Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

颅内皮样囊肿和表皮样囊肿的MRI鉴别诊断

目的：探讨颅内皮样囊肿及表皮样囊肿的MRI表现及其诊断价值。方法：回顾性分析5例经手术病理证实的颅内皮样囊肿和7例颅内表皮样囊肿病例,对其MRI表现、病理和临床特征进行分析。其中8例行MRI增强扫描。结果：5例颅内皮样囊肿病例中,3例表现为T1WI低信号,T1WI为高信号,2例T1WI及T2WI均为不均匀高信号。增强扫描的3例均表现为厚壁中等强化。7例颅内表皮样囊肿病例中,4例表现为T,WI低信号,T2WI高信号,2例TlWI及T2WI均为高信号,l例T1WI及T2WI均为不均匀高信号。增强扫描的5例中4例表现为薄壁轻微强化,1例壁无强化。结论：颅内皮样囊肿和表皮样囊肿均有较典型的MRI表现,可实现术前正确诊断,MRI鉴别诊断意义重大。     

低场MRI诊断卵巢巧克力囊肿价值探讨

目的探讨卵巢巧克力囊肿低场MRI表现及其诊断价值。方法46例49个卵巢巧克力囊肿均作MR扫描和B超检查，全部病例经手术和病理证实。结果49例卵巢巧克力囊肿因出血时间不同囊液的MRI信号不同，T1WI高信号（与脂肪相等）39个，稍高（低于脂肪）信号6个，低信号4个，囊壁呈等信号；T2WT与STIR信号相似，囊液均匀稍低信号40个，混杂信号9个（其中夹杂高信号5个，夹杂更低信号4个），囊壁低信号；单囊20个，多囊29个，囊壁不规则24个（其中有尖角10个，有分叶4个），囊壁规则24个。低场MRI术前诊断49个卵巢巧克力囊肿，47个与病理相符，2个病理诊断为囊腺瘤：B超术前诊断卵巢巧克力囊肿38个，未定性6个，未发现病变5个。结论MRI和B超对诊断卵巢巧克力囊肿的检出敏感性100％（49／49）、89％（44／49），特异性96％（47／49）、77．6％（38／49），P值〈0．05，具有显著差异，说明低场MRI对卵巢巧克力囊肿定性诊断优于B超。     

磁共振弥散加权成像对表皮样囊肿鉴别诊断的帮助

目的：评价弥散加权成像在诊断表皮样囊肿中的作用。方法：对17例经手术病理证实的表皮样囊肿和6例蛛网膜囊肿行常规MRI扫描和弥散加权成像。结果：表皮样囊肿在弥散加权为高信号,蛛网膜囊肿为低信号。结论：弥散加权成像对鉴别表皮样囊肿有较高的应用价值。     

Rathke囊肿的MRI表现与病理学相关性分析

目的:探讨Rathke囊肿的MRI表现与病理学的关系,MRI在诊断中的价值。方法:回顾性分析经手术与病理证实的15例Rathke囊肿,均行MRI检查。结果:15例Rathke囊肿均显示鞍内或向鞍上圆形或椭圆形病灶。直径1～2 cm者9例。T1WI高信号7例,其中FS-T1WI高信号3例,T2WI高信号4例,等或低信号3例;T1WI低信号8例,T2WI均呈高信号;DWI弥散不受限4例;3例出现边缘强化。囊内容物为黄色、棕色水样或脑脊液、胶冻状粘液或含有胆固醇结晶。囊壁为单层立方上皮细胞或纤毛柱状上皮,有的混有假复层鳞状上皮或慢性炎性细胞,部分含有邻近受压的垂体组织。结论:MRI对本病的诊断与鉴别诊断有重要的价值;囊肿的MRI与病理表现有密切的关系。     

Uncommon locations of hydatid cysts

Human echinococcosis remains a complex problem that may affect several organs, and requires mostly surgical management. We present two cases with uncommon locations of hydatid cysts that were successfully managed in our hospital during the last two years. The first case was a 62-year-old woman with a multicystic lesion in her right thigh that was radically excised, and histology confirmed the diagnosis of echinococcosis. The second case was a 78-year-old man with multiple large intraabdominal hydatid cysts that required a complex operation, including splenectomy, partial removal of the liver cyst wall and evacuation of the content, and excision of pelvic, mesenteric cysts, and suprahepatic cysts. Both cases have not shown any sign of recurrence to date. Since the disease is still endemic in certain parts of the world and pharmaceutical agents are not radical, specific surgical procedures remain the treatment of choice with good results and acceptable morbidity, mortality and recurrence rates.     

肝脏及肺部泡状棘球蚴病CT表现（附11例肝肺病例报告）

目的分析肝脏及肺部泡状棘球蚴病的CT表现，探讨肝脏及肺部泡状棘球蚴痛的CT诊断及鉴别方法分析临床及手术病理证实的9例肝脏及2例肺脏泡状棘球蚴病螺旋CT表现。结果2例肺泡状棘球蚴病CT均表现为实性病灶，边缘清楚，未见钙化影。9例肝脏泡状棘球蚴病中5例表现为中心以实性为主周围伴有多发性小空泡征的圆形、椭圆形阴影，边缘光滑，其中3例囊肿壁有不同程度环形钙化。2例为实性病灶，部分囊壁环形钙化，囊内无小空泡征（小囊肿）。2例CT表现为斑块状低密度影，分界不清，中间散在分布斑点钙化影。结论螺旋CT可以很好显示肝肺泡状包虫病病灶，对肝肺泡状包虫病具有较高的诊断率。     

颅内表皮样囊肿的临床特征及显微手术治疗

目的对1994～2004年完成的颅内表皮样囊肿显微外科手术进行总结,为此种疾病今后的诊断和治疗提供有益的参考。方法对本院12例颅内表皮样囊肿患者,先行CT和MRI检查,随后在全麻下进行显微外科的手术切除。以电凝切开囊膜,将囊内实质逐步摘除,然后沿边界细心分离,逐一电凝并切断血供及粘连,彻底切除囊肿。对于粘连过于紧密的部位,宁可残余少量组织,以免出现术后严重的并发症。并在术后对患者的检查资料进行总结,对病变组织进行影像学和病理学分析。结果12例颅内表皮样囊肿患者中,8例位于桥小脑角,颅底斜坡2例,鞍区1例,脑室1例。手术切除的囊肿组织,75％(9／12例)呈不规则形态。CT平扫83．33％(10／12例)为均匀低密度,且造影后90％(9／10例)未发生强化MRI T1呈均匀低信号,与脑脊液基本类似或略高于脑脊液,T2呈均匀高信号,占75％(9／12例)。周围脑组织未发现有水肿现象;但是当瘤体较大时会引起比较明显的占位效应,占66．67％(8／12例)。结论颅内表皮样囊肿在CT和MRI检查中可见有特征性表现,为手术提供较为准确的术前诊断,术中观察和术后的病理切片均得以证实。经过显微外科手术,基本可以完全切除囊肿组织,达到较好的治疗效果。     

肾包虫囊肿的CT诊断(附3例报告)

本文报告经手术证实的3例肾包虫囊肿的CT表现。其特征性表现是:(1)卵圆形或圆形水样密度囊肿。(2)母囊内有子囊。(3)囊膜剥离征象。(4)囊壁钙化。并讨论了本病的破裂感染和与先天性肾囊肿的鉴别诊断。     

女性盆腔囊性病变鉴别诊断中经腹壁超声与MRI的应用价值探讨

目的探究经腹壁超声与MRI在女性盆腔囊性病变鉴别诊断中的应用价值。方法回顾性分析本院2019年1月至2019年6月收治的86例盆腔囊性病变患者的临床资料,患者分别行经腹壁超声与MRI扫描检查,同时获取病例患者术后病理结果,分析经腹壁超声与MRI在女性盆腔囊性病变鉴别诊断中的应用价值。结果盆腔囊性病变者MRI影像学表现:卵巢囊肿,T₁WI低信号、T₂WI高信号,增强扫描后可见壁、分隔及附壁结节强化信号。单纯卵巢囊肿信号均匀、呈圆形或椭圆形,T₂WI水样高信号,T₁WI水样低信号,囊壁薄且光整,无壁结节。盆腔脓肿,呈长T₁、长T₂及压脂成高信号,内壁光滑整齐,无内壁结节;增强扫描后有明显环形强化。子宫平滑肌瘤,T₁WI等低信号、T₂WI低信号,强化程度较正常子宫实质低。腹部超声表现:盆腔脓肿,呈较厚囊壁且包膜完整;卵巢囊肿,为囊性无回声,部分表现为囊壁薄且均匀,亦见囊壁呈乳头状且囊壁增厚,囊肿内部无明显钙化,囊壁乳头状区域存在部分彩色血流信号;子宫平滑肌瘤,低回声、边界清晰,可见少量血流信号。术后病理结果显示卵巢囊肿50例、盆腔脓肿28例、子宫平滑肌瘤8例,而MRI对盆腔囊性病变的整体准确率明显高于经腹壁超声(P<0.05)。结论经腹壁超声与MRI在女性盆腔囊性病变鉴别诊断中均可提供有价值的参考信息,MRI于女性盆腔囊性病变中的诊断优势高于经腹壁超声,但考虑到MRI检测时间长及价格高等限制,临床实践中可根据实际情况合理选择。     

肝包虫病的螺旋CT诊断

目的:提高对肝包虫病的螺旋CT表现的认识。方法:回顾分析经本院螺旋CT检查及手术病理证实的21例肝包虫病螺旋CT表现。结果:囊型包虫病18例,其中单纯囊肿8例,表现为圆形水样密度区。多子囊型10例,表现为在一个大囊内可见数量不等的更低密度小圆形低密度区,边界清晰。钙化14例,为囊壁壳状钙化囊内不定形条片状钙化。包虫囊肿合并感染4例,表现为囊壁增厚,强化明显。泡型包虫病3例,呈不规则及不均匀密度影,所有病灶内均有钙化灶,其中1例病灶边缘有晕样改变区。所有病例CT均诊断正确。结论:螺旋CT可以很好显示肝包虫病病灶,对肝包虫病具有较高的诊断率。     

半月板囊肿的MRI诊断价值

目的分析膝关节半月板囊肿的MRI表现,评价其MRI诊断的价值。方法收集MRI检出并经手术病理证实的18例膝关节半月板囊肿,回顾性分析其MRI表现。结果半月板旁型囊肿13例,半月板内型囊肿1例,滑膜囊肿4例。半月板囊肿多呈类圆形,边缘光滑的囊性肿块,信号均匀,T1WI呈等或稍低信号,T2WI呈高信号。典型表现呈“吹气球征”。结论MRI对膝关节半月板囊肿的诊断具有重要价值,可作为半月板囊肿的首选检查方法。     

椎管内胚胎性肿瘤的MRI诊断6例临床分析

目的　评估椎管内胚胎性肿瘤的MRI特征。方法　回顾性分析经手术和病理证实的6例椎管内胚胎性肿瘤的MRI表现。结果　表皮样囊肿3例,T1、T2加权显示各种不典型信号类型;脂肪瘤2例,T1加权示高信号,T2加权衰减为中等信号;髓内肠源性囊肿1例,T1加权显示低信号,T2加权示高信号。结论　除脂肪瘤外,椎管内胚胎性肿瘤的MRI表现缺乏典型的特征。MRI诊断应当结合发育异常病史、病理学和病原学。     

脑部脉络膜裂囊肿的MRI诊断

目的:探讨脑部脉络膜裂囊肿的MRI影像学表现及其诊断价值。方法:回顾性分析21例脉络膜裂囊肿的MRI资料,对MRI影像与临床表现之间的关系进行了讨论。结果:21例病灶均位于脉络膜裂内。MRI表现:冠状面呈“双凸透镜”形、卵圆形,矢状面呈卵圆形、“箭头样”表现;内部信号均匀且在各个序列上均呈长T1长T2信号,FLAIR序列示囊肿信号呈低信号。囊壁及其周围无软组织信号,平均大小为0.8cm×1.4cm×1.6cm,病灶周围均无水肿。3例行钆喷替酸葡甲胺(Gd-DTPA)增强扫描后均未见病灶强化。结论:脑部脉络膜裂蛛网膜囊肿是一种良性的先天性发育异常,通常与临床表现无关。由于脉络膜裂囊肿发生在特殊的位置,横轴面扫描易误诊为脑内病变,MRI冠状面及矢状面扫描可做出明确诊断并能够与其他囊性病变相鉴别。     

Rathke囊肿的影像学诊断与鉴别诊断

目的:分析Rathke囊肿的CT和MRI表现,提高对该病的诊断水平。方法:回顾性分析经手术与病理证实的14例Rathke囊肿的CT及MRI资料。结果:14例Rathke囊肿,CT平扫8例,其中4例为低密度,2例等密度,1例高密度,1例囊壁可见钙化。3例CT增强扫描未见明显强化。MRI平扫主要显示为圆形或类圆形,5例位于鞍内,9例位于鞍内及鞍上。6例为长T1、长T2信号,5例为短T1、长T2信号,2例为短T1、短T2信号,1例信号不均匀。12例MRI增强扫描,其中10例未见明显强化,2例囊壁轻度强化。结论:Rathke囊肿囊液密度/信号变化多样,通过总结其影像特点并结合详细的影像学检查可对其中多数病例做出正确的定性诊断。     

颅内蛛网膜囊肿手术治疗的临床分析

目的:探讨颅内蛛网膜囊肿的手术治疗方式及其疗效。方法:回顾性分析72例手术治疗的颅内蛛网膜囊肿患者的临床资料,神经内镜下囊壁部分切除+囊肿-脑室或脑池造瘘术16例,显微镜下囊肿切除术4例,显微镜下囊壁部分切除+囊肿-脑池造瘘术32例,囊肿-腹腔分流术20例。随访6个月～6 a(平均2.2a)。结果:67例患者经治疗后症状改善,有效率93.1%,随访CT或MRI显示83.3%(60/72)幕上蛛网膜囊肿体积显著减小,幕下蛛网膜囊肿体积无明显变化但症状显著改善。结论:有症状的蛛网膜囊肿患者均应积极治疗。针对不同患者选择合适的手术方式对预后有重要意义。神经内镜手术创伤小、并发症少,应继续推广应用。     

硬脊膜内蛛网膜囊肿MRI诊断

目的评估硬膜内蛛网膜囊肿的ＭＲＩ特征。材料和方法６例硬膜内蛛网膜囊肿（４例男性,２例女性,年龄１７～５６岁不等,平均３３岁）,行ＭＲＩ诊断且手术病理证实。使用０．３５特斯拉超导型ＭＲ成像仪,采用自旋回波和多回波技术。行矢状面、横断面Ｔ１加权成像和矢状面Ｔ２加权成像。结果病变分布：颈段、腰段、腰骶段各１例,胸段３例。长度为１～４个椎体长度不等（平均２．２个椎体长度）。４例囊肿位于脊髓平面,将脊髓推向对侧,其上、下端蛛网膜下腔扩大。１例并发其平面下的脊髓空洞症。所有的ＭＲ序列呈现与脑脊液相同的信号。结论ＭＲ是直接显示囊肿的大小、成分及与周围蛛网膜下腔联系的最好的手段。它还直接显示囊肿的信号和周围的结构,且无电离辐射、无损伤性、无骨伪影、多平面成像、无需椎管内注入造影剂。     

肝脏泡状棘球蚴病的CT MRI表现

目的 分析肝脏泡状棘球蚴病CTMRI表现，评价CTMRI对肝包虫病的诊断价值。方法 回顾分析15例经CTMRJ诊断及手术病理证实的肝包虫病影像学资料。结果 15例共发现肝包虫囊肿17个。CT表现边界清晰或稍模糊的圆形或椭圆形不均匀密度减低区；大部分病灶可见钙化。MRI表现在T1加权像上边界清晰或稍模糊的圆形或椭圆形不均匀的低信号影，其内散在分布不规则的更低信号影。在T2加权像上，病灶呈不均匀高信号。病灶内的钙化在T1和T2加权像上呈条状、点状、斑片状无信号区（钙化）。增强扫描强化不明显。结论 CTMRI对肝包虫病有较高的诊断价值。     

Magnetic resonance imaging of occult intracranial malformations

11 patients with angiographically occult intracranial vascular malformations proved by surgery and pathology were studied by magnetic resonance imaging (MRI). The chief MRI findings were: On T1-weighted imaging, there was a homogeneous or heterogeneous hyperintensity or isointensity signal at the centre of the lesion with a surrounding rim of hypointensity signal; On T2-weighted imaging, there was a hyperintensity signal at the centre and hypointensity signal at the peripheral region. Differential diagnosis between hemorrhagic tumor and occult vascular malformation lies in that the latter has no edema and is often single. comparing with CT, the size of occult vascular malformation on MRI was equal to that on CT.     

椎管内胚胎性肿瘤的MRI诊断6例临床分析

目的 评估椎管内胚胎性肿瘤的MRI特征。方法 回顾性分析经手术和病理证实的6例椎管内胚胎性肿瘤的MRI表现。结果 表皮样囊肿3例，T1、T2加权显示各种不典型信号类型；脂肪瘤2例，T1加权示高信号，T2加权衰减为中等信号；髓内肠源性囊肿1例，T1加权显示低信号，T2加权示高信号，结论 除脂肪瘤外，椎管内胚胎性肿瘤的MRI表现缺乏典型的特征，MRI诊断应当结合发育异常病史，病理学和病原学。