脑膜瘤MRI特征与其病理分级相关性分析

目的探讨脑膜瘤MRI特征与其病理分级相关性。方法回顾性分析2010年9月至2017年9月手术治疗的225例脑膜瘤的临床资料,根据术后病理结果分为WHOⅠ级(良性组),WHOⅡ、Ⅲ级(恶性组)。采用多因素Logistic回归分析分析不同性质脑膜瘤MRI特征。结果 225例脑膜瘤中,WHOⅠ级166例,Ⅱ级49例,Ⅲ级10例。多因素Logistic回归分析显示,肿瘤形态不规则、肿瘤强化不均匀、瘤周水肿严重是恶性脑膜瘤的独立预测因子,而脑膜尾征是良性脑膜瘤的独立预测因子。结论肿瘤形态、肿瘤强化、瘤周水肿、脑膜尾征等MRI征象与脑膜瘤分级存在相关性。     

良性脑膜瘤术后复发及预后相关因素分析

目的探讨性别、年龄、手术切除程度、肿瘤周围水肿、有无“脑膜尾征”、肿瘤形状、肿瘤部位、肿瘤大小、有无钙化、肿瘤界限等因素与良性脑膜瘤术后复发及预后的关系。方法对72例经术后病理证实为良性脑膜瘤患者进行回顾性分析。结果手术切除程度、肿瘤周围水肿、有无“脑膜尾征”、肿瘤形状、肿瘤部位、肿瘤大小、有无钙化、肿瘤界限等因素与良性脑膜瘤术后复发及预后显著相关。结论尽可能彻底的手术方式有助于减少术后良性肿瘤的复发，手术切除程度、肿瘤周围水肿、有无“脑膜尾征”、肿瘤形状、肿瘤部位、肿瘤大小、有无钙化、肿瘤界限等因素可做为良性脑膜瘤的术后复发的预测指标．并成为制定术后综合治疗方案的依据．     

脑膜瘤“脑膜尾征”的影像分型及病理

目的 探索脑膜瘤“脑膜尾征”的影像分型及病理.方法 179例凸面脑膜瘤和89例颅底脑膜瘤手术患者,术后其瘤体和硬膜标本做常规病理学检查.选取距离肿瘤基底处0～0.5 em、0.6～1.0 cm、1.1～1.5em、1.6～2.0 cm、2.1～2.5 cm、2.6 ～3.0 cm处硬膜做HE染色,检查硬膜内是否存在肿瘤细胞.分析各型”脑膜尾征”对应的硬膜肿瘤细胞侵袭率和侵袭范围的差异.结果 “脑膜尾征”在MRI上可以分为平滑型(37/268, 13.8％)、结节型(48/268,17.9％)、混合型(84/268,31.4％)、对称多极型(29/268,10.8％)、非对称多极型(70/268,26.1％).179例凸面脑膜瘤中158例(88.3％)可以见到肿瘤侵袭周边硬膜,其中82.3％ (130/158)侵袭范围在2.0 cm以内,94.9％ (150/158)在2.5 cm以内.平滑性“脑膜尾征”对应的硬膜肿瘤细胞侵袭范围在1.5 cm以内,各型“脑膜尾征”对应的硬膜的肿瘤侵袭率和侵袭范围差异均有统计学意义.“脑膜尾征”在凸面和颅底脑膜瘤分布差异也有统计学意义.结论 对于凸面脑膜瘤,肿瘤周边硬膜切除范围建议达2.5 cm,如果这个范围不能达到,“脑膜尾征”的形态可以作为决定切除范围的参考.对于一般行Simpson Ⅱ级切除的颅底脑膜瘤,肿瘤周边的硬膜可以根据“脑膜尾征”形态采取相应的处理.“脑膜尾征”的分型对术前肿瘤周边硬膜的病理变化有一定的预测性,能够使外科医生术前预测侵袭范围和获得足够的切除范围,对降低脑膜瘤远期复发率,有重要的意义.     

脊索瘤样脑膜瘤1例报道及文献复习

目的 探讨脊索瘤样脑膜瘤的诊断、治疗。方法 回顾性分析1例右侧颅内蝶骨嵴起源的脊索瘤样脑膜瘤的临床资料,并结合文献进行分析。结果 MRI和CT与一般类型的脑膜瘤一样具有典型脑膜尾征,但是CT密度（低密度）和MRI信号（长T1、长T2信号）特点不同于常见类型。手术全切肿瘤,术后12个月颅脑MRI复查显示肿瘤未复发。结论 脊索瘤样脑膜瘤是具有脊索瘤样肿瘤特点的脑膜瘤,其影像特征及病理基础均不同于一般类型的脑膜瘤,要注意与其他脊索瘤样肿瘤相鉴别。手术全切肿瘤是主要治疗方法,但是易复发,注意长期随访。     

镰旁脑膜瘤的MRI影像学表现与病理意义

目的分析镰旁脑膜瘤的MRI征象与病理,以期提高其临床诊治水平。方法 73例镰旁脑膜瘤患者行MRI检查。将位置、大小、形状、边缘、水肿、信号、强化方式等影像特征、病理特点综合分析。结果除宽基底、脑膜尾征、假包膜等一般脑膜瘤的MRI表现外,还发现了如下不常见MRI表现:囊变2例,出血2例,钙化5例,颅骨受侵4例及肿块跨越征2例,病理可见相应表现。结论大脑镰旁脑膜瘤具有囊变、出血、钙化、颅骨受侵及肿块跨越征等不常见MRI征象。熟悉这些不典型表现与手术、病理综合分析,在肿瘤的诊断、鉴别诊断与治疗均具有很大价值。     

“脑膜瘤尾征”组织的EMA、Vim表达及临床意义

脑膜瘤是起源于蛛网膜细胞的良性肿瘤。它占全部颅内肿瘤的20％和颅外肿瘤的大部分。其中，60％～72％的脑膜瘤有脑膜尾征。脑膜尾征形态表现多样，其形成的机制是瘤周硬膜的肿瘤侵袋或是硬膜的反应性增生，但是目前仍有争议。本研究通过对术中腑膜尾征组织的显微镜下观察和病理组织的免疫组化检测，     

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。     

脑膜瘤生物学特性与MRI信号特征的相关性研究

目的探讨脑膜瘤手术前MRI信号特征对手术中肿瘤生物学特性的预测价值。方法以WHO 2000年脑膜瘤病理分类为基础，追踪研究85例脑膜瘤患者，寻找肿瘤MRI信号特征与生物学特性，包括供血、质地以及瘤一脑界面是否清楚及其内在联系。结果不同病理亚型的脑膜瘤，表现出不同的MRI信号特征和生物学特性。多数良性脑膜瘤MRI信号均匀、形态规则，肿瘤周围水肿由肿瘤生长部位决定。非典型脑膜瘤MRI信号不均匀、形态不规则，肿瘤周围水肿不明显，间变型脑膜瘤周围水肿则非常明显。血管瘤型、间变型和部分非典型脑膜瘤血供丰富。微囊型、多数上皮型和多数血管瘤型脑膜瘤质地偏软，纤维型、化生型和砂粒体型则质地偏韧、硬。间变型、部分非典型和部分血管瘤型脑膜瘤的瘤一脑界面不清楚。结论脑膜瘤MRI信号特征的分析能为判断其病理亚型和生物学特性提供线索，有助于临床上制定手术策略，提高疗效。     

脑膜瘤全切除术后复发与其MRI影像学特征相关性分析

目的探讨高复发脑膜瘤的MRI影像学特征,以及MRI影像学特征与脑膜瘤病理分级及增殖细胞核抗原(PCNA)表达的关系,以指导临床治疗和预后评估。方法选取自1992年至2002年经我科诊治的有MRI资料的脑膜瘤病例(SimpsonⅠ级和Ⅱ级切除)77例,分为复发组与非复发组,比较两组患者的MRI影像学特征;并应用石蜡标本进行病理学检查及PCNA免疫组织化学检测,比较分析MRI特征与肿瘤复发及病理分级和PCNA标记指数(LI)的关系。结果①分叶状或蘑菇状、边界不清和位于大的静脉窦周围的脑膜瘤复发率较高,脑膜尾征与脑膜瘤的复发无关;②脑膜瘤的PCNALI值大者易复发;③内皮型脑膜瘤复发率高于其他类型脑膜瘤,病理分级级别越高越易复发。结论分叶状或蘑菇状、边界不清和位于大的静脉窦周围的脑膜瘤易复发,临床应采取综合措施,延缓或避免肿瘤复发。     

中枢神经系统血管外皮细胞瘤的诊治探讨

目的探讨中枢神经系统血管外皮细胞瘤(hemangiopericytoma,HPC)的诊断与治疗。方法回顾性分析33例中枢神经系统HPC病人的临床资料。MRI图像显示肿瘤在T_1WI呈等、低混杂信号,在T_2WI呈等或等、高混杂信号。结果肿瘤全切除27例,次全切除6例;16例病人术后行立体定向放疗。术后病理证实肿瘤为来源于脑膜间叶组织的HPC细胞。结论 MRI图像上,中枢神经系统HPC多有分叶征、窄基底与硬膜相连的表现,而"硬膜尾征"欠明显,藉此可与脑膜瘤鉴别。手术全切除联合术后立体定向放疗是治疗与预防复发的关键。     

不同病理类型脑膜瘤对周围组织侵袭性的研究

目的 研究不同病理类型脑膜瘤对周围组织的侵袭性.方法 分析我院2009年4月至2010年6月行手术治疗达Simposon Ⅰ级切除的脑膜瘤患者手术标本124例;病理类型参照WHO2007年版中枢神经系统肿瘤分型,通过病理连续切片分析肿瘤对周围组织的侵袭性.结果 脑膜瘤侵袭性主要表现为纵向和横向侵袭.良性脑膜瘤对基底硬膜侵袭常见,但对骨质和脑组织侵袭少见;非良性脑膜瘤对硬膜、骨质以及脑组织均有明显的侵袭;部分良性脑膜瘤对周边硬膜存在横向侵袭,范围绝大多数在2 cm以内;绝大多数非良性脑膜瘤对周边硬膜存在明显的侵袭,范围在2 cm以外.结论 脑膜瘤不同的病理亚型对周围组织侵袭有所不同.强调术中冰冻病理以及针对不同病理亚型选择术中着重处理点,对降低脑膜瘤术后复发率有重要意义.

Abstract：

Objective To explore the invasion of different types of meningeoma to the surrounding tissue. Method The specimen from 124 patients with meningeomas, who underwent surgery in Southern Hospital from April 2009 to June 2010 were used to analyze the invasion of different types of meningeomas to the surrounding tissue. All the tumor were resected in the standard of Simposon I. We referred to WHO 2007 edition to indentify the type of pathology. Results The invasion included longitudinal type and transversal type. The invasion in the basal dura mater was commonly seen in the benign meningioma, while the invasion was rarely seen in the bone and brain. As to the non - benign meningioma, invasion was commonly seen in dural mater, bone and brain. Some benign meningioma could invase the peripheral dural mater within the range of 2 cm, while most non - benign meningioma invased the peripheral dural mater beyond the range of 2 cm. Conclusions Different types of the 124 cases of meningioma own different characters on the invasion. The frozen pathological examination during the operation and special treatment on the key point of the surrounding tissue may decrease the relapse rate after operation.     

脑膜瘤的病理类型、部位与瘤周水肿的关系

目的分析脑膜瘤病理类型、发生部位与瘤周水肿的关系。方法回顾性分析428例脑膜瘤病人的临床资料,病理类型参照WHO 2007年版中枢神经系统肿瘤分型,同时分析术前MRI瘤周水肿特点。结果出现瘤周水肿211例(49.30%)。WHO分级高的脑膜瘤比分级低者水肿程度高(P<0.001),且在WHOⅠ级的脑膜瘤中,四种常见的脑膜瘤水肿程度较其他脑膜瘤低(P=0.006)。不同部位的脑膜瘤瘤周水肿程度没有统计学差异(P=0.113),但大脑凸面肿瘤较颅底肿瘤瘤周水肿发生率高(P<0.05)。结论脑膜瘤瘤周水肿与脑膜瘤发生部位及病理类型有关。分析肿瘤周围水肿情况,对肿瘤病理类型的初步判断和肿瘤切除方式的选择有重要意义。     

颅内血管外皮细胞瘤的临床分析

目的提高对颅内血管外皮细胞瘤的认识.方法回顾性分析经手术病理证实的8例颅内血管外皮细胞瘤的临床、病理和CT、MRI表现,并结合文献进行讨论.结果颅内血管外皮细胞瘤临床上多以头痛等症状就诊.CT和MRI表现类似脑膜瘤,但前者多具有分叶征,血管流空显著,窄基底附着硬膜,肿瘤明显强化,没有硬膜强化（硬脑膜尾征）,无颅骨增生和钙化.组织学上,肿瘤组织内血管丰富,可见典型＂鹿角状＂血管,血管周围为短梭形肿瘤性外皮细胞,瘤细胞异形,有核分裂相.免疫组化标记示瘤细胞Vim阳性,EMA、GFAP和S-100蛋白阴性.8例均行手术治疗,肿瘤全切7例,近全切除1例.术后均行放疗.结论颅内血管外皮细胞瘤预后不良,手术切除辅以放疗是其主要治疗手段.确诊依赖于病理和免疫组化检查.     

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。     

Metastatic skull tumors from cancers associated with subcutaneous mass lesions]

The incidence of metastatic brain tumors is increasing because of the recent progress in the detection and management of primary cancer. However, metastatic skull tumors from cancers associated with giant subcutaneous mass lesions are rare. We present four patients with metastatic skull tumors: two from hepatic cancer, one from lung cancer, and one from mamma cancer. In these patients, plain skull X-ray and bone CT showed osteolytic lesions. Angiograms revealed a tumor stain fed by abnormal vessels from the external carotid artery. MRI demonstrated masses with marked homogeneous enhancement with the "dural tail sign" in the dura adjacent to the tumors in three skull tumors from hepatic and mamma cancers, and a mass with slightly enhancement without the "dural tail sign" in a skull tumor from lung cancer. At surgery, hemorrhagic well-demarcated tumors were totally removed. The histological diagnosis was skull metastases from cancers in all cases. In cases with the "dural tail sign" on MRI, no tumor cells were seen in the inner layer of the dura and the dura adjacent to the tumors. It is possible that the "dural tail" is due to increased vascular permeability of the dural vessels. The recurrence of these skull tumors was not observed during the follow-up period. Surgical treatment for the metastatic skull tumors from cancers may be indicated to prevent deteriorating neurological symptoms affecting the quality of life.     

Dural cavernous angioma mimicking a meningioma and causing facial pain.

An 18-year-old girl who had severe headaches in the left temporal and facial regions was found to have a small enhanced dural-based parietal convexity mass. On magnetic resonance imaging (MRI), this mass was homogeneously enhanced with "dural tail sign," and was similar to a meningioma. This mass was completely removed surgically, and pathology proved it to be a cavernous angioma without previous hemorrhages. The patient's facial pain was dramatically relieved after surgery. A small dural mass causing severe facial pain is an unusual situation. The lack of hemosiderin in the extra-axial cavernous angioma often leads to the preoperative diagnosis of meningioma.     

MR imaging features of spinal schwannomas and meningiomas

Spinal schwannomas and meningiomas are mostly benign, intra-dural extramedullary tumours. We retrospectively reviewed the Magnetic Resonance Imaging (MRI) examinations of 52 spinal schwannomas and meningiomas operated on at our institution since 1998. The series included 28 schwannomas and 24 meningiomas. We compared MRI features of schwannomas and meningiomas and evaluated statistical features that would allow differentiation. Tumours with extraspinal extension were excluded. Concerning the cranio-caudal distribution, half of the cervical tumours were schwannomas, 72% of thoracic lesions were meningiomas and all lumbar tumours were schwannomas. Meningiomas were significantly located at the upper and mid thoracic levels and schwannomas in the lumbar area. On T1-weighted images, MRI signal intensity and heterogeneity were not statistically different between meningiomas and schwannomas. On T2-weighted images, the signal intensity appeared significantly hyperintense and heterogeneous for schwannomas. After Gd-DTPA, we observed a significant difference between meningiomas and schwannomas, the enhancement being intense and heterogeneous in cases of schwannomas, and moderate and homogeneous in cases of meningiomas. The last significant qualitative item was the "dural tail sign", a dural enhancement or thickening near the tumour. It was found in only 16 cases of meningiomas. A simple diagnostic test was built for schwannomas by processing a multiple agreement analysis with the 6 significant items: cranio-caudal location, T2 signal intensity, T2 signal heterogeneity, Gd-DTPA enhancement intensity and heterogeneity, and the "dural tail sign". This test allowed diagnosis of schwannomas with a sensitivity of 96.4%, a specificity of 83.3%, a positive predictive value of 87.1%, and a negative predictive value of 95.7%. In conclusion, we consider that a diagnosis of schwannoma should be made when a spinal intradural extramedullary tumour shows hyperintensity on T2W images or intense enhancement without dural tail sign; otherwise meningioma is more probable.     

Comparison of MRI features and surgical outcome among the subtypes of focal cortical dysplasia

PurposeFocal cortical dysplasia (FCD) is the most common pathological diagnosis in patients who have undergone surgical treatment for intractable neocortical epilepsy. However, presurgical identification of MRI abnormalities in FCD patients remains difficult, and there are no highly sensitive imaging parameters available that can reliably differentiate among FCD subtypes. The purpose of our study was to investigate the surgical outcome in FCD patients with identifiable MRI abnormalities and to evaluate the prognostic role of the various MRI features and the characteristics of FCD pathology.MethodsWe retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with focal MRI abnormalities and the pathological diagnosis of FCD. We evaluated the surgical outcome according to the pathological subtypes, and studied the prognostic roles of various MRI features. We used recently proposed three-tiered FCD classification system which included FCD type III when FCD occurs in association with other potentially epileptogenic pathologies.ResultsA total of 69 patients were included, and 68.1% of patients became seizure free. Patients with FCD type III had a lower chance for achieving seizure freedom (7/15) than in patients with isolated FCD (FCD types I and II) (40/54, p = 0.044). Cortical thickness and blurring of gray–white matter junction were more common in isolated FCD than in FCD type III, but most MRI features failed to differentiate between FCD types I and II, and only the transmantle sign was specific for FCD type II. We failed to find a prognostic value of specific MRI abnormalities of prognostic value in terms of post-epilepsy surgery outcome in FCD patients.ConclusionsOur study showed that patients with FCD III have poor surgical outcome. Typical MRI features of isolated FCD such as cortical thickness and blurring of gray–white matter junction were less common in FCD type III and only transmantle sign was helpful in differentiating between FCD types I and II.