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.     

Clinical and pathological features in 49 elderly patients with meningiomas

BACKGROUND: As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the space occupying lesion, and it is difficult to detect the meningioma because it grows to expand slowly, the tumor locates in non-functional region, and there are atypical symptoms and deficiency of localization signs. OBJECTIVE: To investigate the clinicopathologic features of senile meningiomas. DESIGN: A retrospective analysis. SETTING: Affiliated Hospital of Hebei University. PARTICIPANTS: Forty-nine elderly patients with meningioma were selected from the Department of Neurosurgery, Affiliated Hospital of Hebei University from May 1999 to March 2005, including 15 males and 34 females, 60–74 years of age, and they were all diagnosed by CT and MRI. METHODS: The sites of tumors were identified by CT and MRI examinations in all the patients. The tumors were partially or totally resected according to their own conditions. The types of the resected tumor were pathologically observed. The conditions of postoperative recovery were observed after 1, 3 and 6 months, and without new neurological dysfunction or complication was considered as good outcome. MAIN OUTCOME MEASURES: ① Sites and pathological types of the tumor; ② Postoperative outcomes and complications. RESULTS: All the 49 patients were involved in the analysis of results. ① The tumors had wide distributions with a main location in brain convexity. Among the 49 cases of meningioma, there were 25 cases of fibrocystic type, 12 cases of meningothelial type, 6 cases of psammomatous type, 4 cases of angiomatous type and 2 cases of microcystic type. ② Among the 49 patients, 35 had good outcome, 8 had self-care ability, 4 required care by others, 2 (4.1%) died postoperatively. No long-term complication related to the operation was observed during the follow-up postoperatively. CONCLUSION: Meningioma has a main location in brain convexity, and its pathological type is mainly fibrocystic one, and there is good operative outcome.     

Therapeutic imaging window of cerebral infarction revealed by multisequence magnetic resonance imaging An animal and clinical study

In this study, we established a Wistar rat model of right middle cerebral artery occlusion and observed pathological imaging changes (T2-weighted imaging [T2WI], T2FLAIR, and diffusion-weighted imaging [DWI]) following cerebral infarction. The pathological changes were divided into three phases: early cerebral infarction, middle cerebral infarction, and late cerebral infarction. In the early cerebral infarction phase (less than 2 hours post-infarction), there was evidence of intracellular edema, which improved after reperfusion. This improvement was defined as the ischemic penumbra. In this phase, a high DWI signal and a low apparent diffusion coefficient were observed in the right basal ganglia region. By contrast, there were no abnormal T2WI and T2FLAIR signals. For the middle cerebral infarction phase (2-4 hours post-infarction), a mixed edema was observed. After reperfusion, there was a mild improvement in cell edema, while the angioedema became more serious. A high DWI signal and a low apparent diffusion coefficient signal were observed, and some rats showed high T2WI and T2FLAIR signals. For the late cerebral infarction phase (4-6 hours post-infarction), significant angioedema was visible in the infarction site. After reperfusion, there was a significant increase in angioedema, while there was evidence of hemorrhage and necrosis. A mixed signal was observed on DWI, while a high apparent diffusion coefficient signal, a high T2WI signal, and a high T2FLAIR signal were also observed. All 86 cerebral infarction patients were subjected to T2WI, T2FLAIR, and DWI. MRI results of clinic data similar to the early infarction phase of animal experiments were found in 51 patients, for which 10 patients (10/51) had an onset time greater than 6 hours. A total of 35 patients had MRI results similar to the middle and late infarction phase of animal experiments, of which eight patients (8/35) had an onset time less than 6 hours. These data suggest that defining the "therapeutic time window" as the time 6 hours after infarction may not be suitable for all patients. Integrated application of MRI sequences including T2WI, T2FLAIR, DW-MRI, and apparent diffusion coefficient mapping should be used to examine the ischemic penumbra, which may provide valuable information for identifying the "therapeutic time window".     

颅内脉络膜囊肿四例临床分析

目的 总结脉络膜囊肿的诊治方法及治疗效果.方法 回顾性分析本院2005年3月至2010年3月收治的4例颅内脉络膜囊肿患者的临床资料、病理学改变、手术措施和治疗效果.结果 4例均临床表现为颅内囊性占位病变和局部压迫症状,MRI检查表现T1WI低信号,T2WI高信号,增强无包膜强化.病理检查见完整基底膜上被覆单层扁平或柱状上皮.开颅手术及脑室镜下囊肿大部分切除治疗各2例.术后随访0.5-5.0年,4例患者术前症状全部缓解,无并发症出现.结论 脉络膜囊肿无特征性临床表现.影像学检查侧脑室、小脑脑桥角区囊性病变应注意该病.开颅或脑室镜囊肿大部分切除术是有效的治疗方法.

Abstract：

Objective To summarize and report the diagnosis and management of choroid plexus cysts.Methods The clinical date of 4 choroid plexus cysts cases from March 2005 and 2010 March were analyzed retrospectively,and pathology appearances,surgical treatment were evaluated.Methods Intracranial cystic lesion and compression symptoms were represented in 4 cases.The MR feature of the choroid plexus cyst was low signal intensity on T1- weighted and high signal intensity on T2-weighted.The cyst walls were not reinforcement while contrast enhancement.Histological examination revealed the choroid plexus cyst consisted of complete basement membranes covered with a layer of cuboidal or flat choroid plexus epithelium.4 cases were followed up for 0.5-5.0 years and showed satisfying results with no complication.Conclusion The clinical presentations of choroids plexus cysts are not representative.Attention to the diagnosis of choroid plexus cyst while radiological examination review a cystic lesion within the lateral ventrical and the cerebellopontine angle.Craniotomy or endoscopic cyst resection to remove the cysts is an effective treatment method.     

麻痹性痴呆的MRI表现(附32例报道)

目的 探讨麻痹性痴呆(GPI)的MRI特征和诊断价值,提高对GPI患者MRI表现的认识.方法 中山大学第三附属医院放射科自2006年5月至2010年11月共诊断GPI患者32例,回顾性分析患者的临床资料并总结GPI的MRI表现.结果 本组患者的MRI表现分为两型:脑萎缩型(30例)和脑肿胀型(2例),其中脑萎缩型GPI的MRI表现为:(1)以颞叶、额叶、海马、胼胝体萎缩为主,脑白质萎缩较脑皮质萎缩明显;(2)杏仁体及海马形态异常及伴T2信号增高;(3)皮层/皮层下"脑回状"T2信号增高,以岛叶多见;(4)双侧豆状核对称性T2信号减低;脑肿胀型GPI的MRI表现为弥漫型或局灶型.结论 GPI的MRI表现多样,但具有一定特征性,结合临床表现和相关实验室检查结果可作出正确诊断.

Abstract：

Objective To evaluate the MRI findings in patients with general paresis of insane (GPI) to enhance the understanding of MRI diagnosis of this disease. Methods The clinical data and MRI findings of 32 patients with GPI, admitted to our hospital from May 2006 to November 2010, were retrospectively analyzed. Results The MRI findings of GPI were mainly divided into 2 types: cerebral atrophy (n=30) and cerebral swell (n=2). The major MRI findings in the type of cerebral atrophy included white cerebral atrophy in the temporal lobe, the frontal lobe, the hippocampus and the corpus callosum, morphological changes and T2 hyperintensity in the amygdaloid body and the hippocampus, gyral T2 hyperintensity in the cortex and subcortex, and T2 hypointensity in the lenticular nucleus. The MRI findings in the type of cerebral swell manifested as suffused and focal types. Conclusion The MRI findings in GPI are multiple with some characteristic manifestations. Diagnosis must be made through the combination of imaging features with clinical data and related laboratory tests.     

中枢神经细胞瘤的MRI诊断

目的 探讨中枢神经细胞瘤(CNC)的MRI表现特征.方法 南方医科大学珠江医院自2007年1月至2010年1月行手术治疗CNC患者13例,术前均行MRI平扫及增强扫描,其中1例并行术前CT平扫及增强扫描.总结分析患者的临床、MRI资料及病理表现.结果 肿瘤最大径约3.2～8.5 cm,12例CNC位于侧脑室内孟氏孔区,1例位于左颞顶叶脑实质内,均表现为分叶状的实体瘤,平扫以等T1、稍长T2信号为主,信号不均匀,可见多发、散在分布的小囊变区,表现为更长T1、更长T2信号;6例T2WI上可见流空血管影;8例见斑点状稍短T1信号;增强扫描肿瘤呈不均匀显著强化,6例可见强化肿瘤血管;病理表现为灶性钙化,可见典型无细胞纤维岛.结论 脑室内CNC具有特征性的发病部位,结合患者发病年龄、MRI平扫及增强扫描表现多可做出正确诊断;脑室外CNC定性诊断较困难.

Abstract：

Objective To evaluate the MRI features of central neurocytoma (CNC). Methods Thirteen patients with CNC (7 males and 6 females, aged 18-28), admitted to our hospital fiom January 2007 to January 2010, were chosen; preoperative plain and contrast enhanced MRI scans were performed on these 13 patients and 1 also received CT scan. The clinical and imaging data and pathological features of these patients were retrospectively analyzed. Results The largest tumor enjoyed its maximum diameter of 3.2-8.5 cm; the CNC in 12 patients located at the lateral ventricle and that in 1 patient at the parenchyma of the left frontal and temporal lobes. Lobulated solid tumors were noted in these lesions,showing T1 isointense and T2 hyperintense in MRI; some multiple, scattered cystic lesions showed stronger T1 and T2 signal than the former ones; vascular "flow void" signal was shown in 6 patients in T2WI, and slightly weak T1 signal was shown in 8. All the tumors demonstrated inhomogeneous enhancement and the tumor vessels in 6 patients were noted under contrast MRI. Focal calcification was found. Conclusion CNC in the lateral ventricle enjoys typical location; considering the age of patients, non-contrast and contrast MRI findings, correct diagnosis of CNC can be made; however, CNC outside the lateral ventricle is hard to diagnose.     

mTOR、VEGF的表达与脑膜瘤病理分级的关系

目的 探讨哺乳动物雷帕霉素靶蛋白(mTOR)、血管内皮生长因子(VEGF)在脑膜瘤组织的表达及其与脑膜瘤病理级别之间的关系.方法 取中山大学第一附属医院神经外科自1995年1月至2010年8月手术切除的脑膜瘤标本76例,其中Ⅰ级40例,Ⅱ级24例,Ⅲ级12例.采用免疫组化SABC法检测mTOR、VEGF在脑膜瘤组织中的表达.结果 mTOR、VEGF阳性蛋白主要位于肿瘤细胞的胞浆中,为浅黄色至深黄色颗粒样物质.Ⅰ、Ⅱ、Ⅲ级脑膜瘤mTOR、VEGF的表达不同,差异均有统计学意3L(P<0.05);脑膜瘤mTOR、VEGF蛋白的表达呈正相关关系(r=0.440,P=0.0000).结论 mTOR、VEGF的表达与脑膜瘤的病理级别有关.

Abstract：

Objective To investigate the relationship between expressions of mammalian target of rapamycin (mTOR) and vascular endothelial growth factor (VEGF) and pathological grading of meningiomas. Methods Seventy-six specimens of meningiomas, performed resection in our hospital from January 1995 to August 2010, were chosen, in which, 40 were of WHO grade Ⅰ, 24 of WHO grade Ⅱ, and 12 of WHO grade Ⅲ. The expressions of mTOR and VEGF were immunohistochemically studied with SABC method. Results The protein expressions of mTOR and VEGF mainly located in cytoplasm of meningioma cells, and these proteins were granular materials colored from pale yellow to dark yellow. The expressions of mTOR and VEGF were significantly different among meningiomas of grade Ⅰ,Ⅱ and Ⅲ (P<0.05);the expressions of mTOR and VEGF had a positive correlation (r=0.440, P=0.000). Conclusion The expressions of mTOR and VEGF are positively correlated with the tumor grades.     

Magnetic resonance imaging diagnosis of acute Guillain-Barré syndrome in children

The present study examined 24 children with acute Guillain-Barré syndrome using magnetic resonance imaging (MRI) plain scans and fat-suppressed enhanced T1-weighted imaging (T1WI) scans.Axial MRI plain scans centering on the medullary conus were positive in nine patients (38%).These displayed variable thickening involving the cauda equina with isointensity on T1WI and isointensity or slight hyperintensity on T2WI.False negatives were obtained in patients with cervical and cranial nerve symptoms.Contrast enhancement of T1WI with fat suppression was positive in all patients in the cauda equina with varied thickening and enhancement centering on the medullary conus.Five patients (36%) were positive in the cervical nerves and 3 patients (50%) were positive in the cranial nerves.These patients had corresponding cervical and cranial nerve symptoms,respectively.Patients with serious clinical symptoms in the lower limbs exhibited obvious involvement of the cauda equina by MRI.Statistical analysis revealed a positive correlation between the extent of enlargement of the cauda equina,centering on the medullary conus,and cerebrospinal fluid protein concentration.     

A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan,China

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classified into three types: type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open transection nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmacotherapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity declined with increasing duration of being trapped. In the first year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor(0 or 1) after a 1-year period of treatment, further treatment was not effective.     

Validation of hyperintense middle cerebral artery sign in acute ischemic stroke Comparison between magnetic resonance imaging and angiography

We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.     

垂体腺瘤囊变和囊内液平面形成的MRI特征及相关因素分析

目的探讨垂体腺瘤囊变及液平面形成的MRI特征及其临床相关因素。方法连续收集83例经手术和病理证实的垂体腺瘤，术前行MRI评估，结合手术所见和病理发现进行研究。结果MRI表现囊变者43例，其中19例无液平面的囊变区多表现为T。WI低或稍低信号，T1WI高信号；24例液平面上／下信号表现为T1WI上呈高／低信号19例，高／等信号4例，低／等信号1例；T1WI上仅7例发现液平面，其中高／等信号4例，高／略高信号2例，略低／等信号1例。垂体腺瘤囊变及液平面形成与肿瘤大小、侵袭性有关（P〈0．05），多见于泌乳素型、促性腺激素型、无功能型和多激素型腺瘤。结论垂体腺瘤囊变及液平面形成主要是因瘤内出血后，血肿衍化吸收沉淀所致。术前对垂体腺瘤囊变及液平面的MRI评估有助于对肿瘤生长方式及行为的判断。     

Cystic meninigioma.

To study the clinical characteristics of cystic meningiomas, we analyzed retrospectively 21 patients with cystic meningiomas and reviewed the literature with regard to clinical presentation, imaging features, preoperative diagnosis, surgical findings, and histopathological results. The cysts were classified into intratumoral and peritumoral cysts based on their relationship to the tumor, and also according to the classification method described by Nauta. For the 21 patients in our group, there were seven peritumoral cysts and 14 intratumoral cysts. Various pathophysiological mechanisms contribute to the formation of cystic meningiomas. The diagnosis of cystic meningiomas based on CT scan can be problematic, and differentiation from glioma or metastasis may be difficult. MRI scans show low signal intensity areas within the mass on T1-weighted images and high signal intensity areas on T2-weighted images, and the solid parts of tumors are contrast-enhanced after gadolinium administration. MRI with gadolinium enhancement dramatically increases the diagnostic accuracy for cystic meningiomas and provides critical information for their surgical care. Total surgical resection of cystic meningioma is ideal, but special attention should be paid to the cyst walls.     

60例颅内血管外膜瘤诊断与治疗分析

目的通过回顾分析颅内血管外膜细胞瘤的临床资料,探讨其相关的诊断依据及治疗方法。方法对近5年我院收治的60例颅内血管外膜细胞瘤病人的一般资料,临床特点,影像资料,病理表现及治疗结果进行总结分析。结果发病率男性大于女性,以青壮年占多数,平均病程11个月;CT显示肿瘤呈略高密度影,无钙化;MR显示肿瘤多呈分叶状,有血管流空信号影,瘤内有坏死囊变和窄基底,“硬膜尾征”少见,T2WI呈等高？昆杂信号,注射对比剂后在T1WI上呈不均匀明显强化;所有病例均被行手术加术后放疗,其中28例第1次术后随诊结果显示：肿瘤全切组平均随访时间28个月,复发率6％;肿瘤近全切除组平均随访时间27个月,复发率71％;肿瘤大部切除组平均随访时间19个月,复发率100％。结论如果CT显示略高密度影和无钙化及MR显示肿瘤呈分叶状;T2WI呈等高混杂信号和无“硬膜尾征”时,应考虑血管外膜细胞瘤的诊断。肿瘤切除的程度是决定肿瘤复发的关键因素,手术应做到尽量全切肿瘤,术后应常规辅以放射治疗,可获得较好的预后。     

MRI of aggressive meningiomas.

The authors have attempted to establish by MRI morphological criteria for the so-called "aggressive" intracranial meningiomas. The MRI features of 20 meningiomas histologically aggressive (numerous mitoses and small necrotic foci) or malignant (same plus invasion of the subjacent brain tissue) were compared with those of a control population of 26 patients with benign meningioma. The site of the tumour and its histological type had little predictive value, but there was a remarkably high proportion of male patients in the group with aggressive meningioma (9/20 versus 2/26). More than other varieties, aggressive meningiomas frequently emitted, on both T1- and T2-weighted sequences, a heterogeneous signal due to a necrotic focus (P less than 0.01). The high-intensity signal observed on T2-weighted sequences (11/20) was suggestive of syncitial or angioblastic meningioma. Cystic meningiomas were present in virtually equal proportions (3/20 versus 3/26) in the two populations and could raise problems concerning the diagnosis of nature, especially when intraventricular. Gadolinium injection provided further evidence of aggressiveness, such as irregular tumour outline or even contrast enhancement of brain tissue in malignant cases (3/4), but enhancement of the dura mater was equally frequent in both groups (P greater than 0.2). Massive peritumoral oedema was significantly more frequent in aggressive melanomas (P less than 0.01).     

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。     

Clinical and histopathological analysis of cystic meningiomas.

Between 1993 and 2003, we treated 21 patients with cystic meningioma (of 365 with meningioma, 5.5%). We grouped these patients according to classifications by Nauta and Rengachary and analyzed them by gender, age, tumor location, clinical manifestations, MRI features and histopathology. The mean duration of symptoms was relatively short at 1.6 months. There were five atypical and 16 benign meningiomas on histopathology. In type I and II cystic meningiomas, with intratumoral cysts, all cyst walls enhanced on MRI and had tumor cells in the cyst wall on histopathology. In type III and IV cystic meningiomas, with peritumoral cysts, the cyst wall did not enhance on MRI and only one case (type III) had tumor cells in the cyst wall on histopathology. We suggest that when the cyst wall shows contrast enhancement on imaging, the cyst wall should be completely removed at surgery. If there is no contrast enhancement, multiple biopsies of the cyst wall should be taken to assess the presence of tumor cells in the cyst wall.     

脑桥出血后继发肥大性下橄榄核变性的临床及影像学特点

目的探讨脑桥出血后继发肥大性下橄榄核变性症(hypertrophic inferior olivary degenerationsyndrome,HOD)的临床及影像学特点。方法对2009年1月至2011年6月在我院确诊的脑桥出血的65例,其中63例患者进行为期1年的随访,并对随访过程中发现有继发性下橄榄核变性症的9例患者的临床资料进行分析。结果HOD发生影像学改变时仅有3例患者有临床症状,主要表现为眼震、软腭阵挛、躯干粗大震颤。脑桥出血均发生在被盖区。头颅MRI下橄榄核信号改变距离出血时间平均为4.05个月。出血病灶9例中有8例存在含铁血红素沉着。肥大的橄榄核直径多数在0.7～0.8 cm左右,下橄榄核信号改变6例为等T1WI,长T2WI改变,3例为长T1WI长T2WI改变,其中2例长T1WI患者出现典型临床症状。7例Flair显像为高信号,1例低信号,1例为等信号。治疗上,1例患者先后予森福罗、氯硝西泮、心得安、氟哌啶醇、美多巴等治疗,其中氯硝西泮及心得安有效。结论HOD多发生在脑桥被盖部出血1个月后,头颅MRI特征为下橄榄核区的圆形的T2WI长信号改变;予心得安及氯硝西泮可能有效。     

中颅窝区脑外肿瘤的MRI表现

目的 探讨中颅窝区脑外肿瘤的MRI特点,提高其诊断准确率. 方法 经手术病理证实的31例中颅窝区脑外肿瘤(包括三叉神经鞘瘤13例,脑膜瘤6例,蛛网膜囊肿3例,皮样囊肿3例,骨母细胞瘤2例,脊索瘤2例,表皮样囊肿2例)均行MR平扫及增强扫描检查,并对其影像资料进行回顾性分析. 结果 不同的中颅窝区脑外肿瘤各具不同MR特征;(1)三叉神经鞘瘤MR/T1WI像多呈等或低混杂信号,T2WI像呈高或低混杂信号,本组13例三叉神经鞘瘤增强后有9例可见"包壳征";(2)脑膜瘤多表现为等或稍低T1、等或低或高T2信号,增强后呈中度较均匀强化;(3)骨母细胞瘤可见"骨包壳",脊索瘤骑跨中、后颅窝生长,其一侧与斜坡紧密相连;(4)蛛网膜囊肿与表皮样囊肿均呈长T1、长T2囊状信号,增强后无强化或囊壁轻微强化;蛛网膜囊肿多呈膨胀生长,而表皮样囊肿多有"见缝就钻"的特点;(5)皮样囊肿均呈短T1、长T2囊状信号,脂肪抑制序列扫描呈低信号,可出现"爆米花"样改变. 结论 中颅窝区脑外肿瘤均有比较特征性的MRI表现,密切结合临床可进一步提高其术前诊断的正确率.     

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.     

颅内血管周细胞瘤的影像诊断七例

目的分析颅内血管周细胞瘤(HPC)影像表现,总结其影像特点,探讨影像诊断的价值。方法分析7例经手术切除、病理证实的HPC,术前5例行MRI平扫及增强扫描,2例复发行CT平扫及增强扫描。结果 7例肿瘤均位于颅内脑外,单发,体积较大,边界清楚,可见分叶,T1WI示肿瘤呈等信号或稍高信号,T2WI呈等信号或稍高信号,FLAIR呈稍高信号,DWI呈不均匀低信号,CT呈稍高密度影,增强扫描肿瘤实体性部分显著强化,内可见斑点、片状囊变或坏死区;4例可见脑膜尾征,肿瘤内及周围可见血管流空或强化血管信号;瘤周水肿随肿瘤增大而明显;结论颅内血管周细胞瘤(HPC)是一种少见颅内脑外肿瘤,肿瘤形态不规则,边缘有分叶,增强扫描显著强化,内均可见斑点、片状囊变、坏死无强化区,瘤内无钙化,肿瘤周边可见血管流空信号,肿瘤恶变时,可见大片坏死出血,肿瘤可侵犯破坏周围脑组织和骨组织,但无骨质增生。