拉克囊肿的伽玛刀治疗

目的 探讨伽玛刀治疗拉克囊肿(Rathke's cleft cysts,RCCs)的效果,并讨论其可能的治疗机制.方法 2002年1月-2009年3月对7例RCCs进行伽玛刀治疗.MRI检查均具有典型的RCCs特征.伽玛刀治疗中心剂量22.6～40.0 Gy(平均32.5 Gy),周围剂量9.0～20.0 Gy(平均1...     

Concomitant pituitary adenoma and Rathke's cleft cyst

We reviewed the clinical, radiological and surgical findings in patients with both pituitary adenoma and Rathke's cleft cyst. We retrospectively selected patients with both lesions from the 374 patients in whom a sellar/juxtasellar lesion was detected on MRI at 1.5 tesla. All patients received intravenous contrast medium. Concomitant pituitary adenoma and Rathke's cleft cyst were found in eight patients (2.1 %). The frequency of the combination was 3.5 % of pituitary adenomas and 11 % of Rathke's cleft cysts. Symptoms were always due to the adenoma, secreting adrenocorticotrophin in two patients and growth hormone in six. The adenoma was larger in five patients, and the cyst in three. The cysts gave variable signal. The adenoma was adjacent to the cyst in seven patients, and enclosed it in the other patient. As a result of experience with MRI, concomitant pituitary adenoma and Rathke's cleft cyst are now known not to be as rare as thought previously. When a nonenhancing cyst-like structure is demonstrated in a patient with pituitary adenoma, the possibility of a coexisting Rathke's cleft cyst should be considered. Received: 23 March 2000/Accepted: 12 July 2000     

Rathke's cleft cyst with pituitary apoplexy: case report

We report a Rathke's cleft cyst which presented as pituitary apoplexy, a rare presentation. A 46-year-old woman suffered sudden headache and visual loss. T1-weighted MRI 3 weeks after this apoplectic episode demonstrated a cystic lesion between the anterior and posterior lobes of the pituitary, with some high-signal material layering in it. The mass showed spontaneous regression on an image 3 weeks later. Trans-sphenoidal surgery confirmed the diagnosis of a Rathke's cleft cyst with a haematoma within it. Received: 30 September 1998 Accepted: 5 February 1999     

鞍区Rathke囊肿的MRI表现

目的 总结垂体Rathke囊肿的MRI表现，以提高对该病的认识。方法回顾性分析17例经手术和病理证实的Rathke囊肿的MRI表现。结果 17例Rathke囊肿多呈圆形或类圆形，边界清楚，10例位于鞍内，7例位于鞍内和鞍上。MR信号在T1WI和T2WI上表现为：7例长T1、长T2，6例短T1、长T2，2例等T1、等T2，1例等T1、长T2，1例短T1、短T2。6例行增强扫描，3例无增强，3例囊肿边缘增强。结论 垂体Rathke囊肿表现为鞍内或鞍内和鞍上的囊性占位，MRI信号多样，但结合MRI形态、临床表现和其他影像学表现可作出正确诊断。     

鳃裂囊肿的少见MRI表现

目的 报告鳃裂囊肿的不常见MRI表现，以提高对该病的认识。方法 分析10例经手术病理证实的鳃裂囊肿的MR／表现。男6例，女4例。年龄15-70岁，平均37．4岁。全部病例均行术前MR平扫检查。其中6例还作了增强检查，4例作了颈部磁共振血管造影。结果 10例均为第2鳃裂囊肿，其中Bailey Ⅰ型4例，Bailey Ⅱ型6例。少见的MR／表现包括囊内出血（2例）、囊壁异常增厚（4例）、囊液固化（2例）及合并癌变（2例），这些表现使MR／诊断产生困难。结论 MR／形态或信号表现不典型的鳃裂囊肿，诊断时需结合其发病位置，以下颌角、胸锁乳突肌前缘等典型部位最有帮助。如出现囊壁增厚、边缘不清以及周围血管累及或颈部淋巴结肿大等征象时，则高度提示癌变。     

鳃裂囊肿的MRI和CT诊断

目的：讨论鳃裂囊肿的ＭＲ和ＣＴ表现及其诊断价值。方法：对均经手术和病理证实的１１例鳃裂囊肿病人（第一鳃裂囊肿２例,第二鳃裂囊肿９例）的ＣＴ或ＭＲＩ的表现进行分析,并结合文献进行讨论。结果：第一鳃裂囊肿表现为耳前区反复感染或瘘,其特征为瘘道与外耳道平行;第二鳃裂囊肿常表现为颈外侧部和颌下区无压痛囊性肿块,ＣＴ和ＭＲＩ表现为薄壁、均质的囊性肿块,胸锁乳突肌受压向后外或向后移位,颈动脉间隙大血管向内或向     

MR imaging findings of Rathke's cleft cysts: significance of intracystic nodules

BACKGROUND AND PURPOSE: Rathke's cleft cysts often may be difficult to differentiate from other intrasellar or suprasellar masses on radiologic studies. The purpose of this study was to describe the significance of intracystic nodules, a diagnostic characteristic found in Rathke's cleft cysts, on MR images. METHODS: A retrospective review of MR studies was conducted for 13 patients who, after pathologic analysis, were diagnosed as having Rathke's cleft cyst. These patients underwent unenhanced and contrast-enhanced T1- and T2-weighted axial and coronal spin-echo sequential imaging. The signal intensity and incidence of the intracystic nodules on T1- and T2-weighted images were analyzed. The signal intensity of the nodule was compared with that of white matter and surrounding cyst fluid. The signal intensity of cyst fluid was compared with the intraoperative appearance of the cyst fluid. Biochemical and pathologic analyses of the intracystic nodules were conducted in two cases. RESULTS: An intracystic nodule having high signal intensity on T1-weighted images and low signal intensity on T2-weighted images was observed in 10 (77%) of the cases. At surgery, intracystic nodules were yellow, waxy, solid masses. Pathologic analysis showed this nodule to be a mucin clump. Biochemical analysis of the intracystic nodules showed cholesterol and proteins as the main constituents. In the Rathke's cleft cyst with intracystic nodules, cyst fluid revealed low signal intensity to isointensity relative to the intensity of the nodules on T1-weighted images, and isointensity to high signal intensity on T2-weighted images. Intracystic nodules were clearly visible on T2-weighted images. CONCLUSION: Because cyst fluid of Rathke's cleft cysts shows variable intensities on MR images, the specific diagnosis is often difficult when based on MR signal intensity values alone. The presence of an intracystic nodule with characteristic signal intensities on MR images may be indicative of the diagnosis of Rathke's cleft cyst.     

Imaging of large Rathke's cleft cysts by CT and MRI: report of two cases

Two patients with large Rathke's cleft cysts in the sella turcica and suprasellar region presented with visual impairment and hypopituitarism. The entirely different CT and MRI appearances of the two cysts were thought to depend principally on the protein content of the cyst fluid.     

MR appearance and cyst content of Rathke cleft cysts

The magnetic resonance signal intensity and cyst content were analyzed in 2 new and 17 previously reported cases of Rathke cleft cyst. Lesions displaying hypointensity on T1-weighted images (T1WI) and hyperintensity on T2-weighted images (T2WI) contained CSF-like fluid. Cases showing hyperintensity on T1WI and isointensity on T2WI frequently contained mucoid material. Hyperintensity on both T1WI and T2WI suggests the presence of blood. A small area of hypo- or isointensity indicates thickening of the cyst wall or collection of cellular debris.     

鞍区Rathke裂囊肿的影像诊断

目的:研究鞍区Rathke裂囊肿的CT及MRI的表现特点。方法:回顾性分析21例经手术病理证实的Rathke裂囊肿的CT和MRI表现。结果:囊肿多位于鞍内,呈圆形或类圆形,边界清楚。病变大小为0.5~3.2cm,平均1.35cm。CT多为低密度,MRI信号表现根据囊液成分的不同变化多样。囊内可见漂浮结节4例。增强扫描一般无增强。结论:CT和MRI对鞍区Rathke裂囊肿的诊断有一定的价值,但应注意与垂体瘤和颅咽管瘤相鉴别。     

鞍区Rathke囊肿的MRI表现

目的总结垂体Rathke囊肿的MRI表现,以提高对该病的认识。方法回顾性分析26例经手术和病理证实的Rathke囊肿的MRI表现。结果 26例Rathke囊肿多呈圆形或卵圆形,边界清楚,10例位于鞍内,16例位于鞍内和鞍上。10例T1WI呈低信号,T2WI呈高信号,6例T1WI呈等信号,T2WI呈高信号,9例T1WI和T2WI均呈高信号,1例T1WI和T2WI均呈等信号,其中5例T2WI上囊内显示类圆形低信号结节,16例行增强扫描,仅4例囊肿边缘出现轻度增强。结论垂体Rathke囊肿表现为鞍区的囊性占位,仔细分析其MRI表现,有助于术前对本病做出正确诊断。     

Characteristics of Rathke's cleft cyst in MR imaging.

PURPOSE: Symptoms, macroscopic appearances and microscopic findings of Rathke's cleft cysts with magnetic resonance (MR) imaging. Patients and METHODS: We analyzed the data from 31 patients with pathologically confirmed Rathke's cleft cysts. MR appearances were evaluated on T1WI, T2WI and contrast T1WI. Symptoms, macroscopic appearances and pathological findings were obtained from available medical records. We analyzed the images according to the following criteria: 1. findings on the location and shape of the lesions and form of the lesional wall; 2. the relationship between the maximum diameter of the lesions and symptoms; 3. the relationship between MR and macroscopic appearance; 4. the sites of adjacent contrast enhancement. RESULTS: The lesions were located mostly in both the intrasellar and suprasellar regions for a total of 87%. All lesions revealed either an oval or dumbbell shape with a smooth lesional wall. When correlated with physical symptoms, asymptomatic cases were associated with smaller lesions, while visual disturbances and dizziness were associated with relatively larger lesions. MR lesion signal intensity was related to the content of macroscopic appearance to some degree: the selected lesions showed shortening of T1 and T2 relaxation times in relation to the increase in protein concentration. This should have been macroscopically reflected in the color and turbidity of the liquid within the cyst. Adjacent contrast enhancement around the lesion was found at various sites, but anterior enhancement was most frequent. Circumferential enhancement was revealed to be derived from inflammatory changes. CONCLUSION: Rathke's cleft cyst exhibits a varied MR signal. It may be difficult to differentiate from craniopharyngioma from the intensity alone.     

MRI appearance of meniscal cysts

Purpose The purpose of this study was to review the MRI criteria for the distinction of meniscal cysts from other cystic lesions in the knee so that appropriate treatment may be planned.Design A retrospective review of 62 knee MRI scans possibly showing meniscal cysts was performed. The type of meniscal tear, the appearance of the connection between the cyst and the meniscal tear, and the location, size, morphology, and signal characteristics of the meniscal cysts were recorded. Other types of fluid collections that had been mistaken for meniscal cysts were described.Patients Sixty-two patients were studied, ages 16–79 years, 61% male, 39% female.Results and conclusions Most of the meniscal cysts (91%) occurred immediately adjacent to the meniscal tear (98% horizontal cleavage tears, 49% anterolateral), with the tear leading directly into the cyst. In two cases, the cyst had dissected into the soft tissues distant from the meniscus and a connecting stalk was visualized. Fluid collections in normal bursae and recesses that had been mistaken for meniscal cysts had no direct connection to a meniscal tear. MRI can be used to distinguish meniscal cysts from other fluid collections that may mimic meniscal cysts. Pitfalls can be avoided by familiarity with the normal bursal and capsular anatomy, and by the application of specific diagnostic criteria.     

MR imaging of epidermoid cysts

Summary After a short review of literature, MRI assessments of four cases of epidermoid cysts (EC) are reported. EC, (characterized in computed tomography by hypo or iso-density areas nonenhanced by contrast), are characterized in MRI by: 1) an important variability of signal intensity between the different cases, and sometimes between the different parts of the same cyst, 2) the absence of edema in surrouding parenchyma, in spite of important mass effect, 3) well defined limits, permitting certainty of the extra-cerebral nature of this tumor, 4) the presence of calcifications easily perceptible in MRI.It is proposed that the variability of signal intensity of EC is caused by different relaxation time values corresponding to different concentrations of keratin, cholesterol and water content.     

Transient bifrontal solitary periventricular cysts in term neonates

We describe three children born at term investigated for neonatal seizures or transient apnoea. Cranial ultrasound and MRI unexpectedly revealed symmetrical periventricular cysts adjacent to the anterior horns. We found no evidence of prenatal viral infection, intraventricular or subependymal haemorrhage or hypoxic-ischaemic lesions. The lesions were not seen on MRI at 3 months of age, but there was no compensatory dilatation of the anterior horns nor secondary loss of white matter. The appearance and location of these transient cysts were different from those of the cystic changes which typically follow germinal matrix haemorrhage or periventricular leukomalacia. Their pathogenesis and clinical significance remain to be determined.     

Evaluation of intracranial cysts by intraoperative MR

Eleven patients with intracranial cystic collections were evaluated in the open-bore intraoperative MR system. In each case, the cystic collection or the surrounding cerebrospinal fluid (CSF) space was injected with .02 to .5 cc of .5 mol/1 gadopentetate dimeglumine. Serial Imaging was performed using T1-weighted imaging. In seven patients, free communication was demonstrated between the cystic collection and the surrounding CSF spaces. In four cases, the cyst did not communicate with the CSF; two of these were drained in the intraoperative MR system with reduction in symptoms. One patient developed an aseptic meningitis 10 days after the study, which was successfully treated with steroids; no other complications were noted. We conclude that the communication of intracranial cystic collections with the cisterns and ventricies can be safely and effectively elucidated with gadolinium injection in the intraoperative MR system.     

Ruptured supratentorial dermoid cysts

Two cases with ruptured supratentorial dermoid cysts are presented. Computerised tomography and magnetic resonance findings are illustrated. The pathology and differential diagnosis is discussed.