基底节区非生殖细胞瘤性生殖细胞肿瘤1例

患者男,8岁.父母偶然发现患者外生殖器大、出现阴毛且近期学习成绩下降明显,逐来医院就诊.查体:患儿双上肢肌力V级,右上肢灵活性差,用手习惯由右手改为左手.右侧轻度跛行.无发热、盗汗、头痛、头晕、恶心、呕吐.实验室检查:甲胎蛋白(α-FP)460.92ng/ml(0～13.4ng/ml),绒毛膜促性腺激素(3-HCG)71.62mIU/ml(0～5 mIU/ml),癌胚抗原(CEA) 1.14ng/ml(0～5ng/ml).     

Imaging of sacrococcygeal germ cell tumors

Sacrococcygeal teratoma is the most common solid tumor in neonates. Malignant sacrococcygeal germ cell tumors also occur in infants and children. Diagnostic imaging studies help confirm the diagnosis of a clinically palpable sacrococcygeal mass, determine its relationship to other structures, and detect metastases. Despite the relative frequency of sacrococcygeal germ cell tumors, characteristics of these lesions as evaluated with computed tomography (CT) and magnetic resonance (MR) imaging have received little attention in radiologic literature. We outline important clinical information, review the spectrum of manifestations of these tumors with traditional imaging studies, and illustrate the value of CT and MR imaging for diagnosis and staging of sacrococcygeal germ cell tumors.     

基底细胞痣综合征的影像诊断

基底细胞痣综合征(basal cell nevus syndrome,BCNS)又称为 Gorlin-Goltz 综合征或痣样基底细胞癌综合征(nevoid basal cell carcinoma syndrome,NBCCS),主要表现为多发基底细胞痣、颌骨牙源性角化囊性瘤、脊柱或肋骨畸形、颅内异常钙化[1-2]。本综合征在临床上比较少见,不易诊断,但具有较特征性的影像学表现。笔者收集本院经临床和术后病理共同确诊的6例患者的影像资料,结合相关文献进行探讨,以提高对该病影像学特征的认识。     

MR imaging and histologic features of capillary telangiectasia of the basal ganglia

Capillary telangiectasias are being recognized with increasing frequency on MR imaging studies. Most are located in the brain stem and show slightly increased signal intensity on T2-weighted images, low signal intensity on T2*-weighted images (reflecting the presence of deoxyhemoglobin), and contrast enhancement. These findings are considered fairly typical for capillary telangiectasia, and pathologic correlation is not generally pursued. We present a case of a proven capillary telangiectasia in the basal ganglia. The imaging features of the lesion were identical to those described for capillary telangiectasias in the brain stem.     

原发性纵隔混合型恶性生殖细胞瘤的影像学表现

目的探讨原发性纵隔混合型生殖细胞瘤(mixed germ cell tumor,MGCT)的影像学表现及临床特征。方法回顾性分析经病理确诊的7例纵隔MGCT的临床、影像及病理资料。7例患者行胸部CT平扫及增强检查,5例同时行PET/CT检查。结果7例病灶均表现为分叶状或类圆形囊实性肿块,病灶最大径9.0~20.1cm,中位数15.7cm;增强动脉期瘤内均见强化迂曲血管影,静脉期血管影增多,瘤灶实性部分强化较动脉期明显,不均匀渐进性强化。5例PET/CT检查病灶最大标准化摄取值(SUVmax)范围约5.0~8.3,平均6.7±1.5。结论青少年男性、增强动静脉两期血管影逐渐增多、瘤灶实质不均匀渐进性强化、瘤灶血供丰富却不同程度囊变及坏死、18F-FDG高代谢的前纵隔囊实性肿块,有助于提示MGCT的诊断。     

Dynamic MR imaging of neurohypophyseal germ cell tumors for differential diagnosis of infundibular diseases

Purpose: To investigate the MR dynamic patterns of neurohypophyseal germ cell tumors (GCTs) for differential diagnosis of infundibular diseases affecting young people.Material and Methods: Eleven patients with neurohypophyseal GCTs underwent dynamic MR studies with T1-weighted spin-echo (SE) or turbo SE techniques. Other infundibular lesions, including adenohypophysitis (n=3), Langerhans' cell histiocytosis (LCH, n=2), and 1 hemangioblastoma from von Hippel-Lindau disease, were also evaluated. Serial images were obtained every 15 s (turbo SE) or 30 s (SE technique) for 240 s after rapid injection of contrast medium. The dynamic patterns were analyzed quantitatively with the contrast medium enhancement ratio.Results: On dynamic MR images, GCTs typically showed a gradual enhancement increase with a peak between 105 s and 180 s, while two showed a relatively rapid increase. LCH and hemangioblastoma showed a dynamic pattern similar to GCTs, while adenohypophysitis demonstrated a sharp rise and a steeper wash-out with an obvious peak before 90 s.Conclusion: Typical dynamic pattern of GCTs was the gradual enhancement increase without wash-out. Dynamic MR imaging can distinguish GCTs from adenohypophysitis, but is not useful for differentiation from LCH.     

基底细胞痣综合征的影像诊断简

目的探讨基底细胞痣综合征（BCNS）特征性的临床、影像及病理表现。方法对我院收治的2例经病理证实患者的临床及影像资料进行报道及回顾性分析,并进行相关文献复习。结果2例均有特征性的颌骨多发囊肿,肋骨分叉;其中1例有颅内异常钙化。结论目前文献对BCNS确诊的病例报道较少。由于BCNS具有临床及影像特征表现,因此提高对该病的认识,对临床早期诊断及治疗有积极的意义。     

睾丸生殖细胞肿瘤的MRI诊断

目的：探讨睾丸生殖细胞肿瘤的 MRI 表现,提高对该疾病的 MRI 诊断水平。方法回顾性分析经手术病理证实的25例睾丸生殖细胞肿瘤患者临床及 MRI 资料,所有病例均行 MRI 平扫,其中16例行动态 MRI 增强扫描。利用 MRI 对睾丸肿瘤的大小、形态、信号特点、毗邻关系、强化方式及肿瘤血管情况进行评估,并与病理对照。结果25例睾丸生殖细胞肿瘤中,精原细胞瘤10例,其中 T2 WI 呈均匀低信号8例,稍低信号2例,增强扫描轻度结节样强化5例,明显均匀强化2例,其中4例可见纤维间隔强化;卵黄囊瘤4例,T1 WI 呈等低信号,T2 WI 呈稍高信号,增强扫描后肿瘤呈渐进式强化;成熟型畸胎瘤、表皮样囊肿、混合性生殖细胞肿瘤各3例,T1 WI 呈混杂低信号,T2 WI 呈混杂高信号;胚胎性癌2例,T1 WI 呈等低信号,T2 WI 呈混杂低信号,其内可见出血信号,增强扫描呈分隔强化。结论MRI 对睾丸生殖细胞肿瘤诊断正确率较高,对其病理分型、分期及鉴别诊断具有重要价值。     

Malignant germ cell tumours of undescended testes: imaging features with pathological correlation

AIM: To illustrate the imaging features of malignant germ cell tumours complicating undescended testes, emphasizing the importance of recognizing this condition and providing a correct diagnosis to facilitate appropriate management. METHODS: The clinical presentation, ultrasonography (US) and computed tomography (CT) features of eight consecutive patients with malignant germ cell tumours of undescended testes were reviewed. RESULTS: CT performed in seven patients showed well-circumscribed soft-tissue masses with inhomogeneous enhancement in all cases. US in four patients showed circumscribed masses with inhomogeneous echogenicity. On pathological examination, there were two cases of embryonal carcinoma and six cases of seminoma. All tumours showed necrosis that correlated to inhomogeneous areas on imaging. CONCLUSION: The radiologist has an important role as he may be the first physician to suggest the diagnosis.     

Imaging features of glomus tumors

Objective  

To describe the imaging findings with pathologic correlation and clinical presentation of glomus tumors.     

Imaging features of granulosa cell tumors of the ovary: about three cases

Granulosa cell tumors of the ovary are rare, and included in the sex cord-stromal tumor category. They have a low malignancy potential and generally have a good prognosis. They are the most frequent hormone-secreting tumors of the ovary and may lead to suggestive clinical symptoms. Some biological markers (serum inhibin B and AMH) may be helpful for diagnosis, though their sensitivity is not perfect. Preoperative imaging diagnosis remains challenging due to the wide variability in morphology and lack of epidemiological data in the imaging literature (small patient populations). From a review of the clinical and MR imaging features of three cases of granulosa cell tumor of the adult and a review of the literature, we will describe a few imaging features that may suggest the correct diagnosis.     

Imaging features of intraosseous ganglia: a report of 45 cases

The aim of this study is to report the spectrum of imaging findings of intraosseous ganglia (IG) with particular emphasis on the radiographic and magnetic resonance (MR) features. Forty-five patients with a final diagnosis of IG were referred to a specialist orthopaedic oncology service with the presumptive diagnosis of either a primary or secondary bone tumour. The diagnosis was established by histology in 25 cases. In the remainder, the imaging features were considered characteristic and the lesion was stable on follow-up radiographic examination. Radiographs were available for retrospective review in all cases and MR imaging in 29. There was a minor male preponderance with a wide adult age range. Three quarters were found in relation to the weight-bearing long bones of the lower limb, particularly round the knee. On radiographs all were juxta-articular and osteolytic; 74% were eccentric in location, 80% had a sclerotic endosteal margin and 60% of cases showed a degree of trabeculation. Periosteal new bone formation and matrix mineralization were not present. Of the 29 cases that underwent MR imaging, 66% were multiloculated. On T1-weighted images the IG contents were isointense or mildly hypointense in 90% cases. Forty-one per cent of the cases showed a slightly hyperintense rim lining that enhanced with a gadolinium chelate. Thirty-eight per cent were associated with soft tissue extension and 17% with a defect of the adjacent articular cortex. Fifty-five per cent showed surrounding marrow oedema on T2-weighted or STIR images and two cases (7%) a fluid-fluid level prior to any surgical intervention. The authors contend that it is semantics to differentiate between an IG and a degenerate subchondral cyst as, while the initial pathogenesis may vary, the histological endpoint is identical, as are the imaging features apart from the degree of associated degenerative joint disease. IGs, particularly when large, may be mistaken for a bone tumour. Correlation of the typical radiographic and MR imaging features will indicate the correct diagnosis and obviate the need for biopsy.     

Hyperintense basal ganglia on T1-weighted MR imaging

OBJECTIVE: This study was designed to evaluate the safety, MR imaging characteristics, and clinical response to intrathecal gadopentetate dimeglumine (gadolinium) administration in human patients. SUBJECTS AND METHODS: Eleven adult patients were included in this prospective study. Via lumbar puncture, a single dose of either 0.2 ml, 0.5 ml, or 1.0 ml of gadolinium (500 mmol/l) mixed with 5 ml of previously removed CSF was slowly injected into the lumbar subarachnoid space. Immediate and delayed MR imaging were subsequently carried out using a 1.0-T magnet. RESULTS: No patient manifested gross behavioral changes, neurologic alterations, or seizure activity. The intrathecal gadolinium-enhanced MR myelography revealed disk herniation (n = 4), posttraumatic spinal stenosis (n = 3), postsurgical noncommunicating cyst (n = 1), myelitis (n = 1), intradural extramedullary mass formation (n = 1), and intradural vascular malformation (n = 1). CONCLUSION: This pilot study shows the relative safety and feasibility of low-dose intrathecal gadolinium administration. The potential clinical applications include the evaluation of obstructions and communications of the subarachnoid space, spontaneous or traumatic CSF leaks, and CSF dynamics. Additional animal and human studies must be performed to further evaluate the long-term safety and to prove the clinical applications of this procedure in a larger number of subjects.     

MRI of intracranial germ cell tumors

We reviewed MRI findings in proven intracranial germ cell tumours in 22 cases, 12 of whom received Gd-DTPA. On T1-weighted images, the signal intensity of the tumour parenchyma was moderately low in 19 cases and isointense in 3; on T2-weighted images, it was high in all cases. Regions of different intensity thought to be cysts were found in 17 (77%): 7 of 12 patients with germinoma (58%) and in all other cases. Of the 13 patients with pineal lesions T1-weighted sagittal images showed the aqueduct to be obstructed in 5, stenotic in 7 and normal in 1. Strong contrast enhancement was observed in all 12 cases. Of the 14 patients with suprasellar lesions, 5 were found to have an intrasellar extension, and in 3 of these, the normal pituitary gland, which could be distinguished from the tumour, was displaced anteriorly. Ten patients (45%) had multiple lesions.     

Imaging features of phosphaturic mesenchymal tumors

Skeletal Radiology - To examine the CT and MR imaging features of phosphaturic mesenchymal tumors (PMTs). With IRB approval, our institutional radiology/pathology database was reviewed for...     

Imaging features of solitary fibrous tumors

OBJECTIVE: The goal of this pictorial essay is to illustrate the multimodality imaging features of pleural and extrapleural solitary fibrous tumors. CONCLUSION: Solitary fibrous tumors tend to be well-defined, ovoid, heterogeneously enhancing lesions. MRI characteristically depicts areas of low signal intensity that correspond to dense collagen. The findings of lesion multiplicity and hypermetabolism on PET images should raise the suspicion of malignancy.     

肝肿瘤的影像学诊断(一)

肝肿瘤分为良性肿瘤和恶性肿瘤两大类.良性肿瘤中比较常见的是海绵状血管瘤,其他包括肝腺瘤、局灶性结节增生、肝脏囊腺瘤和脂肪瘤等.恶性肿瘤中常见的是肝癌,分为原发性和继发性(转移性)两种,其他比较少见的肝恶性肿瘤包括淋巴瘤、肉瘤和胆管细胞囊腺癌等.