颅内室管膜下瘤磁共振特征与鉴别诊断

目的探讨颅内室管膜下瘤磁共振影像学表现,以期提高对该病的影像学认识水平,有利于术前的诊断。方法回顾性分析9例(我院及外院)经手术病理证实的室管膜下瘤的磁共振影像学资料,并与脑室内其他肿瘤进行鉴别诊断。结果肿瘤位于侧脑室5例,透明隔区2例,三角区2例。瘤体主要呈椭圆形6例,另外3例呈分叶样不规则形。瘤体边界清楚,大小约1.4~4.4 cm。T1WI、T2WI呈等信号4例,3例呈等长T1等长T2信号,2例T1像见短信号,DWI呈略高信号,T2FLAIR病灶呈较高信号。对比剂增强后肿瘤3例无强化,4例轻度强化,2例中等强化。5例瘤体内见小类圆形囊状改变,2例患者同时伴有梗阻性脑积水。结论颅内室管膜下瘤好发于脑室系统内,MRI平扫T2小囊性变及增强后不强化或轻度强化为其典型表现,接近孟氏孔区病灶可较大,增强后可中等强化,本病易与脑室内其他肿瘤相鉴别,术前能够较为准确地诊断。     

室管膜下巨细胞型星形细胞瘤六例分析

目的 探讨室管膜下巨细胞型星形细胞瘤(SEGA)患者的临床、影像学、病理学特点以及诊断和治疗方法.方法 对自2000年2月至2007年8月收治的6例SEGA患者的临床和影像学表现、病理学特点、治疗及随访结果进行回顾分析.结果 6例SEGA的临床表现以高颅压和视力下降最为常见.CT显示肿瘤实体部分呈等或稍高密度,边界清楚,部分可见瘤内钙化.MRI扫描肿瘤实体部分T1WI多呈等信号,少数可呈稍低信号;T2WI呈等或稍高信号:增强扫描肿瘤实体部分呈不均匀强化.4例经胼胝体入路,2例经额叶皮质入路,肿瘤全切除均成功,无手术死亡.随访10月～8年,肿瘤无复发.结论 室管膜下病变如位于室间孔周围伴有结节性硬化,引起脑积水或呈现逐渐生长趋势者,应考虑SEGA的诊断,尽早手术治疗.SEGA为良性肿瘤,手术全切者预后良好.定期影像学检查对于跟踪室管膜下结节以及监测肿瘤复发是必要的.     

室管膜下巨细胞型星形细胞瘤

目的探讨室管膜下巨细胞型星形细胞瘤的病理、临床表现、影像学（CT、MRI）、诊断及治疗,以便提高诊断率和治愈率。方法回顾分析自1996年9月至2004年8月收集的12例室管膜下巨细胞型星形细胞瘤的临床特点,头颅CT、MRI及病理学特征。结果（1）室管膜下巨细胞型星形细胞瘤好发于青少年儿童,男性多于女性,以＂三联征＂和不同程度神经系统缺失为特征的首发临床表现。本组12例中5例伴发结节性硬化综合征。（2）影像学多数病例头颅CT表现侧脑室室管膜下或脑室内门氏孔附近呈椭圆形或不规则结节状较均匀低密度肿块,少数为等或高密度,伴室管膜下多发点状钙化。MRI常表现等T1、等T2,少数出现T1高信号、T2低信号。病变周围没有或很少水肿。CT或MRI增强扫描病变出现均匀强化。（3）临床诊断应与室管膜下室管膜瘤、室管膜下结节、室管膜瘤及脉络丛乳头状瘤等相鉴别。（4）只要全切除,术后不必放、化疗。结论典型病例较易诊断,绝大多数室管膜下巨细胞型星形细胞瘤为WHOⅠ级,只要全切除预后良好。     

结节性硬化合并室管膜下巨细胞型星形细胞瘤临床及影像学特点分析

目的 探讨结节性硬化合并室管膜下巨细胞型星形细胞瘤患者的临床特点及影像学特征,以便及早诊断与治疗.方法 收集三九脑科医院神经内科自2007年7月至2009年8月诊断为结节性硬化的48例患者的临床资料,根据患者病史、体征及影像学检查结果分析其中合并室管膜下巨细胞型星形细胞瘤的患者的临床特点和影像学特征.结果48例中4例患者合并有室管膜下巨细胞型星形细胞瘤,其中2例合并梗阻性脑积水.4例患者均为男性,平均发病年龄5岁(1～12岁);均有癫痫发作及皮肤损害,其中3例患者伴有智力低下.室管膜下巨细胞型星形细胞瘤在CT呈等密度或略低密度,有些瘤内可见钙化,呈高密度影;MRI上T1WI呈等低混合信号,T2WI呈等或高信号,FLAIR序列呈高信号,合并钙化则信号强度不均匀,增强后常有明显强化.结论 部分结节性硬化患者可合并室管膜下巨细胞型星形细胞瘤,肿瘤生长缓慢,常邻近室间孔周围,易发生梗阻性脑积水.对于结节性硬化患者应进行长期追踪,以尽早发现肿瘤.     

MRI无强化侧脑室额角室管膜下瘤1例并文献复习

目的探讨侧脑室额角室管膜下瘤的临床及影像学特征、手术技巧。方法回顾性分析1例侧脑室额角室管膜下瘤病人的临床资料,MRI增强检查示肿瘤无明显强化,经纵裂-胼胝体入路切除肿瘤。结果病理证实室管膜下瘤,WHOⅠ级。复查CT示肿瘤完全切除,随访3个月状态良好。结论 MRI无强化是侧脑室室管膜下瘤的重要特征,位于额角者首选早期经纵裂-胼胝体前入路手术全切。     

结节性硬化合并室管膜下巨细胞型星形细胞瘤临床及影像学特点分析

目的 探讨结节性硬化合并室管膜下巨细胞型星形细胞瘤患者的临床特点及影像学特征,以便及早诊断与治疗.方法 收集三九脑科医院神经内科自2007年7月至2009年8月诊断为结节性硬化的48例患者的临床资料,根据患者病史、体征及影像学检查结果分析其中合并室管膜下巨细胞型星形细胞瘤的患者的临床特点和影像学特征.结果48例中4例患者合并有室管膜下巨细胞型星形细胞瘤,其中2例合并梗阻性脑积水.4例患者均为男性,平均发病年龄5岁(1～12岁);均有癫痫发作及皮肤损害,其中3例患者伴有智力低下.室管膜下巨细胞型星形细胞瘤在CT呈等密度或略低密度,有些瘤内可见钙化,呈高密度影;MRI上T1WI呈等低混合信号,T2WI呈等或高信号,FLAIR序列呈高信号,合并钙化则信号强度不均匀,增强后常有明显强化.结论 部分结节性硬化患者可合并室管膜下巨细胞型星形细胞瘤,肿瘤生长缓慢,常邻近室间孔周围,易发生梗阻性脑积水.对于结节性硬化患者应进行长期追踪,以尽早发现肿瘤.     

结节性硬化合并室管膜下巨细胞型星形细胞瘤临床及影像学特点分析

目的 探讨结节性硬化合并室管膜下巨细胞型星形细胞瘤患者的临床特点及影像学特征,以便及早诊断与治疗.方法 收集三九脑科医院神经内科自2007年7月至2009年8月诊断为结节性硬化的48例患者的临床资料,根据患者病史、体征及影像学检查结果分析其中合并室管膜下巨细胞型星形细胞瘤的患者的临床特点和影像学特征.结果48例中4例患者合并有室管膜下巨细胞型星形细胞瘤,其中2例合并梗阻性脑积水.4例患者均为男性,平均发病年龄5岁(1～12岁);均有癫痫发作及皮肤损害,其中3例患者伴有智力低下.室管膜下巨细胞型星形细胞瘤在CT呈等密度或略低密度,有些瘤内可见钙化,呈高密度影;MRI上T1WI呈等低混合信号,T2WI呈等或高信号,FLAIR序列呈高信号,合并钙化则信号强度不均匀,增强后常有明显强化.结论 部分结节性硬化患者可合并室管膜下巨细胞型星形细胞瘤,肿瘤生长缓慢,常邻近室间孔周围,易发生梗阻性脑积水.对于结节性硬化患者应进行长期追踪,以尽早发现肿瘤.     

室管膜下瘤临床分析

目的深入认识室管膜下瘤,提高其诊断及治疗水平。方法回顾性分析8例经病理证实的室管膜下瘤MR表现及手术治疗效果。结果肿瘤在T1WI为稍低、等信号,部分可见小囊状更低信号区,T2WI为高信号;增强扫描,肿瘤无明显强化或轻度强化。8例均手术治疗,1例先行放疗后再行手术治疗。8例随访3个月～2年,均未见肿瘤复发。结论室管膜下瘤具有较特征的MR表现,术前MR检查可作出明确的定位,定性诊断,运用显微神经外科全切除肿瘤是主要的治疗方法 。     

室管膜下瘤临床分析

目的深入认识室管膜下瘤,提高其诊断及治疗水平。方法回顾性分析8例经病理证实的室管膜下瘤MR表现及手术治疗效果。结果肿瘤在T1WI为稍低、等信号,部分可见小囊状更低信号区,T2WI为高信号;增强扫描,肿瘤无明显强化或轻度强化。8例均手术治疗,1例先行放疗后再行手术治疗。8例随访3个月～2年,均未见肿瘤复发。结论室管膜下瘤具有较特征的MR表现,术前MR检查可作出明确的定位,定性诊断,运用显微神经外科全切除肿瘤是主要的治疗方法 。     

颅内室管膜下瘤的诊断和显微外科治疗(附33例报告)

目的 探讨颅内室管膜下瘤的临床特点和治疗方法.方法 回顾性分析北京天坛医院收治的33例室管膜下瘤患者的临床特点、诊断和治疗.结果 本组33例,男19例,女14例;年龄2～54岁,平均27.4岁;第四脑室13例,侧脑室18例,脑内2例.MRI T1WI呈等或略低信号,T2WI呈高信号;22例无强化,11例呈片状、结节或条索样轻度强化.侧脑室18例,手术全切13例,近全切除5例.第四脑室13例,手术全切3例,近全切除7例,大部切除3例.脑内2例均近全切除.结论 颅内室管膜下瘤少见,影像学有显著特征,有助于术前诊断,显微外科治疗手术全切除预后好.

Abstract：

Objective To explore the clinical characteristics and treatment of intracranial subependymoma.Method 33 patients with intracranial subependymoma treated with microneurosurgical management at Beijing Tiantan Hospital from 1998 to 2008 were analyzed retrospectively.Results In this serials,19 patients were in male and 14 patients in female.Tumors located in the lateral ventricles in 18 cases,located in the fourth ventricle in 13 cases,intra-brain tissue in 2 cases.On MRI scans,the tumors showed iso/hypointensity on T1-weighted and hyperintensity on T2-weighted images.On enhanced scans,the tumors showed no enhancement or only slightly enhancement.Tumors located in the lateral ventricles,were totally removed in 13 cases and subtotal in 5 cases;tumors located in the fourth ventricle,were totally removed in 3 cases, subtotally in 7 cases and partial in 3 cases; tumors were subtotally removed in 2 cases in intra-brain tissue type.Conclusions MRI may contribute to diagnose the intracranial subependymoma and surgical management.Radical resection usually contributes to a good outcome.     

Tumours around the foramen of Monro: clinical and neuroimaging features and their differential diagnosis.

The clinical and neuroimaging features of 20 patients with lateral ventricular tumours located around the foramen of Monro were reviewed retrospectively with special emphasis on the differential diagnoses. Histologic types were: eight neurocytomas, four subependymal giant cell astrocytomas (SGCAs), three subependymomas, two fibrillary astrocytomas, and one each of pilocytic astrocytoma, malignant astrocytoma and malignant teratoma. The mean age of the patients with neurocytoma was 29.6 years, with SGCA 13.3 years and with subependymoma 55.3 years. All tumours appeared nodular in shape, and on computed tomography (CT) neurocytomas were either isodense or highdense with the brain, while all subependymomas and SGCAs were lowdense. Calcification was observed in two SGCAs, and one neurocytoma. Five neurocytomas and all four SGCAs showed mild to moderate contrast enhancement, while all three subependymomas showed either no, or scarce, enhancement. Magnetic resonance imaging (MRI) studies were available in 10 patients, with the signal characteristics of four neurocytomas and three SGCAs being nonspecific, while two subependymomas were both hypointense on T1-weighted images and hyperintense on T2-weighted images. Thus important features for differential diagnosis included age of the patient and density on precontrast CT. In this series, either an extensive excision of the tumour or a partial removal, thus relieving the obstruction of the foramina of Monro, usually provided long term survival, with 18 patients surviving a mean of 10.8 years.     

侧脑室内室管膜下瘤的诊治(附13例分析)

目的 探讨侧脑室内室管膜下瘤的诊治策略.方法 回顾性分析13例侧脑室内室管膜下瘤病人的临床表现、影像学表现及显微外科手术治疗效果.结果 该病多见于中年人,以颅内压增高为主要临床表现;MRI显示:T2WI多呈高信号,T1WI上多表现为低、等信号,增强扫描大多无明显强化.肿瘤全切除12例,次全切除1例.术后死于并发症1例.对12例随访0.5～11年,均未见复发.结论 侧脑室内室管膜下瘤影像学表现具有一定特征,是术前诊断的重要参考;显微手术切除肿瘤是最佳的治疗手段,预后良好.     

Lateral ventricular subependymomas: An analysis of the clinical features of 27 adult cases at a single institute

Objective: To evaluate the unique clinical characteristics and management of lateral ventricular subependymomas (LVSs). Patients and Methods : The case records of 27 adult consecutive patients with LVS admitted between March 1996 and May 2011 were reviewed. The relevant clinical data (including patient age and sex, neuroimaging studies, surgical records and follow up) were collected through a chart review. Patient neurological status was recorded using the Karnofsky Performance Scale (KPS). Results: The gender distribution was 14:13 and the age from 33 to 66 years (median 45 years) at the time of operation. Headache and dizziness were the most common initial symptoms (17/27). Most of these tumours were located at the foramen of Monro (12/27). Magnetic resonance imaging (MRI) (21/27) showed well circumscribed tumours with cystic changes (21/27). The lesions were hypointense on T1-weighted images (19/21), hyperintense on T2-weighted images (21/21), and contrast enhancement was no or minimal (19/21). Gross total resection was performed in 23 patients. Five patients required a ventriculo-peritoneal shunt because of postoperative hydrocephalus. The follow-up period ranged from 6 to 188 months (mean 55.5 months). No recurrence was observed during the follow up. Conclusion: In this study LVSs had equal gender distribution. Tumours around the foramen of Monro were the candidates for aggressive treatment; surgery was the best curative treatment; postoperative hydrocephalus should be attended to.     

Symptomatic subependymoma of the lateral ventricle in a young female]

We present a case of a symptomatic subependymoma (SE) in a young. The patient was a 20-year-old female who suffered from severe headache and vomiting. Precontrast CT scans revealed a large spotty-calcified isodensity mass lesion in the right anterior lateral ventricle, showing scarce contrast enhancement at the center of the mass and with marked hydrocephalus. MRI demonstrated the lesion as slightly hypo-intensity on T1-weighted image, hyper-intensity on T2-weighted image. On FLAIR imaging, the lesion indicated remarkable hyperintensity and was clearly distinguishable from surrounding brain parenchyma and the cerebrospinal fluid. After Gd-DTPA infusion central vein was revealed, but no tumor enhancement was seen. The tumor was totally extirpated through the transcortical approach. Histological diagnosis was SE, and high MIB-1 staining index (9.3%) was seen. FLAIR imaging is useful for the preoperative diagnosis and the postoperative assessment of SEs.     

A case of juvenile pilocytic astrocytoma with unusual neuroimaging features]

We present a case of cerebellar juvenile pilocytic astrocytoma(JPA) with unusual neuroimaging features. The patient was a 14-year-old male who suffered from chronic headaches for a couple of weeks. Plain craniogram showed a decalcification and bulging of the occipital bone. Computed tomography(CT) scans demonstrated low density multiple components with small calcifications in the right cerebellar hemisphere extending to the left. These calcifications were found at the margin of these multi-lobular components. Magnetic resonance imaging(MRI) revealed iso or low intensity on T1 weighted image, and slightly high intensity on T2 weighted image. The lesion indicated more heterogeneous and higher intensity than brain parenchyma on FLAIR imaging, and remarkable higher intensity than brain parenchyma with some small low intensity areas on diffusion weighted imaging. He underwent the complete resection except for the cranial tissue surrounding the pons. Histologic diagnosis was juvenile pilocytic astrocytoma, because of biphasic pattern of bipolar cells and a number of Rosenthal fibers. Generally JPA has sharp and smooth demarcated cysts with well-enhanced mural nodule. It was difficult to diagnose the presented tumor as JPA before operation, since its unusual neuroimaging resembled both dermoid and high grade gliomas.     

Magnetic Resonance Imaging Features of Solitary Inflammatory Brain Masses

Brain lesions in inflammatory diseases may present as solitary masses, prompting a biopsy. We present neuroimaging and histologic findings in five patients with solitary, inflammatory, demyelinating mass lesions located in the supratentorial white matter and gray–white junction. The patients presented with seizures, focal neurologic signs, and neuroimaging findings that indicated the possibility of a neoplasm. Computed tomography (CT) revealed enhancing, sing le hypodense lesions associated with mild or no mass effect. On MRI, the lesions were hypointense on T3–weighted images and hyperintense on T2–weighted images. Variable patterns of enhancement were noted on CT and MRI, including homogeneous/patchy (n = 3) and ring/nodular (n = 1) enhancement. There was no evidence of calcification or hemorrhage. Biopsies revea led a leukoencephalitis and demyelination, with varying degrees of demyelination among the cases. The syndrome, re lating to a solitary lesion, was corticosteroid–sensitive, and it ultimately stabilized. Extensive longitudinal evaluations fai led to reveal multiple sclerosis, infection, or neoplasm. Solitary inflammatory lesions add to the differential diagnosis of large, supratentorial, solitary spaceoccupying lesions noted on CT and MRI scans.     

颅内间变型星形细胞瘤影像表现回顾性分析

目的 分析间变型星形细胞瘤的螺旋CT和磁共振影像表现,以提高对本病的认识.方法 回顾性分析颅内间变性星形细胞瘤螺旋CT和磁共振影像表现,使用GE64排螺旋CT和GE 3.0T磁共振,所有病例均进行CT平扫+增强扫描和磁共振SE序列T1WI和T2WI、DWI、MRS、FLAIR序列及对比增强T1WI扫描.结果 间变型星形细胞瘤在螺旋CT和磁共振扫描时密度或信号多不均匀,增强后可见不规则斑片样强化,占位效应明显.MRS显示病灶Cho/NAA的比值5.5～6.3,Cho/Cr比值4.7～5.3.结论 间变型星形细胞瘤的CT及MRI表现具有一定的特征性,螺旋CT和磁共振影像学检查有助于间变型星形细胞瘤的诊断和鉴别诊断.     

Neuroimaging in Pineal Tumors

BACKGROUND AND PURPOSE: The authors report radiological findings in 11 tumors in the pineal region, which were histologically diagnosed as germinomas, pineocytomas pineoblastomas, ependymomas, teratomas, and astrocytomas. METHODS: Computed tomography (CT) was performed in seven patients and magnetic resonance imaging (MRI) was performed in all patients. RESULTS: CT showed a solid or solid/cystic mass with variable contrast enhancement. MRI showed a heterogeneous mass, with hypointense signal on T1 and iso/hyperintense signal on T2-weighted images (WI) and gadolinium enhancement. Extension to adjacent structures occurred in five patients and spread through the cerebral spinal fluid (CSF) in two. CONCLUSIONS: Pineal region tumors have no pathognomonic imaging pattern. MRI and CT are complementary in diagnosis and are important to determine localization, extension, and meningeal spread.