脊髓室管膜瘤MRI特征分析及其鉴别诊断

目的探讨脊髓室管膜瘤的MRI特征。资料与方法回顾性分析经病理证实的16例脊髓室管膜瘤,所有患者均行MRI平扫和增强扫描,分析肿瘤部位、大小、生长方式、信号特点及强化方式,有无囊变、出血及“帽征”。结果全部脊髓室管膜瘤呈中心性生长,3例终丝室管膜瘤合并有椎间孔扩大,肿瘤平均累及2．7个椎体。在平扫MRT1WI上．大部分肿瘤呈等或低信号,在T2聊上全部肿瘤呈高信号,10例肿瘤实质头端或尾端脊髓反应性囊变;3例瘤内囊变,2例可见肿瘤内出血,在T2WI上。5例肿瘤可见“帽征”。增强扫描后。15例肿瘤表现为显著强化,14例肿瘤与正常脊髓分界清楚。结论脊髓室管膜瘤MRI表现具有一定的特征性,了解这些特征,有助于脊髓室管膜瘤术前诊断和鉴别诊断。     

不同级别室管膜瘤MRI表现分析

目的 对比分析不同级别室管膜瘤的年龄、性别分布及其MRI表现.方法 回顾性分析经病理证实的57例室管膜瘤的MRI表现,比较不同级别室管膜瘤在年龄、性别分布及MRI特征上的差异.结果 57例室管膜瘤中,WHOI级者占12.3%,男女比例为61,好发于青年,中位年龄32岁,肿瘤均发生于脊髓,以终丝、马尾为主,呈膨胀性生长,囊变及包膜常见,出血少见;WHOII级者占64.9%,男女比例约为1.21,各年龄均可发生,但以年轻成人多见,约占83.8%,发生于少年儿童者多位于后颅凹,发生于成年者多位于脊髓,且以颈胸段为主,大部分呈膨胀性生长,囊变及假包膜较多见,出血少见;WHOIII级者占22.8%,男女比例为1.61,53.8%见于儿童,颅内多发,约占92.3%,主要发生在脑实质及四脑室内,多呈侵袭性生长,囊变和包膜相对少见,出血相对多见,并可见瘤周水肿.增强后各级肿瘤实质均表现为明显强化,WHOIII级者肿瘤实质强化更显著.结论 不同级别的室管膜瘤在年龄、性别、好发部位、MRI信号、生长方式及强化方式等方面存在差异,MRI表现结合年龄、性别分布和部位有助于该病的诊断及良恶性判断.     

终丝室管膜瘤的甲泛葡糖脊髓造影CT表现

4例终丝部位室管膜瘤,均?脊髓造影及甲泛葡糖脊髓造影CT检查(简称CTMM),并经手术及病理证实。室管膜瘤是最常见的髓内肿瘤,占马尾肿瘤的第一位。本文主要讨论有关的CT征象,以期在术前作出正确诊断。     

脑室内胶质瘤的MRI诊断

目的 分析脑室内胶质瘤的MRI特点,提高诊断准确性.资料与方法 经手术病理证实的脑室内胶质瘤29例,其中20例位于侧脑室,2例位于三脑室,7例位于四脑室.29例均行MR平扫及增强扫描.结果 (1)大多数脑室内胶质瘤如室管膜瘤、星形细胞瘤、脉络丛乳头状瘤等具有特征性的MRI表现;(2)部分肿瘤具有其好发部位,如脉络丛乳头状瘤好发于侧脑室三角区,室管膜瘤好发于侧脑室体部,髓母细胞瘤好发于四脑室区;(3)某些肿瘤具有年龄和性别特征,如星形细胞瘤患者年龄均＜30岁,脉络丛乳头状瘤患者年龄均＞50岁,室管膜瘤女性占66.67%.结论 脑室内胶质瘤有比较特征性的MRI表现,结合患者临床和发病年龄、性别、部位等特点,可进一步提高其术前诊断准确性.     

胆管内乳头状黏液性肿瘤二例并文献复习

目的 探讨临床少见的胆管内乳头状黏液性肿瘤的影像表现.方法 结合文献分析2例经病理证实的胆管内乳头状黏液性肿瘤患者的CT、MRI表现特点.结果 2例在CT、MRI检查时均显示胆管扩张,但无确切肿块,ERCP显示胆管内有充盈缺损,内镜下十二指肠乳头处见黄绿色胶冻样黏液,病理诊断分别为腺体乳头状增生并黏液内癌细胞和乳头状腺瘤.结论 影像学检查表现为胆管瘤样扩张,MRCP示扩张胆管内信号不均,其内可见有充盈缺损,内镜检查发现十二指肠乳头处黄绿色胶冻样黏液可提示胆管内乳头状黏液性肿瘤诊断,但最终诊断依赖于病理检查.     

侧脑室肿瘤的MRI诊断

目的:分析侧脑室肿瘤的MRI特征,提高对侧脑室肿瘤的诊断水平.方法:48例侧脑室肿瘤患者,其中41例经手术病理证实包括脑膜瘤13例,室管膜瘤10例,星形胶质细胞瘤4例,少突胶质细胞瘤、室管膜下瘤、脉络丛乳头状瘤和胶样囊肿各2例,室管膜下巨细胞型星形细胞瘤和神经母细胞瘤各1例;7例转移瘤原发肿瘤明确.回顾性分析其MRI表现,按病变部位分为侧脑室三角部,体部,前角及室间孔区.按年龄分为＜10岁,10～30岁和＞30岁三个年龄组.结果:本组中11例(11/13)脑膜瘤增强表现为明显均匀强化,8例(8/10)室管膜瘤可见多发囊变区,2例(2/4)星形胶质细胞瘤可见瘤内出血;11例(11/13)脑膜瘤发生于侧脑室三角部,5例室管膜瘤及4例星形胶质细胞瘤发生于侧脑室体部,所有室管膜下瘤(2例)、室管膜下巨细胞型星形细胞瘤(1例)和胶样囊肿(2例)均发生于侧脑室前角及室间孔区;10例(10/13)脑膜瘤发生于30岁以上,3例(3/4)星形胶质细胞瘤发于10～30岁,7例转移瘤全部发生于30岁以上.结论:侧脑室肿瘤的诊断和鉴别诊断主要依据其MRI表现,结合肿瘤的部位和年龄特征可提高诊断准确性.     

幕下室管膜瘤与髓母细胞瘤的鉴别诊断

目的:分析幕下室管膜瘤和髓母细胞瘤的MRI表现特点,提高MRI对两者的鉴别诊断水平。方法:回顾性分析经病理证实的11例幕下室管膜瘤和18例髓母细胞瘤,对肿瘤的常规MRI平扫、增强扫描、DWI及T_2 FLAIR信号特点进行分析。结果:幕下室管膜瘤与髓母细胞瘤的内部信号特点、瘤周水肿、生长方式、强化特点差异均无统计学意义(均P0.05),肿瘤实性成分的T_2 FLAIR和DWI信号特点,差异均有统计学意义(均P0.001)。结论:常规MRI平扫和增强扫描鉴别幕下室管膜瘤和髓母细胞瘤较困难,结合DWI和T_2 FLAIR可明显提高对两者的鉴别诊断水平。     

脊髓室管膜瘤的MRI表现

目的探讨脊髓内室管膜瘤的MRI表现,提高对本病的认识。方法收集我院经病理证实的脊髓室管膜瘤13例,分析肿瘤部位、信号特点、有无囊变、出血及帽征、椎间孔扩大及肿瘤强化方式。结果肿瘤位于颈髓6例,胸髓3例,终丝及马尾4例.在T1WI上呈等、低信号,在T2WI上呈高信号、混杂信号.9例见囊变,3例可见肿瘤内出血,2例椎间孔扩大.13例均出现不同程度强化,1例呈轻度强化,3例中度强化,9例重度强化,11例肿瘤与正常脊髓分界清楚。结论髓内室管膜瘤MRI表现具有一定特点,结合其发病部位、边界、囊变、出血、强化特征及临床资料常可作出正确诊断。     

儿童侧脑室肿瘤的CT和MRI诊断

目的 分析儿童侧脑室肿瘤的CT与MRI影像学特征.方法 回顾性分析26例经手术与病理证实的儿童侧脑室肿瘤的CT与MRI表现,其中5例CT检查,7例MRI检查,14例同时做CT和MRI.结果 26例肿瘤包括脉络丛乳头状瘤10例,室管膜肿瘤7例,室管膜囊肿4例,室管膜下巨细胞星形细胞瘤2例,表皮样囊肿、脑膜瘤、恶性生殖细胞瘤各1例.儿童侧脑室肿瘤具有一定的CT、MRI特征性表现.结论 CT与MRI相结合,能为儿童侧脑室肿瘤的诊断和鉴别诊断提供更全面的信息,有助于提高术前诊断率.     

侧脑室肿瘤的MRI诊断及鉴别诊断

目的 探讨侧脑室肿瘤的MRI表现特点. 资料与方法 回顾性分析25例经手术病理证实的侧脑室肿瘤的MRI表现. 结果 25例侧脑室肿瘤中,星形细胞瘤9例,其中3例(3/9)位于侧脑室三角区,3例(3/9)位于侧脑室体部;脑膜瘤6例,其中4例(4/6)位于侧脑室三角区,6例增强扫描均呈明显均匀强化;室管膜下瘤3例,2例位于侧脑室前角和室间孔区,增强扫描不强化或轻度强化;中枢神经细胞瘤2例, 1例位于侧脑室前角,1例位于侧脑室体部;脉络丛乳头状瘤2例;室管膜瘤2例;转移瘤1例. 结论 侧脑室肿瘤MRI表现有一定特点.     

Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation.

Intramedullary spinal cord neoplasms are rare, accounting for about 4%10% of all central nervous system tumors. Despite their rarity, these lesions are important to the radiologist because magnetic resonance (MR) imaging is the preoperative study of choice to narrow the differential diagnosis and guide surgical resection. On contrast materialenhanced MR images, intramedullary spinal tumors almost always manifest as expansion of the spinal cord and show enhancement. Syringohydromyelia and cystic lesions are frequently associated with intramedullary tumors. Nontumoral cysts tend to be located at the poles of the tumors and do not enhance on contrast-enhanced MR images, whereas cysts within the substance of the tumor are considered tumoral cysts and typically demonstrate peripheral enhancement. Spinal cord ependymomas are the most common type in adults, and cord astrocytomas are most common in children. Both entities constitute up to 70% of all intramedullary neoplasms. A central location within the spinal cord, presence of a cleavage plane, and intense homogeneous enhancement are imaging features that favor an ependymoma. Intramedullary astrocytomas are usually eccentrically located within the cord, are ill defined, and have patchy enhancement after intravenous contrast material administration. Even with these characteristics, it may not be possible to differentiate these two entities on the basis of imaging features alone. Cord hemangioblastomas are the third most common type of intramedullary spinal tumor. Gangliogliomas commonly extend over more than eight vertebral segments. Paragangliomas and primitive neuroectodermal tumors have an affinity for the filum terminale and cauda equina. Other spinal cord tumors include metastatic disease, which is characterized by prominent cord edema for the size of the enhancing portion, and primary lymphoma.     

Spinal arteriovenous fistulas of the filum terminale

The filum terminale is an anatomic structure at the end of the spinal cord. Only a few cases of AVFs of the filum terminale have been reported. These AVFs usually consist of a single communication between the anterior spinal artery and a single draining vein. We retrospectively analyzed the clinical and radiologic features and treatment of 4 patients with spinal AVFs of the filum terminale. Clinical manifestations and MR images are similar to those of spinal dural AVFs. All patients underwent surgical or endovascular treatment, resulting in complete occlusion. Clinical outcomes were good to excellent in all patients.     

Thickened fatty filum terminale: MR imaging

Summary MR images of four patients with a thickened filum terminale showing a fat signal are presented. There were no related symptoms and no evidence of tethering. The thickened fatty filum terminale seemed to be a developmental anomaly and without clinical significance. As the incidence of this anomaly was 0.24% in our series, knowledge of its possible presence of this anomaly is important for routine reviews of MR image.     

DTI对脊髓圆锥与终丝界限区分的初步研究

目的 探讨DTI脊髓成像在区分脊髓圆锥与终丝界限的可行性及临床意义.方法 选取10例腰椎MRI检查患者,行常规腰椎矢状位T1WI,T2WI检查,轴位T2WI检查,同时行T11～L4椎体水平脊髓EPI序列DTI成像.结果 DTI能清晰显示脊髓及圆锥的形态及走行,终丝未见显影,脊髓圆锥位于L1椎体下缘及L2椎体上缘,与常规MRI检查二者有较好的一致性.脊髓的ADC值低于脑脊液,FA值高于脑脊液.结论 脊髓DTI能区分脊髓圆锥与终丝的界限.     

儿童视网膜母细胞瘤伴脑脊液种植转移的MRI表现(附6例分析)

目的:探讨儿童视网膜母细胞瘤(RB)伴脊髓脑脊液种植转移的MRI表现及其诊断价值。方法:对6例经手术病理证实的儿童RB的CT及MRI资料进行回顾性分析。结果:6例中1例为双侧,5例为单侧。6例均行MRI检查发现软脊膜转移,其中2例合并脊髓受侵,表现为软脊膜呈弥漫性、不均匀结节状增厚,马尾、终丝明显增厚、聚集,肿块填充椎管。讨论:RB的MRI表现具有一定特征性。MRI可清楚显示脊髓脑脊液种植转移的范围、信号特征及与脊髓的关系,对RB的分期、治疗和预后具有重要意义。     

腱鞘巨细胞瘤MRI表现及信号特点

目的:总结腱鞘巨细胞瘤的MRI表现及信号特点。方法:回顾性分析14例经手术和病理证实的腱鞘巨细胞瘤患者的病例资料,其中2例为术后复发。所有病例均行MRI平扫,其中1例行增强扫描,分析所有病例的MRI信号特征及发病部位。结果:14例中局限性12例,弥漫性2例,肿瘤信号与正常骨骼肌对比,11例T1WI上以等信号为主,3例以稍低信号为主;T2WI信号呈多样性,8例以稍高信号为主,2例呈稍低信号,2例呈等信号,2例呈混杂信号。14例可见T1WI及T2WI上均呈低信号病灶。结论:腱鞘巨细胞瘤多发生于手、足等肢体远端,且以局限型多见。MRI信号呈多样性,但T1WI及T2WI双向低信号为其特征性表现,且其对诊断、指导临床治疗和随访具有重要价值。     

Myxopapillary ependymoma of the ischioanal fossa

Ependymomas outside the confines of the cranium and spinal cord are rare. Direct extension into the soft tissues of the sacrococcygeal area may occur from a primary ependymoma of the spinal cord, cauda equina or filum terminale. Alternatively they may occur as a primary pre-sacral, pelvic and abdominal tumour, or as a primary tumour of the skin and subcutaneous tissue of the sacrococcygeal area without any demonstrable connection with the spinal cord. The Authors report a case of myxopapillary ependymoma of the ischioanal fossa, demonstrated by MRI. To our knowledge, our case is the first lesion reported at this site.     

Myxopapillary ependymoma of the conus medullaris with subarachnoid haemorrhage: MRI in two cases

Subarachnoid haemorrhage due to cauda equina tumour is rare. We report two myxopapillary ependymomas of the conus terminalis, presenting with in this way. Rims of low signal were observed at their upper and lower borders, mainly on T2-weighted images. This finding has been described in ependymomas of the cervical region but not, to our knowledge, in myxopapillary ependymomas of the conus terminalis. Received: 8 August 2000 Accepted: 8 September 2000     

Fatty filum terminale: assessment with MR imaging

Five cases of fatty filum terminale were encountered in a retrospective analysis of 332 routine lumbosacral magnetic resonance studies. The T1-weighted and GRASS images were particularly useful in evaluating the filum. An irregularly thickened fatty filum, especially if associated with a low conus, is likely to be pathologic and responsible for a patient's symptoms and signs.