analysis on these images, the disease detection may become much easier.

Materials and Methods: Texture of any image is recognized by distribution of gray levels in the neighborhood. The Texture Analysis plays an important role in study of medical images. It identifies the prominent features of an image and highlights the same using different feature extraction technique. In this paper, 3D MRI of human brain is considered and texture analysis based on Haralick's and GLCM texture features is performed. Haralick's feature explains the image intensities of each pixel and their relationship with neighborhood pixels. The entire data set consists of 40 brain tumor patients, out of which a sample has been depicted.

Results: The analysis of different features such as Contrast, Correlation, Energy, Homogeneity and Entropy is carried out. Conclusion: Further, the study highlights about the highly useful features for early detection of brain tumor disease.     

Petroclival meningioma mimicking the presentation of a transient ischemic attack

A case of petroclival meningioma with pseudo-vascular clinical feature, documented by magnetic resonance imaging, is described. The location of the tumor and the persistent normality of the clinical examination excluded any surgical attempt. Such transient neurological symptoms in case of posterior fossa meningiomas have been seldom reported. Attempts for a physiological explanation are considered.     

桥小脑角脑膜瘤的分类及其意义

目的 探讨桥小脑角脑膜瘤的分类及其临床意义。方法 回顾分析经于术治疗的21例桥小脑角脑膜瘤，并对其分类。结果 肿瘤全切除16例(72.7％)，无手术外死亡。随访发现2例死亡，2例复发，根据肿瘤与内听道的解剖位置关系分为后外侧(59％)和前内侧(4l％)。术前面神经功能和听力障碍的发生率前内侧组(33％，100％)高于后外侧组(8％，54％)，而后外侧以小脑症状为主，术后前内侧组易发生面神经和听力损害。结论 将桥小脑角脑膜瘤根据其与内听道之间的关系进行局部解剖分类是重要的，两的临床症状、手术入路及预后均不同。