全中枢神经系统照射治疗脑瘤(附7例报告)

原发于中枢神经系统肿瘤如髓母细胞瘤、幕下室管膜瘤等由于有沿蛛网膜下腔随脑省液循环播散的倾向，在放射治疗中常需要行全中枢神经系统即全脑、全脊髓照射。我院1988年4月至1991年6月共治疗7例，现就治疗技术和疗效报告如下。材料与方法本组男6例，女1例；年龄6～36岁，中位年龄21岁，10岁以下2例。肿瘤类型与部位：髓母细胞瘤5例，其中小脑蚓部2例，小脑半球2例，右侧杨叶1例。室管膜瘤2例，位于第三脑室和右侧脑室1例（室管膜母细胞瘤）和第四脑室1例。肿瘤完整摘除1例，部分切除5例，穿刺活极1例。全部病例放疗前均穿刺抽吸脑脊液细胞…     

小儿颅脑肿瘤28例临床分析

为了分析小儿颅内肿瘤的临床诊断和治疗特点,收集28例颅内肿瘤患儿的临床资料及实验室检查、颅脑CT和MRI结果,并进行临床分析。28例患者发病年龄1～3岁5例,3～7岁12例,7～14岁11例。小脑蚓部髓母细胞瘤4例,小脑蚓部星形细胞瘤5例,室管膜瘤4例,颅咽管瘤3例,脑干肿瘤2例,大脑半球胶质瘤2例,松果体区肿瘤2例,畸胎瘤2例,不能确定性质4例。有16例首诊时被误诊。初步研究结果提示,颅内肿瘤易误诊,应对顽固性呕吐、脑炎、脑膜炎、颅内高压的表现、脑积水尤其合并智力低下患儿做详细体检和影象学检查,尽早确诊,为患儿争取早期适当的治疗。     

髓母细胞瘤的CT和MRI影像学分析及临床意义

目的:通过对髓母细胞瘤的CT 及MRI表现分析,加强对本病的认识,提高术前诊断的准确性并合理选择治疗方案.方法:对31例经手术、病理证实的髓母细胞瘤进行回顾性分析,所有病例均行 CT 和/或 MRI检查.结果:髓母细胞瘤好发于儿童,常见于小脑蚓部;成人髓母细胞瘤少见,多见于小脑半球.CT 平扫呈等或稍高密度影,增强扫描多强化明显.MRI扫描 T1 加权像呈低或等信号,T2 加权像呈略高或混杂信号,增强扫描强化明显.结论:髓母细胞瘤有特定的发生部位、年龄及影像学特征性;仔细分析CT和 MRI表现,可做出准确的术前诊断并指导制定治疗方案,改善预后.     

髓母细胞瘤的CT诊断(附50例分析)

目前ＣＴ在诊断髓母细胞瘤方面虽有经验 ,但也经常遇到一些非典型ＣＴ表现的特殊病例误诊为其他颅内肿瘤。为进一步提高髓母细胞瘤的ＣＴ诊断水平 ,对经ＣＴ检查 ,并经手术病理证实的 50例髓母细胞瘤总结如下。1　材料与方法　　 50例中 ,男 2 6例 ,女 2 4例。年龄2岁～ 37岁。主要临床表现 :头痛、呕吐、视力减退、走路不稳。全部病例经ＣＴ检查 ,并经手术病理证实。2　结果　　ＣＴ表现 :肿瘤位于小脑蚓部 38例 ,小脑半球 8例 ,第四脑室 4例。ＣＴ平扫均匀稍高密度区 2 3例 ,见图 1。混合密度区 1 2例 ,等密度区 9例 ,略均匀低密度区 4例…     

颅内血管母细胞瘤34例临床分析

目的:探讨颅内血管母细胞瘤的临床特点和诊治方法。方法:回顾性分析我院自1988~2005年间经手术和病理证实的34例颅内血管母细胞瘤患者的临床资料并复习相关文献。结果:本病的好发年龄在20~40岁,男性多于女性,绝大多数发生在小脑,多为囊结节型。本组所有患者的囊壁瘤结节和实质型肿瘤被完全切除。结论:颅内血管母细胞瘤是良性肿瘤,其诊断主要依靠CT和MRI检查。MRI对囊性血管母细胞瘤的诊断具有特异性。手术切除肿瘤是最佳选择,彻底切除肿瘤可获治愈。     

髓母细胞瘤CT诊断(附93例报告)

目的探讨CT对髓母细胞瘤的诊断价值.方法对93例髓母细胞瘤的CT表现与手术病理对照进行回顾性分析,93例患者全部行CT检查,其中65例经MRI检查,全部病例经手术及病理证实.结果髓母细胞瘤好发于10岁以下儿童（88%）,且肿瘤位于小脑蚓部,成人则常发生在一侧小脑半球.肿瘤血运较丰富,可有囊变、坏死（25%）,偶有钙化（7%）.其影像学特点是肿瘤呈高或略高密度肿块影,有中等度较均一增强,有8%增强不显著.结论髓母细胞瘤恶性度高、预后差,其CT表现有一定的特异性.     

髓母细胞瘤的放疗和化疗

目的探讨髓母细胞瘤对放疗和化疗的敏感性及提高髓母细胞瘤治愈的可能性。方法回顾性分析了1987年2月～1997年2月我院用放射治疗和化疗的方法治疗了61例病例,儿童50例,中位年龄4．5岁（1～12岁）,其中男性30例,女性20例。成人11例,中位年龄19岁（13～36岁）,男性4例,女性7例。完全切除肿瘤有8例,部分切除肿瘤有3例。所有病人都采用全颅全脊髓分野照射。全依照射30～35Gy,后颅窝局部增量20～25Gy。成人每次照射剂量为1．8～2Gy,儿童每次照射剂量为1．6～1．8Gy。儿童病人都采用联合用药,成人病人主要应用VM26＋CDDP＋CCNU。结果儿童髓母细胞瘤病人放疗结束时CT片检查均发现肿瘤有明显退缩约50％,但无一例完全退缩。经过化疗后CT片复查发现肿瘤退缩不明显,生存期为3个月～7年,中位生存期为3年。成人髓母细胞瘤放疗后肿病退缩没有像儿童髓母细胞瘤那么明显,几乎没有改变。放疗后CT片有肿瘤存在的3例病人平均生存期为1年。CT片无肿瘤的8例病人均存活5年以上。结论髓母细胞瘤对放射线仅有部分敏感性。有一部分髓母细胞瘤细胞对放射线具有抵抗性。提高肿瘤手术切除率是提高病人生存率的重要因素。     

髓母细胞瘤的CT和MRI影像学分析及临床意义

目的：通过对髓母细胞瘤的CT及MRI表现分析,加强对本病的认识,提高术前诊断的准确性并合理选择治疗方案。方法：对31例经手术、病理证实的髓母细胞瘤进行回顾性分析,所有病例均行CT和／或MRI检查。结果：髓母细胞瘤好发于儿童,常见于小脑蚓部;成人髓母细胞瘤少见,多见于小脑半球。CT平扫呈等或稍高密度影,增强扫描多强化明显。MRI扫描T1加权像呈低或等信号,T2加权像呈略高或混杂信号,增强扫描强化明显。结论：髓母细胞瘤有特定的发生部位、年龄及影像学特征性;仔细分析CT和MRI表现,可做出准确的术前诊断并指导制定治疗方案,改善预后。     

嗅神经母细胞瘤5例报告

嗅神经母细胞瘤是鼻腔较少见的神经源性肿瘤 ,具有低度恶性特征。本文收集我院自 1995— 2 0 0 3年经病理证实且资料完整的 5例嗅神经母细胞瘤病例 ,现报道如下。1　资料与方法1 1　临床资料　本组 5例中 ,其中男 3例 ,女 2例 ,年龄 39～ 79岁 ,中位年龄 5 1岁。临床表现以反复鼻衄、鼻塞 2例 ,视力障碍及眼球突出 2例 ,头痛、头晕及呕吐、行走不稳 1例。全部病例均经手术和病理证实。1 2　影像检查　 3例行CT平扫和增强扫描 ,常规轴位扫描 ,1例行冠状位扫描 ;2例行MRI检查 ,均进行平扫及增强扫描 ,常规行横轴位扫描 ,1例行矢状位、冠状位…     

脊柱骨母细胞瘤的诊断与治疗

目的 探讨脊柱骨母细胞瘤的临床特点、治疗方法及预后.方法 回顾性分析2001年7月至2009年7月本院收治的12例脊柱骨母细胞瘤患者的临床表现、诊断和治疗方法.结果其中男4例,女8例;中位年龄21岁(9～63岁).累及颈椎1例,胸椎4例,腰椎3例,胸腰段1例,骶椎3例.均有疼痛,伴有神经损伤症状6例,伴有脊柱侧凸4例,1例患者存在肿块,1例存在脊髓压迫.7例为复发病例或术前活检明确诊断,4例患者术前影像学表现典型,考虑为骨母细胞瘤,其中1例误诊为骨肉瘤.所有患者均行手术治疗,根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除,并予以相应方式重建.手术时间平均3.3h(1.5-6.5h).出血量平均1975ml (300～4500ml).术后疼痛和神经根损害表现均消失,3例脊柱侧弯患者畸形得到纠正,2例患者4次出现脑脊液漏,经应用抗生素和床尾抬高治疗后愈合.10例随访平均4年(1-8年),2例分别于术后3个月、2年6个月复发,其余均无疼痛症状,未见肿瘤复发.结论 脊柱骨母细胞瘤临床特征复杂,临床表现、影像学检查结合穿刺病理有助于确诊.根据不同的肿瘤部位,采取不同的手术入路行彻底的切除肿瘤能够取得良好效果.     

乳腺肿瘤MRI形态学表现在临床诊断中的价值

目的探讨乳腺肿瘤MRI形态学表现在临床诊断中的价值。方法对99例患者回顾性分析MRI特征,明确良、恶性乳腺病灶在MRI下的影像学特点,并加以鉴别。结果99例患者的MRI检查结果与术后病理结果相比,乳腺MRI发现恶性肿瘤54例,良性肿瘤43例,误诊2例,诊断率为98%。结论乳腺MRI能够检出乳腺X线摄影及临床上隐匿性的早期和小乳腺癌,是乳腺检查的重要补充。     

颅内室管膜瘤的影像学诊断

目的：分析颅内室管膜瘤的CT、MRI表现。方法：回顾分析18例经手术病理证实的颅内室管膜瘤的CT、MR表现。结果：18例中，脑室系统14例，其中四脑室9例，三脑室1例，侧脑室4例，肿瘤为不规则形或类圆形，边界清楚，CT表现为混合密度肿块，部分可见斑点状钙化，MRI T1加权像为等信号或略低信号，B加权像为不均匀高信号，瘤周无水肿，增强扫描呈不均匀强化；脑实质4例，其中小脑1例、大脑3例均有囊变与瘤周水肿，其余多为实性肿块，肿瘤实质部分CT为等密度，易钙化，在T1加权像为略低信号，B加权像为略高信号，增强扫描实质部分呈轻-中度强化。结论：CT与MRI相结合，能更全面地为临床提供诊断、鉴别诊断及治疗所需要的信息，为治疗方法的选择提供可靠的依据。     

Is MRI more accurate than CT in estimating the real size of adrenal tumours?

BACKGROUND: The size of adrenal tumour plays an important role in the indications for surgical excision of non-functioning adrenal tumours and in selecting the best surgical approach. Computed tomography (CT) has been reported to underestimate the real size of adrenal lesions. The accuracy of magnetic resonance imaging (MRI) in predicting the true tumour size has not been previously investigated. The present retrospective study investigates the accuracy of MRI and CT in the pre-operative determination of true adrenal tumour size. METHODS: The medical records of 65 patients who underwent adrenalectomy for an adrenal mass were reviewed. The size of adrenal tumours as determined by pre-operative MRI and/or CT was compared with the "true" histopathological size. The impact of histological diagnosis on size estimation was also investigated. RESULTS: The median age at diagnosis was 42 years (range 1-82 years) and more patients were female (60%). Five patients had bilateral adrenalectomy, thus giving rise to 70 adrenal specimens. The histopathological size of adrenal tumours ranged from 0.9 to 26 cm with a mean of 5.96 cm and a median of 4.70 cm. For tumours larger than 3 cm, MRI significantly underestimated the real tumour size by 20% (P<0.001). CT also underestimated the size of such tumours by 18.1% (P<0.003). Adrenal phaeochromocytomas were consistently underestimated by both modalities. CONCLUSIONS: MRI and CT significantly underestimated the true size of adrenal tumours larger than 3 cm by 20% and 18%, respectively. Surgeons and endocrinologists should interpret the pre-operative size of adrenal lesions with caution. Copyright Harcourt Publishers Limited.     

卵黄囊瘤的CT及MRI表现

目的:探讨卵黄囊瘤CT及MRI的表现及在诊断中的应用价值。方法:回顾性分析2005年1月至2015年5月经病理证实的40例卵黄囊瘤的CT或MRI表现及临床特征。结果:发病年龄9个月~50岁,平均年龄12.7岁;其中男17例,女23例。肿瘤位于卵巢18例,睾丸12例,骶尾部6例,阴道2例,膈肌1例,腹股沟1例。影像学表现为类圆形或不规则形肿块,呈实性或囊实混合性,肿瘤最大径1.5~28cm。增强扫描实性部分明显不均匀强化,实性部分及囊壁内可见迂曲血管影。结论:卵黄囊瘤在CT及MRI存在特征性的影像学表现,结合发病年龄、AFP升高等临床特征,可以提高对该病的鉴别诊断。     

Complementary role of adjunctive breast magnetic resonance imaging and scintimammography in patients of all ages undergoing breast cancer surgery

The aims of this study were to assess breast MRI and scintimammography (SMM) for the detection of breast cancer, and to determine any complementary role of these tests to each other and conventional imaging. Seventy‐two patients (age 35–81 years) with a suspicious breast mass were investigated by mammography, breast ultrasound, breast MRI and SMM before undergoing surgical excision of the breast mass. Sensitivity, specificity and area under receiver operator characteristic curves were calculated for each test. Of the 72 patients, there were 66 proven malignant tumours, including two patients with bilateral breast cancer. When comparing the diagnostic sensitivity of breast MRI and SMM for lesion size, both tests showed higher sensitivities for lesions >25 mm in size, particularly for SMM. When these tests were compared for patient age, patients less than 51 years showed higher sensitivities for both tests. This was statistically significant for breast MRI. The overall respective diagnostic sensitivities for mammography, mammography with breast ultrasound, breast MRI and SMM were 56, 67, 86 and 85%. The differences were significant between mammography, mammography/ultrasound and both breast MRI and SMM. Breast MRI and SMM offer incremental diagnostic advantage in the diagnosis of breast cancer. Although improved diagnostic accuracy is seen in patients of all ages, those patients less than 51 years of age receive the greatest diagnostic benefit.     

外耳道腺样囊性癌临床病理分析及文献复习

目的:探讨外耳道腺样囊性癌的临床病理特点,提高对该病的认识。方法:观察6例外耳道腺样囊性癌的组织学特点及免疫组化特性。结果:患者男性3例,女性3例,年龄41~68岁,平均年龄55岁,6例均有耳部疼痛,2例发生肺转移。肿物最大径0.8~4 cm,实性,无包膜,镜下均以筛状结构为主,伴有不同比例的管状和实性结构,4例见神经浸润,免疫组化CK和p63均阳性。结论:外耳道腺样囊性癌较少见,易发生肺转移,诊断靠病理诊断。     

Incidence and long-term survival of children with intracranial tumours treated in Denmark 1935-1959

The total number of children under 15 years of age with intracranial tumours in Denmark during the years 1935-1959 was found to be 533. The average incidence was 21 new cases/10⁶ children/year during the 25-year period in question, and 25/10⁶ children/year during the first 17 years of Danish cancer registration. The sex ratio (290 boys to 243 girls) was not significantly different from that of the child population in Denmark. In 219 cases the tumour was located in the supratentorial and in 314 in the infratentorial space. 93% of the tumours were histologically verified, with the following order of frequency for the most usual types: astrocytomas (all grades), medulloblastomas, ependymomas, and craniopharyngiomas. Follow-up was 100%. For the 345 children who survived for more than one month after operation or diagnosis, 36% were alive after 15 years. 119 patients were alive in April 1974 and these were all observed between 15-40 years after diagnosis and operation. Of these 44 had tumours in the supratentorial and 75 in the infratentorial space. 66% of the survivors with supratentorial and 90% with infratentorial tumours led a normal life. Most of the survivors had had a cerebellar astrocytoma, a supratentorial astrocytoma, an apendymoma or oligodendroglioma, but other histological diagnoses were also represented, especially in the supratentorial group. The long-term prognosis was especially bad for children with brain-stem tumours, infratentorial ependymomas and medulloblastomas.     

Acute intracerebral haematomas: Assessment for possible underlying cause with MRI scanning

Forty-seven patients presenting with acute intracerebral haematomas between 1989 and 1992 were retrospectively examined to assess the role of Magnetic Resonance Imaging (MRI) in identifying any underlying lesion. None had any prior known intracerebral pathology. Magnetic resonance imaging scans were done on a 0.5 T unit. Ten patients with an average age of 35 years had angiographically occult vascular malformations (AOVM) found by MRI (one with biopsy confirmation). One of three cases of glioma, three of three cases with secondary tumour, one case of superior sagittal sinus thrombosis with haemorrhagic infarction, one of two cases of venous angioma and one case of arteriovenous malformation were detected by MRI. Progress computed tomography scans discovered two cases of glioma and angiography found a venous angioma and an arterial aneurysm, all undetected by MRI. It is concluded that MRI scanning is helpful in detecting underlying AOVM as a cause of intracerebral haemorrhage but its role in imaging haemorrhagic tumours remains unclear.     

Breast magnetic resonance imaging use in patients undergoing neoadjuvant chemotherapy is associated with less mastectomies in large ductal cancers but not in lobular cancers

BackgroundTo assess the impact of breast magnetic resonance imaging (MRI) use on surgical outcome per histological breast cancer subtype in patients treated with neoadjuvant chemotherapy.Patients and methodsAll patients aged 18–70 years who underwent neoadjuvant chemotherapy for stage I–III invasive breast cancer in the Netherlands in the years 2011–2013 were identified from the Netherlands Cancer Registry. Patients with cT4 tumours were excluded from the analysis. Use of breast MRI and impact on surgical treatment, resection margins and detection of contralateral breast cancer were analysed by multivariable analyses.ResultsBreast MRI was performed in 2879 (83.9%) out of 3433 patients treated with neoadjuvant chemotherapy. Younger age (odds ratio [OR] 1.42; 95% confidence interval [CI] 1.17–1.71 for 18–50 years compared with 50–70 years), larger tumour stage (OR 1.46 [95% CI 1.15–1.86] for cT3, compared to cT1–2 tumours) and multifocality (OR 1.30; 95% CI 1.04–1.61, versus unifocality) were associated with increased breast MRI use. In ductal breast cancer, after stratification for cT-status, breast MRI use is associated with a significant lower OR for mastectomy as final surgery in cT3 tumours (OR 0.45, 95% CI 0.21–0.99). Resection margin involvement and detection of contralateral breast cancer were not associated with breast MRI use.ConclusionIn patients treated with neoadjuvant chemotherapy, the use of breast MRI was associated with a reduced mastectomy rate, particularly in patients with large invasive ductal breast tumours but not in patients with lobular breast cancer.