颅内血管内皮瘤临床及影像学分析并文献复习

背景与目的:原发于中枢神经系统的上皮样血管内皮瘤(epithelioid hemangioendothelioma,EH)非常罕见,本文报道1例天幕起源的EH,并结合文献分析其临床病理、影像学特征及治疗和预后情况,旨在提高对此病的认识.方法:对1例确诊为颅内EH患者的临床、病理和影像学特征、诊断与鉴别诊断、治疗和预后进行回顾性分析并进行文献复习.结果:颅内EH是罕见病变,属于间叶性肿瘤,其生物学行为属交界性或不确定性肿瘤,具有一定特征性的影像学表现.肿瘤由排列呈巢状、索状的上皮样细胞组成.免疫组织化学检测结果显示CD31、CD34和FⅧ阳性.手术切除是其主要的治疗方法,其对放疗敏感.EH的预后较好.结论:EH少见,需与脑膜瘤鉴别,其生物学行为具有潜在的侵袭性,建议尽可能完全切除以及密切随访,对于术后残留病灶推荐放疗.     

Hepatic plasmacytomas: Case report and review of imaging features

Extramedullary plasmacytomas are uncommon and have a better prognosis than disseminated myeloma. We describe the second case of hepatic plasmacytomas (multiple) following a solitary bone plasmacytoma. The imaging characteristics of the few reported cases of these rare hepatic tumours are compared. The value of ultrasound in the assessment of liver lesions is emphasized.     

Epidemiology and etiology of intracranial meningiomas: A review

The frequency of meningiomas has been the topic of relatively few reports. Hospital-based brain tumor series indicate that the incidence is approximately 20% of all intracranial tumors; population-based studies indicate an overall incidence of 2.3/100,000. Although intracranial tumors as a whole show a higher prevalence in males than in females, meningiomas have a 2: 1 female-to-male ratio. Between Caucasians and Africans, African-Americans, and Asians, certain differences also have been noted. Meningiomas in children are rare and differ from those in adults and other childhood tumors; they are even more rare in infants. Several features indicating etiologic factors have been identified, among which are ionizing radiation, head injury, hormones, and other receptor binding sites, genetic factors, and viruses. The most common source of exposure of the head to ionizing radiation is dental radiographic examination. Since 1922, head trauma has been considered a possible risk factor, but recent large studies do not support this link. Several factors have prompted studies of estrogens and progestogens as risk factors for meningiomas. Other studies have sought to determine if certain individuals have an inherited predisposition for developing a meningioma and/or if viruses, which may act alone or with other mutagens, figure into the formation of a meningioma. The most promising studies are those of cytogenetics, and future elucidation of factors associated with the loss of one copy of chromosome 22, another phenomenon that has been identified in meningiomas, may lead to screening tests and gene therapy.     

颅内表皮样囊肿的影像学诊断

目的:分析颅内表皮样囊肿的CT和MRI表现。方法:对30例经手术及病理确诊的颅内表皮样囊肿的CT和MRI表现作回顾性分析,其中30例作MRI平扫与增强扫描;20例作CT平扫检查。结果:肿瘤位于桥前池及桥小脑角池18例,4例位于鞍上,2例位于鞍旁,5例位于第四脑室,1例位于小脑延髓池。肿瘤大小不等,形态不规则,轮廓光整或呈分叶状。CT平扫17例呈均匀低密度,2例呈稍不均匀低密度,CT值为-15～10Hu,1例呈高密度。MRI平扫28例T1加权像上肿瘤呈不均的低信号,T2加权像上呈不均匀高信号,部分病例在FLAIR图象上表现为不均匀高信号,与周围低信号的脑脊液分界清晰;2例表现为T1加权像上为高信号,T2加权像上为低信号。增强后,2例肿瘤边缘有轻微强化,其余肿瘤均无明显强化。结论:典型的颅内表皮样囊肿,通过CT和MRI检查可做出准确诊断,并可以与颅内其他疾病相鉴别;在鉴别诊断中,MRI优于CT。非典型的颅内高密度囊肿,必须CT和MRI相结合诊断,为准确的术前诊断提供更多的信息。     

囊性脑膜瘤的MRI特征分析(附17例)

目的:分析囊性脑膜瘤的磁共振成像特点,加深对该病的认识,以提高诊断准确率.方法:回顾分析经手术病理证实的17例囊性脑膜瘤,其中男8例,女9例,年龄36~70岁,平均49.7岁,行颅脑MRI平扫和增强,其中3例加做MRS,结合手术病理,采用Nauta分型分析囊性脑膜瘤的MRI表现及特点.结果:囊性脑膜瘤主要位于大脑凸面,以广基与硬脑膜相连,MRI多表现为实性肿物伴有大小不等的囊变区,实性部分以等或长T1长T2信号为主,囊性部分均表现为长T1长T2信号;增强扫描实性部分呈中度或明显强化,囊壁可有或无强化.本组17例中,Nauta I型7例,NautaⅡ型8例,NautaⅣ型2例.结论:囊性脑膜瘤较为少见且不易于与其他颅内囊室性病变进行鉴别,磁共振常规扫描结合增强扫描及MRS有助于对该疾病正确诊断,同时对临床治疗和手术方案设计有一定的指导意义.     

10例肝脏淋巴瘤的影像学表现分析

目的：探讨肝脏淋巴瘤的影像学特点。方法回顾性分析10例初诊未治的肝脏淋巴瘤患者的临床表现、病理类型与影像学表现。结果10例均为B细胞型非霍奇金淋巴瘤（4例原发性,6例继发性）,表现为单发肿块型4例,多发结节型4例,浸润型2例。3例CT平扫呈均匀低密度,6例CT增强扫描呈轻度强化,强化程度低于正常肝实质。4例MRI平扫者,T1WI呈低信号,T2WI及脂肪抑制序列呈均匀中高信号,2例DWI扫描呈明显扩散受限,2例行MR增强扫描呈轻度强化。4例有血管穿行肿瘤但无明显受侵征象。7例伴有肝脏区域淋巴结侵犯。原发肝脏淋巴瘤的影像表现与继发性相仿。结论肝脏淋巴瘤的影像表现可多种多样,多数呈密度/信号均匀,增强后呈轻度强化,血管于肿瘤内穿行而无受侵是肝脏淋巴瘤的较为特征性表现。     

颅内黑色素瘤的诊断与治疗--附五例临床分析及文献复习

为讨论颅内黑色素瘤的临床表现、影像学特征及治疗方法 ,对本科近 13年来治疗的 5例颅内黑色素瘤进行回顾性分析。结果示颅内黑色素瘤的临床表现不具有特征性。影像学上CT表现为高密度或混杂密度 ,增强扫描呈不同程度强化。核磁共振检查 (MRI)表现为短T1短T2 信号 ,也可以因顺磁性黑色素含量不同和瘤内有无出血 ,表现为高、低或混杂信号 ,注射二乙胺五乙酸钆 (GD DTPA)后出现不同程度的强化。 5例患者中 ,3例手术全切 ,1例大部分切除 ,1例未手术。初步研究结果提示 ,颅内黑色素瘤的预后差 ,主张在手术基础上进行包括放疗及化疗的综合治疗     

Imaging features of primary pulmonary liposarcoma

Primary liposarcoma of the lung is extremely rare. We report a 28‐year‐old pregnant woman who complained of dyspnoea during the third trimester. Chest radiography, thoracic ultrasound, CT and MRI showed a huge heterogeneous tumour involving all the left lung and the mediastinum. The tumour was composed of soft tissue, and fatty and cystic components with calcifications. Diagnosis was made on core biopsy under CT guidance. Surgical excision was performed but unfortunately the patient died during the operation.     

Two cases of methanol poisoning: CT and MRI features

Methanol poisoning in Australia is now very rare as methanol has been removed from methylated spirits. In acute intoxication methanol may result in a wide range of damage to the central nervous system. Few cases have been imaged with MRI. We present two cases and their striking neuroimaging findings with a discussion of the published work on methanol poisoning.     

Immunocytochemistry of intracranial meningiomas

Summary Fifty meningiomas of four major histological types have been examined by immunocytochemical methods applied to formalin fixed paraffin embedded material and using readily available commercial antisera. The expression of GFAP, S100, NSE, vimentin, cytokeratin, fibronectin and desmoplakin was investigated. The majority of tumours contained NSE (86%) and S100 (78%), and all irrespective of histological type, contained vimentin and fibronectin. The epithelial marker cytokeratin was found in 56% of cases, but showed only focal expression. The relevance of these findings to histogenesis and metabolism is discussed and it is suggested that intermediate filament typing provides valuable information on meningiomas structure and function. The possible role of NSE and 5100 in meningeal neoplasm is discussed.     

Primary leiomyosarcoma of inferior vena cava,a rare entity: Imaging features

Leiomyosarcoma of the inferior vena cava (IVC) is an uncommon neoplasm, most frequently seen in the sixth decade with a female predominance. Imaging modalities allow an early and accurate preoperative diagnosis resulting in a higher rate of surgical resection and improved survival. Imaging findings in a 65‐year‐old woman with leiomyosarcoma of IVC are described. Computed tomography and MRI typically showed a non‐fatty, necrotic intraluminal IVC mass with extension to retroperitoneal compartments. Cavography was useful to evaluate the collateral circulation associated with the extensive intraluminal mass. The lesion was biopsied under ultrasound guidance.     

背部弹力纤维瘤的影像与病理学对照分析

Background and Objective:Elastofibroma dorsi has an extremely low incidence.At present,comparative study on imaging manifestations and pathologic findings of elastofibroma dorsi has not been reported in China.This study was to investigate clinical manifestations,computed tomography(CT) and magnetic resonance imaging(MRI) appearances,and pathologic features of elastofibroma dorsi and to improve preoperative imaging diagnosis of this disease.Methods:The clinical manifestations,imaging findings,and pathologic ...     

A Review of Imaging Practice in Bone and Soft Tissue Lesions

Thirty six consectutive bone and soft tissue lesions which were referred to the Bone Transplantation Service between January 1987 and June 1989 were reviewed with respect to the information provided by pre-operative CT, MR and plain X-ray and the final histopathologic diagnosis. The ability of CT and MR to demonstrate cortical destruction, periosteal reaction, a soft tissue mass and soft tissue calcification was scored on a scale of one (low suspicion of abnormality) to four (definite abnormality) in each case. Of the thirty six cases reviewed there were twenty-two histologically confirmed tumours with all of the above three imaging modalities available for comparison. In each of these tumours MR was found to provide an equal or more accurate assessment of soft tissue extent. On a scale of 1 to 4 the average point scores were 3.6 and 2.6 for MR and CT respectively. Little difference was shown between CT and MR with respect to medullary involvement (4.0 points vs. 3.9) and cortical destruction (2.5 points vs. 2.7). CT (3.7 points) was more sensitive than MR (1.2 points) in detecting fine soft tissue calcification. In only five cases did the radiology report correctly nominate the histologic diagnosis and thus the role of imaging was more valuable in staging than diagnosis. For this reason a management oriented report should include comment regarding cortical destruction, the intramedullary extent of tumour and the extent of soft tissue involvement. MR is recommended in the investigation of all suspected malignant soft tissue or bone tumours.     

Lymphomatoid granulomatosis: Case report and review of the literature

Lymphomatoid granulomatosis (LG) is an uncommon disease now regarded by most authors as an unusual form of lymphoma with the ability to affect any bodily system. The disease and its complications may result in a spectrum of radiological appearances. A case illustrating how cerebral lesions may mimic demyelinating plaque, neoplasm or infection and how pulmonary lesions may lead to pneumopericardium is presented. The difficulty in establishing a definitive diagnosis, due to the non-specificity of symptoms, pathological investigations and radiological appearances of the disease, is emphasized. Clinicians must therefore consider LG in their differential diagnoses, as delayed treatment may affect prognosis.     

A systematic review of diagnostic procedures to detect midgut neuroendocrine tumors

The aim of this work was to assess the diagnostic yield of some clinical diagnostic procedures utilized to establish a diagnosis of midgut neuroendocrine tumors (NETs). Medical databases published between 1982 and 2007 were analyzed. Seventeen observational studies, including 629 patients, met the inclusion criteria. Urinary 5‐HIAA is the first test to prescribe in patients with flushing or persistent, unexplained diarrhea. Abdominal CT scan and OctreoScan should be prescribed whenever NET is suspected. J. Surg. Oncol. 2010;102:877–888. © 2010 Wiley‐Liss, Inc.     

肾脏上皮样血管平滑肌脂肪瘤的CT及MRI表现

目的 探讨肾脏上皮样血管平滑肌脂肪瘤的影像学特点,以提高其诊断水平.方法 搜集经手术病理证实的26例肾脏上皮样血管平滑肌脂肪瘤(EAML)患者的影像学资料并进行回顾性分析.26例患者均未合并结节性硬化症.16例行CT检查,18例行MRI检查.结果 26例患者病灶最大径为0.9～16.3 cm,平均7.3cm.病灶呈类圆形或类椭圆形20例(77.0％),分叶状4例(15.4％),沿肾周间隙铸型生长1例(3.8％),不规则形1例(3.8％);病灶完全位于肾轮廓之内2例(7.7％),部分突出于肾轮廓外24例(92.3％),其中以窄蒂状与肾实质相连2例(7.7％);2例(7.7％)肿瘤侵犯肾静脉形成静脉瘤栓;1例(3.8％)同时发现腹膜后淋巴结转移;1例(3.8％)同期发现肝脏和肺多发转移.12例CT平扫示9例(75.0％)呈高或稍高密度,2例(16.7％)呈等-低或低密度,1例(8.3％)呈等-高密度.18例MRI平扫T1W图像15例(83.3％)病灶以等信号为主,T2W或T2W/FS图像10例(55.6％)病灶以低信号为主,8例(44.4％)呈低-高、低-等或低-等-高混杂信号.双期增强CT和/或动态MRI增强扫描示25例(100％)均呈不均匀强化,其中10例(40％)呈网格样强化,23例(92.0％)病灶动脉期强化程度呈等或略低于正常肾皮质,实质期强化程度均低于正常肾实质.1例(3.8％)病灶内见弯曲条带状钙化;9例(34.6％)可观察到少量脂肪成分;8例(30.8％)病灶内见扩张或粗大迂曲走行的血管;8例(30.8％)瘤内伴有出血.结论 肾脏EAML影像学表现具有如下特征:女性多见;多呈类圆形或膨胀性生长;肿瘤较大时可出现囊变及出血;病灶内成熟脂肪成分并不多见;钙化罕见;肿瘤实性成分CT平扫呈稍高或高密度;T2WI呈稍低信号或高低混杂信号;动态增强扫描多数呈“快进快出”的强化特点,不均匀筛网状强化较多见;部分病灶内可见迂曲扩张血管;可以伴有局部淋巴结及远处转移.     

Central neurocytoma occurring in the thalamus: CT and MRI findings

A case of central neurocytoma occurring in the thalamus, confirmed by electron microscopy and immunohistochemistry, is reported. Computed tomography demonstrated a hypodense mass with an irregular margin arising from the right thalamus, extending into the lateral ventricle and crossing the midline. It contained areas of calcification and showed slight enhancement after contrast injection. On magnetic resonance imaging (MRI) scan, the tumour was hypointense to the brain in T1-weighted images and was heterogeneously hyperintense to the brain in T2-weighted images.     

胃肠道间质瘤的CT和MRI特征及其与病理危险度的关系

目的探讨胃肠道间质瘤(GIST)的计算机断层扫描(CT)和核磁共振成像(MRI)特征,并分析其与病理危险度的关系。方法收集52例GIST患者的临床资料,所有患者均接受了腹部CT和MRI检查,观察病变的形态学特征。根据美国国立卫生研究院原发GIST危险度分级方案,将GIST患者分为高危组(n=16)、中危组(n=16)、低危组(n=15)和极低危组(n=5),分析不同组别GIST患者的CT和MRI特征。结果高危组、中危组、低危组、极低危组GIST患者的肿瘤直径、形状、密度分布情况、瘤内继发改变、CT强化程度及强化方式比较,差异均有统计学意义(P<0.01)。极低危组和低危组GIST的肿瘤直径较小,形状规则,密度较均匀,内部无囊性变、溃疡或出血;高危组GIST患者的肿瘤直径较大,形状较不规则,密度不均匀,多数可见囊性变,少数可见溃疡和出血。极低危组和低危组GIST患者的平均表观弥散系数(ADC)值为(1.81±0.21)×10^-3,中危组GIST患者的平均ADC值为(1.69±0.18)×10^-3,高危组GIST患者的平均ADC值为(1.21±0.21)×10^-3,差异有统计学意义(P<0.01)。结论 GIST的CT和MRI表现具有一定的特征,通过对肿瘤直径、形状、密度、内部囊变情况、ADC值进行分析,可以对肿瘤的危险度做出一定的评估。