颅咽管瘤的MRI诊断及鉴别诊断颅咽管瘤的MRI诊断及鉴别诊断

目的:研究颅咽管瘤的MRI诊断及鉴别诊断。方法:回顾性分析经病理证实的13例颅咽管瘤的MRI表现。结果:9例呈圆形或类圆形,4例呈不规则形。平扫6例表现为长T1长T2信号,3例表现为等T1长T2信号,2例短T1长T2信号,1例等T1短T2信号,1例混杂T1混杂T2信号。其中囊内见出血1例,分层征象2例,钙化3例,壁结节4例,3例DWI弥散不受限呈低信号。增强后3例实性颅咽管瘤和5例囊实性颅咽管瘤实性部分明显均匀或不均匀强化,5例囊实性和4例囊性颅咽管瘤囊壁呈弧形或环形强化,4例囊性颅咽管瘤壁结节明显强化,1例囊性颅咽管瘤未见明显强化。结论:颅咽管瘤的MRI影像表现具有一定特征,但需注意与垂体腺瘤、Rathke囊肿、生殖细胞瘤等鉴别。     

鞍区肿瘤患者的眼部改变

鞍区肿瘤最常见的有垂体腺瘤、颅咽管瘤、脑膜瘤、三叉神经瘤及脊索瘤 ,大多数患者因眼部发生改变而就诊于眼科。因此眼科医生要仔细询问病史、选用适当的辅助检查方法尽早作出诊断和治疗。笔者采集了经手术病理证实以眼部症状就诊的鞍区肿瘤 32例患者的资料 ,并进行回顾性分析     

CT与MRI对鞍区常见肿瘤的诊断价值对比分析

目的 比较CT与MRI诊断鞍区常见肿瘤的临床价值,以期为临床鞍区肿瘤的诊断提供参考.方法 收取确诊为鞍区肿瘤的患者81例对其CT及MRI等影像学诊断结果及病理学诊断结果进行比较与分析,判断两种方法的诊断价值.结果 CT诊断鞍区肿瘤肿瘤检出率为71.60％,MRI诊断鞍区肿瘤检出率为82.72％,MRI检查略高于CT检查,无统计学差异(P＞0.05).垂体腺瘤、脑膜瘤的MRI检出率均明显高于CT检查,颅咽管瘤CT检出率明显高于MRI检查,差异有统计学意义(P＜0.05).由于病理类型不同,CT、MRI检查对于鞍区肿瘤均可显示出不同的影像学特征.结论 CT与MRI对鞍区肿瘤临床诊断价值相当,可能与肿瘤具体病理类型密切相关,因此常规使用两种方法进行联合检测可能获得更佳的辅助诊断效果.     

鞍区罕见肿瘤的临床诊治分析

目的 探讨鞍区罕见肿瘤的临床特点及其显微手术治疗,以提高对该病的诊治水平.方法 收集经显微手术治疗的6例鞍区罕见肿瘤患者的临床资料进行回顾性分析,并结合术前肿瘤标记物甲胎蛋白(AFP)和绒毛膜促性腺激素(HCG)联合检测与术后免疫组化染色指导后续治疗.结果 本组6例患者术前全部误诊,术毕病变镜下全切2例,大部切除4例.病理诊断肿瘤5例,炎性假瘤1例,病理类型分别为平滑肌肉瘤、卵黄囊瘤、混合性生殖细胞肿瘤、胚胎癌和毛细胞性星形细胞瘤及霉菌性炎性假瘤.术前AFP或HCG在卵黄囊瘤、胚胎癌和混合性生殖细胞瘤中均有不同程度升高.随访1个月至3年,卵黄囊瘤、胚胎癌和平滑肌肉瘤患者分别在术后5、6、10个月死亡,炎性假瘤患者术后2个月出现蛛网膜下腔出血,病情危重,余生存良好.结论 鞍区罕见肿瘤以高度恶性生殖细胞肿瘤为主,病理类型复杂,术前误诊率高,临床预后差.术前AFP和HCG联合检测对指导治疗、判断预后有一定意义.

Abstract：

Objective To investigate the clinical characteristics and microsurgical managements of rare tumors in the sellar region. Methods Six rare cases of tumors in the sellar region treated by microsurgery from Jan 2000 to Jan 2010 were reviewed retrospectively.Subsequent treatments were according to the status of preoperative alpha fetal protein(AFP) and human chorionic gonadotropin(HCG) measurement as well as confirmed by histopathological examination in all six patients. Results Total resection of the tumor was achieved in 2 cases and subtotal resection in 4 cases.Postoperative histopathology confirmed that the lesions were tumors in 5 cases and fungal pseudotumor in 1 case.Moreover,variety of histological types were observed in the present series,including leiomyosarcoma,malignant yolk sac tumor,mixed germ cell tumor,embryonal carcinoma,pilocytic astrocytoma and fungal pseudotumor,respectively.The serum levels of AFP and HCG were elevated to some extent in the patients with malignant yolk sac tumor,mixed germ cell tumor or embryonal carcinoma.Follow-up was conducted in all patients for 1 month to 3 years.The patients with malignant yolk sac tumor and embryonal carcinoma as well as leiomyosarcoma died in 5,6,10 months after operation,respectively.Subarachnoid hemorrhage occurred in the case of fungal pseudotumor at 2 months sfter surgery.The other two patients were surviving well. Conclusions Rare nongerminomatous malignant germ cell tumors are predominantly susceptible to the sellar region.Furthermore,High misdiagnosis rate and poor prognosis are characteristic in the present study.Dynamic AFP and HCG detection may play an important role in the diagnosis of those non-germinomatous malignant germ cell tumors located in the sellar region.The importance of awareness of the presence of such rare lesions in the sellar region is emphasized.     

磁共振弥散加权成像在肿瘤鉴别诊断中的应用

磁共振弥散加权成像（DWI）依靠不同组织间水分子弥散的差异性，提供一种与以往T1加权像、T2加权像不同的、新的成像对比。其在超早期脑缺血定位、定位诊断中的作用已被肯定，并已逐渐应用于其他系统疾病的诊断和鉴别诊断，其利用已引起人们广泛关注。现综述该技术的基本原理及在肿瘤鉴别诊断中的应用价值。     

鞍区肿瘤的CT与临床诊断：附91例分析

Ninety-one patients with parasellar lesions proved by pathology and surgery from July 1982 to May 1987 and 22 patients misdiagnosed clinically or by CT are reported. The authors found that: 1. Besides the main group of parasellar lesions such as pituitary tumor, meningioma, and craniopharyngioma, some rare disease like glioma, pituitary carcinoma, chordoma, olfactory neuroblastoma, Rathke's pouch and tuberculoma of optic nerve were also found which comprised 12% (11/91) in this series. They should be considered in differential diagnosis; 2. Correct diagnosis was made when CT findings conformed well with the clinical features. Over-emphasis of clinical features or neglect of CT findings should be discouraged as they may lead to erroneous diagnosis; 3. In this series, the highest correct diagnosis rates were: pituitary tumor (95%), parasellar meningioma (78%) and craniopharyngioma (50%). It is difficult to make a correct diagnosis for these rare disease entities before operation; and 4. CT scan cannot completely replace angiography and ventriculography when they are needed for differential diagnosis.     

磁共振弥散加权成像在肿瘤鉴别诊断中的应用

磁共振弥散加权成像(DWI)依靠不同组织间水分子弥散的差异性，提供一种与以往T1加权像、T2加权像不同的、新的成像对比。其在超早期脑缺血定性、定位诊断中的作用已被肯定，并已逐渐应用于其他系统疾病的诊断和鉴别诊断，其作用已引起人们广泛关注。现综述该技术的基本原理及在肿瘤鉴别诊断中的应用价值。     

侧脑室肿瘤的MRI诊断及鉴别诊断

目的:分析侧脑室肿瘤的MRI影像特点,提高侧脑室肿瘤诊断的准确性。方法:回顾性分析28 例经手术病理证实的侧脑室占位性病变的MRI影像学表现。 结果:大多数侧脑室肿瘤具有年龄和性别特征。如脑膜瘤好发于30~50岁,女性多见;中枢神经细胞瘤发病年龄在20~40岁;转移瘤均大于40岁。不同的侧脑室肿瘤,其好发部位不同。室间孔区好发中枢神经细胞瘤,侧脑室体部好发星形细胞瘤,脑膜瘤和转移瘤好发于侧脑室三角区。不同侧脑室肿瘤的MRI表现有所不同,部分具有特征性表现。脑膜瘤增强后呈明显均匀强化。星形细胞瘤,邻近脑组织受侵伴水肿,增强扫描可见不均匀强化。中枢神经细胞瘤,围绕透明隔生长,周围可见多发囊变,增强可见不均匀强化。少突胶质细胞瘤内可见多发钙化灶。转移瘤,增强扫描大多数可见环形强化。室管膜瘤,增强扫描明显强化,容易侵犯邻近脑实质。结论:MRI影像学表现结合肿瘤的部位、发病年龄、强化程度和磁共振波谱(MRS)表现等可以提高侧脑室肿瘤的术前诊断准确率。     

软组织肿瘤的MRI诊断

目的探讨MRI对软组织肿瘤的诊断价值。方法回顾性分析经病理证实的60例软组织肿瘤的MRI表现（大小、部位、边界、信号强度、瘤周水肿、液化坏死、囊壁特征及侵袭性特点）,总结其不同影像学征象并进行统计学分析。结果 T2WI信号的均匀性、瘤周水肿、囊壁特征及侵袭性在软组织良、恶性肿瘤中的差异均有统计学意义（均P﹤0.05）;肿瘤大小、肿瘤边界及液化坏死在两组肿瘤中的差异无统计学意义（均P﹥0.05）。脂肪源性肿瘤均含有脂肪成分;神经鞘瘤呈梭形,典型特征为靶征、神经出入征;血管瘤分为皮下和肌肉内,前者边界较清,后者通常累及多块肌肉,界限不清,最典型的特点是肿瘤内部或周边可见流空血管影。结论 MRI在软组织肿瘤中的表现具有一定的特征性,在区分软组织肿瘤良、恶性及其组织起源上具有重要的价值。     

MRI对乳腺含粘液良、恶性肿瘤的鉴别诊断价值

目的:探讨磁共振成像对乳腺含黏液良、恶性肿瘤鉴别诊断价值。方法:回顾性分析2018年12月至2021年02月经我院病理证实的乳腺含黏液肿瘤25例共26个病灶的术前MRI图像及临床病理资料,依据病理分为良性组及恶性组,比较良、恶性组的临床及MRI表现差异性。结果:25例患者共26个病灶纳入研究,良性肿瘤10例共10个病灶,恶性肿瘤15例共16个病灶。恶性组发病年龄高于良性组（P＜0.01）;病变的边缘多不规则,与良性组比较差异具有统计学意义（P＜0.01）;而两组间肿块大小、形态、动态增强曲线类型及ADC值无统计学差异（P＞0.05）。恶性组出现由周围向中央填充式渐进性强化,而良性组未出现,差异具有统计学意义（P＜0.01）。恶性组T2WI上的低信号分隔纤细并在增强后图像显示不清（31.25%,5/16）,良性组T2WI上的低信号分隔增强后显示清晰（30.00%,3/10）,差异具有统计学意义（P＜0.05）。结论:乳腺含黏液的恶性肿瘤患者发病年龄较良性肿瘤大,边缘多不规则,以不均匀强化为主,出现由周围向中央填充渐进性强化方式,T2WI序列的低信号分隔于增强后显示不清为较特征性表现。     

磁共振弥散加权成像对良恶性腮腺肿瘤鉴别诊断的效果分析

目的 分析磁共振弥散加权成像(DWI)对良恶性腮腺肿瘤鉴别诊断的效果.方法 回顾性分析55例疑似腮腺肿瘤患者的磁共振成像(MRI)和DWI资料,比较良恶性腮腺肿瘤影像学表现和表观扩散系数(ADC),分析MRI动态增强扫描中时间-强度曲线(TIC)分型在良恶性腮腺肿瘤中的差异,以病理检查结果 为准,分析常规MRI诊断、DWI诊断和两者联合诊断恶性肿瘤的效果.结果良性肿块边界多清晰,以腺瘤和腺淋巴瘤最常见,T2WI呈等信号或低信号,增强扫描显著强化;恶性肿瘤形态不规则,边界模糊,信号不均匀,增强扫描均匀或不规则强化,伴周围结构侵犯和颈部淋巴结肿大.良性腮腺肿瘤中腺淋巴瘤和良性淋巴上皮病变的ADC值均较低,其他良性肿瘤的ADC值较高,恶性肿瘤的ADC值多数介于两者之间;良性腮腺肿瘤中多形性腺瘤和其他良性肿瘤及恶性腮腺肿瘤的ADC值分别为(1.185±0.113)×10-3、(1.430±0.524)×10-3、(0.996±0.254)×10-3 mm2/s,均高于良性肿瘤中腺淋巴瘤(0.768±0.133)×10-3 mm2/s,差异均有统计学意义(P﹤0.05).良性肿瘤的TIC曲线分型中缓升型34.29％、平台型25.71％、速升速降型40.00％与恶性肿瘤10.00％、75.00％、15.00％比较,差异均有统计学意义(P﹤0.05).MRI联合DWI诊断恶性腮腺肿瘤的灵敏度85.00％和准确度87.27％高于单纯MRI诊断或DWI诊断(P﹤0.05),特异度比较差异无统计学意义(P﹥0.05).结论 DWI应用于鉴别良恶性腮腺肿瘤的效果较好,值得临床推广应用.     

MRI直方图在头颈部肿瘤诊断中应用的研究进展

肿瘤的精准评估是肿瘤影像学研究的关键点。随着高分辨率磁共振成像(magnetic resonance imaging,MRI)和信号处理方法的不断进步,利用磁共振功能成像结合影像组学方法在肿瘤诊断中受到广泛关注。MRI直方图分析是从标准影像数据中通过高通量算法提取定量参数特征来分析肿瘤整体的异质性,进一步开发诊断、预测与预后模型,为临床医生诊疗过程提供参考依据。本文就近年来MRI直方图在头颈部肿瘤异质性诊断及治疗效果评估、预测方面进行综述,并强调了不同磁共振成像技术直方图在头颈部肿瘤诊断中的研究进展。     

Dynamic 1H-MRS assessment of brain tumors: A novel approach for differential diagnosis of glioma

Purpose

To determine whether the changes of [Cho/NAA] ratio in patients with glioma, measured by dynamic ¹H-MRS can be used to differentiate between high-grade and low-grade gliomas.

Materials and Methods

This prospective study was approved by the institutional ethics committee. Written informed consent was obtained. Forty-nine patients with biopsy-proven glioma and 20 normal control subjects were recruited in this study. The maximum [Cho/NAA] ratios, acquired at 0 min, and at 6 min, were calculated and assessed from volume of interests (VOI) in the tumor areas and in the surrounding normal tissue for each patient. Absolute difference in the [Cho/NAA] ratios, from MRS acquired at 0 and 6 min, in high-grade glioma, low-grade glioma, and control subjects were compared.

Results

The maximum [Cho/NAA] ratio acquired from the tumor area at the 0 min is 6.08 ± 2.02, which was significantly different (p = .017) from that acquired after 6 min, 4.87 ± 2.13. The [Cho/NAA] ratio from the surrounding normal tissue area did not change significantly from spectra acquired at different times (0 min, 6 min). Absolute difference in [Cho/NAA] ratios acquired at 0 and 6 min time points were significantly higher (P < 0.001) in high-grade glioma (= 3.86 ± 3.31) than in low-grade glioma (= 0.81 ± 0.90), and control subjects (0.061 ± 0.026, P = 0.000), while there was no significantly difference in low-grade glioma and control subjects.

Conclusions

Dynamic ¹H-MRS can be useful for differential diagnosis between high-grade and low-grade gliomas as well as insight into the heterogeneity within the tumor.     

MRI对颅内孤立性纤维瘤/血管外皮瘤分级诊断的价值

目的:探究核磁共振成像(MRI)在颅内孤立性纤维瘤/血管外皮瘤(SFT/HPC)Ⅰ、Ⅱ级诊断鉴别中的价值.方法:回顾性分析2016年3月至2019年3月经手术病理证实SFT/HPC的39例患者MRI影像资料,其中WHO-Ⅰ级24例、WHO-Ⅱ级15例,从病灶形态、T2WI信号及DWI特征分析其差异.结果:WHO-Ⅰ级(...     

MRI技术在乳腺癌诊断中的应用进展

乳腺癌作为女性恶性肿瘤的常见病，其发病率和发病人数表现出逐年递增趋势。伴随诊治技术及方案的改进，乳腺癌的诊治方式、疗效监督及预后评估等各方面都有了显著提升，从而也对乳腺癌临床早期诊断的检出率及分期的准确率有了较高的要求。医学影像技术尤其是 MRI检查在乳腺疾病诊治方面不断取得新突破和新应用，乳腺MRI检查技术的角色和作用显得越发重要。MRI基础及功能序列扫描等多种辅助检查，多角度、全方位提供病灶相关解剖、血流动力学、功能及代谢等信息。因而需要全方面熟悉MRI检查技术在乳腺癌诊治中的应用现状，才能使之合理高效的运用于临床诊断、术前分期、治疗方案选取及疗效评估等各方面。     

乳腺良恶性病变的磁共振T2*W首过灌注成像与血管生成相关性研究

Objective： To study the diagnostic value of T2^＊-weighted first-pass perfusion imaging in breast tumors. Methods： We analyzed the magnetic resonance imaging （MRI） information along with the pathological and immunohistochemistry results. Magnetic resonance imaging was performed in 28 patients with breast tumor. The time to signal intensity curves were generated according to the T2^＊-weighted first-pass perfusion imaging. The curve＇s maximal signal intensity drop rate and maximal signal intensity decrease time were analyzed and compared with the pathological diagnoses after surgery. Results： Malignant breast lesions showed higher maximal signal intensity drop rate （44.69% ± 17.07 vs. 17.22% ±7.49, P 〈 0.001） than benign lesions, but there was no significant difference of maximal signal decrease time between those two lesions （23.94 s ± 4.92 vs. 20.02 s ± 6.83, P 〉 0.05）. Conclusion： The T2^＊-weighted first-pass perfusion imaging has enough sensitivity and specificity in breast tumor diagnosis.