肿瘤软脑膜-蛛网膜转移的CT、MRI诊断

目的研究肿瘤软脑膜蛛网膜转移的ＣＴ、ＭＲＩ表现,并探讨两种检查方法对该病的诊断价值。方法回顾分析２１例肿瘤软脑膜蛛网膜转移的临床及影像学资料。病变经ＣＴ检查１６例,ＭＲＩ检查７例,其中经两种方法检查者２例。结果全部病例软脑膜蛛网膜下腔均出现病理性强化,其中１０例呈弥漫性,８例呈结节性,３例呈弥漫与结节混合性。弥漫性强化沿脑和脑干表面分布,并延伸入脑沟、脑池;结节性强化病灶数目１个或多个不等,直径０．２～３．０ｃｍ。病变见于基底脑池及相邻蛛网膜下腔者共１８例。伴室管膜结节性强化４例,天幕增厚强化１０例,脑积水１３例,合并脑内转移９例。结论增强ＣＴ和ＭＲＩ对病变的诊断具有重要临床意义,且ＭＲＩ优于ＣＴ。但两者在定性诊断上均有局限性。正确诊断有赖于结合临床资料和影像征象的综合分析     

肺癌脑转移瘤的CT诊断

肺癌脑转移瘤的ＣＴ诊断曲丽英，尚乃舰，刘晓洁脑转移瘤是常见的脑肿瘤之一，占全部脑肿瘤的１３．５％～３７．５％［１］。其中１／３～１／２是来源于肺癌。现将我院收集的病理证实的肺癌脑转移瘤５５例的ＣＴ表现分析如下。材料与方法５５例中男性４８例，女性７例，...     

脊椎肿瘤30例CT分析

本文回顾性分析了经临床或手术病理证实的脊椎肿瘤３０例。在１８例转移性肿瘤中（共累及２７个脊椎），ＣＴ表现为骨质破坏的占２０／２７，成骨型占４／２７，混合型占３／２７。在溶骨型转移中，２０个转移灶位于椎体后２／３，其中１３个病灶同时亦累及椎弓或附件。伴有脊椎周围软组织肿胀的共１１例，８例为局限性，３例为弥漫性。多发性骨髓瘤和血管瘤往往具有典型的ＣＴ表现。骨母细胞瘤多原发于椎弓和附件，并累及椎体。骨巨     

颅内包虫病的CT诊断：附四例报告

颅内包虫病的ＣＴ诊断（附四例报告）张玉珂，董兆虎，赵辉，巴吐尔包虫病（细粒状棘球蚴）绝大多数寄生于肝、肺，发生在颅内者少见。据统计脑包虫仅占包虫病的０．２％～１．５９％［１］。而颅内硬膜外包虫则罕见。我院１９８８年以来经ＣＴ检查发现脑包虫３例，硬膜外...     

颅内生殖细胞肿瘤及其影像学诊断

颅内生殖细胞肿瘤及其影像学诊断湖北省宜昌市中心医院戴洪修综述安徽省合肥市第二医院全冠民综述宁夏医学院放射诊断教研室刘闽生审校颅内的生殖细胞肿瘤（ＧＣＴ）占全部脑肿瘤的０．５％～４．８％￣［１，２］。ＧＣＴ好发于脑中线，半数以上发生在松果松区。在７０年...     

儿童神经母细胞瘤的CT诊断

目的：探讨ＣＴ对儿童神经母细胞瘤的诊断价值。材料与方法：分析经手术、病理证实的２６例神经母细胞瘤的ＣＴ表现，其中：神经母细胞瘤２１例，神经节神经母细胞瘤５例。胸部７例（２７％），肾上腺１６例（６２％），腹部、盆腔交感神经链３例（１１％）。全部病例行ＣＴ平扫与增强检查。结果：肾上腺和后纵隔近头端为本组两个最好发部位。肿瘤钙化发生率为７３％，肿瘤大小与钙化无关，神经母细胞瘤钙化明显多于神经节神经母细胞瘤，转移瘤可发生钙化。强化程度与瘤细胞分化程度相关。肿瘤向椎管内延伸２例，肾上腺神经母细胞瘤侵袭同侧肾脏７例，侵袭肝脏３例，肝转移１例，淋巴结转移１９例。１３例患者尿３－甲氧－４－羟苦杏仁酸（ＶＭＡ）阳性。本组术前诊断准确率为９２％。结论：ＣＴ是诊断儿童神经母细胞瘤最有价值的检查方法之一，好发部位、钙化、早期发生淋巴结转移，以及血、尿ＶＭＡ增高是诊断的重要依据。ＣＴ表现可为术前定性诊断、确定治疗方案及估计预后提供重要依据。     

120例脑转移瘤的CT诊断

目的：研究脑转移瘤的ＣＴ诊断特征及规律。方法：本组１２０例，男８０例，女４０例。８１例行ＣＴ平扫及增强扫描，３９例直接增强扫描。结果：幕上脑转移瘤８８例，小脑３１例，脑干１例。形态表现多样。多发脑转移瘤６９例，单发５１例，瘤周水肿大多明显，Ⅱ～Ⅲ度水肿占５２．７％；脑转移瘤多明显强化，囊变坏死区不强化。结论：１．脑转移瘤幕上多见，大多位于灰白质交界区；２．多发脑转移瘤具有“多形性”ＣＴ表现特征。３．多为结节状稍高密度影，伴有坏死囊变区，瘤实质部分多明显强化。４．瘤周水肿显著，且具有肿瘤与水肿程度不成比例的特性。     

颅内原发恶性肿瘤柔脑膜转移的MRI诊断

目的：探讨颅内原发恶性肿瘤柔脑膜转移的MR影像学特征,为临床提供早期诊断和治疗依据。方法：搜集33例诊断颅内原发恶性肿瘤柔脑膜转移惠者的MR扫描资料,扫描选用常规自旋回波脉冲序列,10例加扫液体衰减反转恢复脉冲序列,全部病例均行增强扫描。结果：平扫表现为不同范围脑池、脑沟和／或脑室变形、移位,结构模糊,其中28例伴有明显脑回肿胀．合并脑室壁不均匀增厚8例;合并蛛网膜下腔肿瘤结节9例,共发现结节17个,合并脑积水10例,部分病例上述表现合并存在。其中10例另选用液体衰减反转恢复脉冲序列扫描后,转移病灶轮廓显示较常规SE序列清晰,信号略高于TSE—T2WI。瘤体边缘与周围水肿难于分辨。增强扫描后脑内瘤体均明显增强,柔脑膜转移显示呈不同强化特征,8例尾征,14例线征,6例条索征及9例环征或结节征,少部分病例合并两种征象存在。结论：加深对颅内原发恶性肿瘤柔脑膜转移的MR影像特征的认识,选择适当的MR成像技术,提高脑膜病变的早期检出率,对临床选择治疗方案具有十分重要的意义。     

颅内生殖细胞瘤CT与临床表现的关系及其CT检查

本报道了１６例颅内殖细胞瘤，着重探讨其ＣＴ表现与临床表现的关系，合理使用ＣＴ。１６例颅内生殖细胞瘤，分别行脑ＣＴ平扫和增强扫描，还采用冠状位及轴位扫描，轴位扫描层厚为１０ｍｍ，冠状位扫描层厚３ｍｍ。结果：８例肿瘤位于松果体区，４例肿瘤同时位于区和松果体区，１例位于松果体风和胼胝体膝部，２例位于鞍区，１例位于基底节区。     

甲状腺癌的CT诊断

目的分析甲状腺癌及其颈部转移淋巴结的ＣＴ表现，探讨肿瘤侵犯周围重要器官的诊断指征。方法回顾性分析经手术及病理证实的５２例甲状腺癌的术前ＣＴ表现。结果５２例原发肿瘤均密度不均，３２例边缘不规则（８２．５％），１１例原发肿物及５例转移淋巴结内有细颗粒状钙化，４例原发肿瘤及６例转移淋巴结内有囊性变伴囊壁高密度乳头状结节，手术证实气管受侵２２例；１０例ＣＴ示气管内壁呈锯齿状，５例肿物突入气管腔内而明确诊断。食管受侵２１例，颈动脉受侵１０例。以肿物包绕食管１／２周或颈动脉１／３周以上为侵犯的诊断指标，敏感性分别为７１．４％、１００．０％；特异性分别为９６．３％、９５．２％。结论原发肿物及转移淋巴结内颗粒状钙化及囊性变伴高密度乳头状结节是甲状腺癌（特别是乳头状癌）的特征性密度变化。ＣＴ增强扫描对诊断甲状腺癌及评价其与周围结构的关系和制定手术方案十分重要     

Trilateral retinoblastoma: clinical and radiologic progression

OBJECTIVE: The purpose of this study was to assess the clinical and radiologic features of tumor progression in children with trilateral retinoblastoma. MATERIALS AND METHODS: Clinical records of eight children with trilateral retinoblastoma were reviewed for the patient's age at the time of diagnosis of the ocular tumor, time interval from diagnosis of ocular retinoblastoma to discovery of the intracranial tumor, time interval from diagnosis of retinoblastoma to death, and time interval from diagnosis of the intracranial tumor to death. CT or MRI studies were reviewed for the appearance of the primary intracranial neoplasm, intracranial metastases, and spinal metastases. RESULTS: The mean age of the patients at diagnosis of bilateral retinoblastoma was 4.5 months, and the mean age at diagnosis of the intracranial midline tumor was 26 months. The mean interval from the time of diagnosis of retinoblastoma to discovery of the intracranial tumor was 21.5 months. Two children had spinal leptomeningeal metastases at the time of discovery of the midline intracranial mass although no intracranial metastases were seen on imaging. In the other children, intracranial and spinal leptomeningeal metastases frequently developed within months of the diagnosis of retinoblastoma despite lack of progression in the midline intracranial lesion. Six children died of leptomeningeal spread of tumor. The mean interval from diagnosis of the ocular tumor to death was 46 months and from diagnosis of the intracranial tumor to death was 17 months. One child developed metastatic retinoblastoma in the ulna 10 years after the diagnosis of the intracranial tumor. CONCLUSION: Children typically died of leptomeningeal tumor dissemination despite lack of progression in the midline intracranial mass. Effective treatment of trilateral retinoblastoma may require close evaluation of these children for leptomeningeal dissemination.     

18F-FDG PET/CT在原发灶不明的脑转移瘤中的诊断价值

目的 探讨18F-FDG PET/CT在查找原发灶不明的脑转移瘤中的价值。 方法 回顾性分析17例原发灶不明的脑转移瘤患者的全身18F-FDG PET/CT检查资料。 结果 17例患者均经活检确诊原发灶,准确率100%。原发性肺癌13例,占76%,其中有2例在第二次行PET/CT检查时才检出原发灶;原发性肝癌2例,占12%;原发性贲门癌1例,占6%;原发性升结肠癌1例,占6%。在检查到原发灶的基础上,18F-FDG PET/CT亦发现10例合并转移者,其中合并肺转移者2例、合并淋巴结转移者3例、合并骨转移者2例及合并其他部位转移者3例,共发现病灶61处;2例肝癌患者单发脑转移灶中均有脑卒中。 结论 18F-FDG PET/CT在查找原发灶不明的脑转移瘤原发灶中有重要价值,并为临床分期及治疗提供有利帮助。     

Medulloblastoma in infants and children: computed tomographic follow-up after treatment

Thirty-six proven cases of medulloblastoma were reviewed by serial CT follow-up examinations from 4 months to 10 years, 2 months after the initial diagnosis, with a mean follow-up time of 3 years, 9 months. The children ranged in age from 10 months to 16 years, 7 months at the time of follow-up. The tumor recurred at the primary site in 20 cases (56%). Leptomeningeal metastasis was demonstrated on CT in 14 cases (39%); seven of these patients also presented with solid subarachnoid metastases. Thirteen patients (36%) showed evidence of severe brain atrophy, which was confined to the posterior fossa in seven of the 13. Calcification resulting from mineralizing microangiopathy developed in five cases (14%), including three patients who had extensive dystrophic calcification in the corticomedullary junction and the deep-seated nuclei of the cerebrum and cerebellum. Only one case of leukoencephalopathy was observed. The patterns of tumor recurrence in the posterior fossa that is severely deformed by surgery and other treatment modalities and leptomeningeal spread of tumor are discussed.     

Prominent dural enhancement adjacent to nonmeningiomatous malignant lesions on contrast-enhanced MR images

Prominent dural enhancement was noted in 10 (16%) of 61 superficial malignant intracranial tumors studied with contrast-enhanced MR imaging during a 2-year period. Included were six glioblastomas, three parenchymal metastases, and one case of dural metastasis. Seven patients had surgery. In four, there was extensive leptomeningeal invasion in the center of the lesion. In two of these lesions there was firm attachment of the center of the tumor to the dura, but without dural invasion despite extensive external carotid artery supply to the tumor in one case. In two cases the overlying dura was normal, and there was no leptomeningeal tumoral invasion. In the case of dural metastasis, huge nodular lesions were present along the inner aspect of the dura. In none of the cases did prominent dural enhancement adjacent to the tumor correspond with tumoral invasion or extension to the dura. Prominent dural enhancement on contrast-enhanced MR images appears to be much less frequent in malignant tumor than in meningioma, where it is seen in up to 60% of the cases. We believe this finding is more likely to represent reactive changes of the dura than tumoral invasion.     

Intramedullary spinal cord and leptomeningeal metastases from intracranial low-grade oligodendroglioma

We present an unusual case of a patient with an intracranial low-grade oligodendroglioma who developed recurrence with an intramedullary spinal cord metastasis and multiple spinal leptomeningeal metastases. The intramedullary spinal cord metastasis showed mild enhancement similar to the original intracranial primary, while the multiple spinal leptomeningeal metastases revealed no enhancement. This is the seventh reported case of symptomatic intramedullary spinal cord metastasis from a low-grade oligodendroglioma.     

Gd-DTPA-enhanced MR imaging of leptomeningeal spread of primary intracranial CNS tumor in children

Three children with known primary brain neoplasms and leptomeningeal disease were evaluated with MR imaging. Two of the patients had medulloblastoma and one had pineoblastoma. The presence of leptomeningeal tumor spread was established by positive CSF cytopathology in conjunction with compatible contrast-enhanced CT findings. Contrast-enhanced CT, nonenhanced MR, and Gd-DTPA-enhanced MR studies were then compared. In two cases, leptomeningeal lesions were seen better with Gd-DTPA-enhanced MR than with contrast-enhanced CT. In all three cases, Gd-DTPA MR imaging revealed lesions that were not identified on noncontrast MR. Gd-DTPA-enhanced MR imaging is useful when searching for intracranial leptomeningeal tumor deposits in pediatric patients at risk for this condition.     

囊状膨胀型骨转移瘤X线诊断(附35例报告)

目的探讨囊状膨胀型骨转移瘤临床X线特点。方法报告35例囊状膨胀型骨转移瘤,从临床X线上作回顾性分析,结合文献进行讨论。男21例,女14例。年龄35~70岁,平均52岁。结果发现原发瘤后1~10年发现骨转移29例,先发现骨转移瘤5例,始终未找到原发瘤1例。原发瘤为鼻咽癌10例,肺癌9例,肾癌5例,乳腺癌4例,甲状腺癌3例,肝癌、前列腺癌、食管癌及原发瘤不明各1例。病灶在四肢长管骨20例,肋骨4例,骨盆4例,椎体2例,肩胛骨2例,颅骨、锁骨及掌骨各1例。骨质呈囊状破坏16例,膨胀性破坏9例,囊状伴膨胀性改变10例。病灶边缘清楚27例,边缘不清楚8例。骨皮质突破,并形成软组织肿块7例,边缘有硬化11例,病灶内有网格状骨嵴影及散在小斑点状钙化影6例。结论囊状膨胀型骨转移瘤的原发瘤发生骨转移时间取决于原发瘤细胞分化程度与发展快慢因素。     

Calcified cerebral metastasis

A hyperdense intraparenchymal lesion on a cerebral computed tomography (CT) usually corresponds to an acute hematoma; however, it is sometimes necessary to rule out a metastatic cause. Focal calcifications in the brain are common and are most often due to granulomas (tuberculosis, cysticercosis...), hamartomas, and primary brain tumors. Cerebral metastases are the most common intracranial neoplasm; however, their rate of calcification in classic series is only approximately 1%. We report the case of a completely calcified cerebral metastasis studied by CT and magnetic resonance imaging (MRI) that was interpreted as acute hemorrhage on the first CT examination.