不典型脑膜瘤的CT诊断与临床

目的探讨不典型脑膜瘤的CT表现，提高脑膜瘤CT诊断的准确性。方法对32例经手术病理证实的不典型脑膜瘤的CT表现进行回顾性分析。结果脑膜瘤CT难于诊断的主要原因是由于CT表现不典型及病变部位的影响。不典型CT表现为肿瘤密度混杂有低密度区，且无明显强化，或呈环形强化或有壁结节的强化。结论确定瘤体位于脑外是提高不典型脑膜瘤CT诊断准确性的关键。     

神经纤维瘤病的CT和MRI表现及诊断价值

目的探讨神经纤维瘤病的CT和MRI影像表现,并就二者的优劣进行比较,以提高诊断准确性。方法收集14例经临床和手术证实的神经纤维瘤病患者的CT和MRI资料,分析其影像学特点。结果 NF-2型患者表现为双侧听神经瘤,伴或不伴胶质瘤、脑膜瘤及脊膜瘤。NF-1型患者表现为单发或多发胶质瘤。CT图像中,双侧听神经瘤表现为等低密度,增强扫描呈不均匀性强化。多发脑膜瘤表现为等或略高密度,增强扫描呈均匀性明显强化。胶质瘤表现为边界不清的低密度,增强扫描无强化或轻度不均匀性强化。MRI图像中,双侧听神经瘤,呈等长T1、等长T2信号,增强扫描呈不均匀明显强化。脑膜瘤呈略长T1、略长T2信号,增强扫描呈均匀性明显强化,胶质瘤呈略长T1、略长T2信号,不均匀强化。结论神经纤维瘤病患者的颅脑和脊柱有特征性的CT、MRI表现,其中MRI技术能够全面准确显示病灶的分布、大小、形态和信号特征以及其与相邻组织结构的关系。     

恶性脑膜瘤CT与MRI表现

目的分析恶性脑膜瘤CT与MRI影像学表现,以提高其术前诊断准确率。方法回顾性分析18例经手术病理证实的恶性脑膜瘤CT与MRI影像学表现。结果 18例肿瘤中,大脑镰旁5例,大脑凸面4例,海绵窦旁3例,鞍上2例,鞍旁2例,小脑半球2例;边缘规整者4例,边缘分叶状者14例,肿瘤边缘清晰者2例,边缘模糊者16例;CT密度、T2WI信号不均匀者15例,内部可见囊变、坏死、出血。肿瘤强化显著,15例表现为不均匀强化,3例均匀强化,13例表现为短、粗不规则硬膜尾征;轻度水肿8例,中度水肿5例,重度水肿5例;临近颅骨破坏5例,2例形成软组织肿块并突向颅外,6例颅骨增生、硬化。结论恶性脑膜瘤具有特殊的影像学特征,正确分析其表现,有助于提高其术前诊断率。     

非典型性和恶性脑膜瘤的CT、MRI诊断

目的探讨非典型性和恶性脑膜瘤的CT、MRI表现,提高术前诊断率。方法收集经病理诊断证实为非典型或恶性脑膜瘤患者36例,术前均进行CT、MRI平扫和增强检查。结果 CT表现为肿瘤呈混杂、等、低密度影,缺少钙化,可伴有出血,骨质呈破坏性改变;MRI T1WI均呈不规则混杂信号,以等、低信号为多见,T2WI以高等混杂信号为多见。增强扫描,肿瘤多显著强化,且以不均匀强化常见,肿瘤形态多不规则,呈分叶状,边界模糊。结论 CT、MRI检查能充分显示肿瘤信号、边界、囊变、坏死、钙化、瘤周水肿、瘤内出血及肿瘤血供等情况,对非典型性或恶性脑膜瘤进行准确的诊断和术前评估。     

良性脑膜瘤的非典型CT表现

脑膜瘤的CT定性准确率很高,一般为90～95％。但有些脑膜瘤,由于形态学和组织学的改变,可呈非典型的CT表现,诊断困难,常被误诊为其它类型的颅内肿瘤。 我科自1980年8月～1984年7月收治经手术和病理证实的颅内良性脑膜瘤157例,其中具有典型的CT表现者144例(91.7％),术前均做出正确诊断。余13例CT扫描呈非典型表现,现报告如下。     

镰旁脑膜瘤的MRI影像学表现与病理意义

目的分析镰旁脑膜瘤的MRI征象与病理,以期提高其临床诊治水平。方法 73例镰旁脑膜瘤患者行MRI检查。将位置、大小、形状、边缘、水肿、信号、强化方式等影像特征、病理特点综合分析。结果除宽基底、脑膜尾征、假包膜等一般脑膜瘤的MRI表现外,还发现了如下不常见MRI表现:囊变2例,出血2例,钙化5例,颅骨受侵4例及肿块跨越征2例,病理可见相应表现。结论大脑镰旁脑膜瘤具有囊变、出血、钙化、颅骨受侵及肿块跨越征等不常见MRI征象。熟悉这些不典型表现与手术、病理综合分析,在肿瘤的诊断、鉴别诊断与治疗均具有很大价值。     

囊性脑膜瘤19例诊治分析

目的 对囊性脑膜瘤的临床特点、影像学表现及其成因进行探讨研究.方法 回顾性分析19例颅内囊性脑膜瘤的临床表现、影像学特征及手术经验.结果 囊性脑膜瘤多位于大脑凸面,多数表现为实性肿块伴大小不等的囊样区,其实质部分明显强化.少数表现为囊性,囊内见实质结节,结节明显强化,而囊壁有或无强化.19例患者肿瘤全切除17例,次全切除2例,无手术死亡.结论 囊性脑膜瘤有特殊的影像学表现, CT和MRI在诊断中具有重要价值.手术应在不损伤神经功能区的前提下全切除肿瘤及囊壁以防止复发.     

增强CT扫描在脑转移瘤诊断中的意义

目的 探讨增强CT扫描在脑转移瘤诊断中的意义.方法 60例脑转移瘤均行CT平扫及增强扫描,所有病例均经临床及病理证实.结果 典型脑转移瘤21例,平扫即基本明确诊断.平扫表现不典型者39例:其中平扫为单发,强化表现为多发者15例;平扫及强化均表现为单发者4例;平扫仅表现为轻度水肿,强化后显示瘤体者12例;平扫无明显异常,强化后发现瘤体者8例.结论 增强CT扫描在脑转移瘤的诊断及鉴别诊断中意义重大,应引起重视.     

不典型星形细胞瘤的CT诊断

目的研究不典型星形细胞瘤的CT征象。方法 回顾分析13例CT首次误诊,手术病理证实的星形细胞瘤的术前CT图像与临床表现。结果 ①13例星形细胞瘤,9例年龄>50岁,11例部位在大脑半球。②星形细胞瘤表现为低密度或带回状高密度灶;形态为楔形或圆形;无强化或带回状强化;瘤周水肿。结论定期追踪CT复查,应用多项指标综合分析,能够提高CT诊断不典型星形细胞瘤的准确率。     

最初误诊为脑内肿瘤的脑膜瘤不常见CT表现

脑膜瘤有特征性的CT表现,但7％的病人症状表现不典型可能误诊为恶性颅内肿瘤。医师有必要仔细观阅CT片,以确定肿瘤位于脑内还是脑外。如果病损的性质可疑、需要做选择性的颈内和颈外动脉造影。本文报导1例CT不常见表现的脑膜瘤病例。 患者,女,48岁,因一次癫痫大发作后就诊。16年前,曾接受过左腿恶性黑色素瘤切除术。神经系统     

非典型性脑膜瘤与良性脑膜瘤MRI征象的对比分析

目的 对比分析非典型性脑膜瘤与良性脑膜瘤的MRI征象特点,提高对非典型性脑膜瘤的认识。方法 回顾性分析经病理证实的37例非典型性脑膜瘤与288例良性脑膜瘤的MRI征象。结果 非典型性脑膜瘤直径>6.5 cm比例、肿瘤呈分叶型比例、瘤脑界面不清晰比例、重度瘤周水肿比例、邻近骨质改变比例均明显高于良性脑膜瘤（P<0.05）。多因素Logistic回归分析显示,肿瘤较大及瘤脑界面不清晰为非典型性脑膜瘤的可能性显著增加,肿瘤大小每增加1.5 cm,非典型性脑膜瘤的概率是良性脑膜瘤的1.507倍,瘤脑界面不清晰为非典型性脑膜瘤的概率是良性脑膜瘤的2.605倍。结论 肿瘤大小及瘤脑界面对于非典型性脑膜瘤与良性脑膜瘤的鉴别诊断具有重要价值。     

Lipomeningioma: case report and review of the literature

We present a case of histologically confirmed lipomeningioma, the first to our knowledge reported in Australia. A 61-year-old man presented with seizures and confusion, and was found to have a non-enhancing left extra axial temporo-parietal lesion on CT and MRI scan. On MRI, the mass lesion showed hyper-intensity on the T1 weighted images, hypo-intensity on fat suppressed T2 weighted images and no enhancement with intravenous gadolinium, indicating a mass consisting predominately of fatty tissue. A subsequent CT also showed the mass lesion to be hypodense with Hounsfield units indicating fatty tissue. A durally based tumour with high fat content macroscopically was excised at craniotomy under ultrasound guidance. Post-operative recovery was uneventful. Histology demonstrated a meningioma with high lipid content in the form of mature adipocytes and without atypical features. While not exceedingly rare, fewer than 30 cases of lipomeningioma, lipomatous meningioma, or lipidised meningioma have been reported in the world literature.     

松果体区肿瘤的影像表现及鉴别诊断

目的 分析松果体区肿瘤的影像特点,以提高诊断及鉴别诊断的准确率.方法 回顾性分析经手术及病理证实的28例松果体区肿瘤的CT和MRI表现,其中8例患者术前行1H-MRS和DWI检查.结果28例松果体区肿瘤分别为生殖细胞瘤11例,畸胎瘤4例,星形细胞瘤3例,室管膜瘤1例,小脑幕缘脑膜瘤3例,松果体细胞瘤2例,松果体母细胞瘤1例,错构瘤1例.表皮样囊肿2例.影像学主要表现为松果体区囊实性肿块,密度/信号多变,部分肿瘤有其特征的形态、密度/信号及强化方式.生殖细胞瘤及松果体细胞肿瘤绝大部分为均匀实性肿块,密度/信号均匀.胶质瘤多为囊实性,且形态多变,密度/信号不均,变化大.成熟性畸胎瘤一般为混杂囊状密度/信号.胶质瘤1H-MRS可见到典型高Cho峰及低NAA峰,脑膜瘤往往测不到NAA峰,松果体母细胞瘤Cho峰较高,无Lip峰,而生殖细胞瘤多出现Lip峰.结论 松果体区肿瘤的形态、密度/信号特征及强化方式有助于松果体区病变的诊断,1H-MRS及DWI对鉴别诊断有帮助,但部分肿瘤鉴别困难.     

松果体区肿瘤的影像表现及鉴别诊断

目的 分析松果体区肿瘤的影像特点,以提高诊断及鉴别诊断的准确率.方法 回顾性分析经手术及病理证实的28例松果体区肿瘤的CT和MRI表现,其中8例患者术前行1H-MRS和DWI检查.结果28例松果体区肿瘤分别为生殖细胞瘤11例,畸胎瘤4例,星形细胞瘤3例,室管膜瘤1例,小脑幕缘脑膜瘤3例,松果体细胞瘤2例,松果体母细胞瘤1例,错构瘤1例.表皮样囊肿2例.影像学主要表现为松果体区囊实性肿块,密度/信号多变,部分肿瘤有其特征的形态、密度/信号及强化方式.生殖细胞瘤及松果体细胞肿瘤绝大部分为均匀实性肿块,密度/信号均匀.胶质瘤多为囊实性,且形态多变,密度/信号不均,变化大.成熟性畸胎瘤一般为混杂囊状密度/信号.胶质瘤1H-MRS可见到典型高Cho峰及低NAA峰,脑膜瘤往往测不到NAA峰,松果体母细胞瘤Cho峰较高,无Lip峰,而生殖细胞瘤多出现Lip峰.结论 松果体区肿瘤的形态、密度/信号特征及强化方式有助于松果体区病变的诊断,1H-MRS及DWI对鉴别诊断有帮助,但部分肿瘤鉴别困难.     

松果体区肿瘤的影像表现及鉴别诊断

目的 分析松果体区肿瘤的影像特点,以提高诊断及鉴别诊断的准确率.方法 回顾性分析经手术及病理证实的28例松果体区肿瘤的CT和MRI表现,其中8例患者术前行1H-MRS和DWI检查.结果28例松果体区肿瘤分别为生殖细胞瘤11例,畸胎瘤4例,星形细胞瘤3例,室管膜瘤1例,小脑幕缘脑膜瘤3例,松果体细胞瘤2例,松果体母细胞瘤1例,错构瘤1例.表皮样囊肿2例.影像学主要表现为松果体区囊实性肿块,密度/信号多变,部分肿瘤有其特征的形态、密度/信号及强化方式.生殖细胞瘤及松果体细胞肿瘤绝大部分为均匀实性肿块,密度/信号均匀.胶质瘤多为囊实性,且形态多变,密度/信号不均,变化大.成熟性畸胎瘤一般为混杂囊状密度/信号.胶质瘤1H-MRS可见到典型高Cho峰及低NAA峰,脑膜瘤往往测不到NAA峰,松果体母细胞瘤Cho峰较高,无Lip峰,而生殖细胞瘤多出现Lip峰.结论 松果体区肿瘤的形态、密度/信号特征及强化方式有助于松果体区病变的诊断,1H-MRS及DWI对鉴别诊断有帮助,但部分肿瘤鉴别困难.     

Pituitary adenoma and meningioma in the same patient

Summary Three patients are presented in whom both pituitary adenoma and meningioma were found. The pituitary tumour was a prolactinoma in one case and non-secreting adenoma in the other two. In one case the meningioma originated from the planum sphenoidale and was seperate from the pituitary adenoma. Another patient had a parasellar meningioma, which was suspected preoperatively by different enhancement on the CT scan. In the third case, both tumours were mainly infradiaphragmatic and could not be differentiated preoperatively or intraoperatively. This appears to be the first case with both tumours below the diaphragm. The clinical, radiological and histopathological findings are presented.     

Secretory meningioma of the middle ear: A light microscopic,immunohistochemical and ultrastructural study of one case

A 66‐year‐old woman was referred with left hearing loss. A probable diagnosis of left secretory otitis media with effusion was formulated. A left myringotomy was performed to remove hyperplastic hard tissue from the tympanic cavity. A high resolution CT scan of the temporal bone disclosed a soft‐tissue mass completely involving the mastoid and tympanic cavity, surrounding the ossicular chain which appeared spared with no signs of infiltration. The histopathologic, immunohistochemical and ultrastructural response was secretory meningioma, a rare variant of conventional meningothelial meningioma in atypical sites.     

Clinical Implications of the Mitotic Index as a Predictive Factor for Malignant Transformation of Atypical Meningiomas

ObjectiveIntracranial atypical meningiomas have a poor prognosis and high rates of recurrence. Moreover, up to one-third of the recurrences undergo high-grade transformation into malignant meningiomas. We aimed to investigate the clinical factors that can predict the propensity of malignant transformation from atypical to anaplastic meningiomas. MethodsBetween 2001 and 2018, all patients with atypical meningioma, in whom the tumors had undergone malignant transformation to anaplastic meningioma, were included. The patients’ medical records documenting the diagnosis of atypical meningioma prior to malignant transformation were reviewed to identify the predictors of transformation. The control group comprised 56 patients with atypical meningiomas who were first diagnosed between January 2017 and December 2018 and had no malignant transformation. ResultsNine patients in whom the atypical meningiomas underwent malignant transformation were included. The median time interval from diagnosis of atypical meningioma to malignant transformation was 19 months (range, 7–78). The study group showed a significant difference in heterogeneous enhancement (77.8% vs. 33.9%), bone invasion (55.6% vs. 12.5%), mitotic index (MI; 14.8±4.9 vs. 3.5±3.9), and Ki-67 index (20.7±13.9 vs. 9.5±7.1) compared with the control group. In multivariate analysis, increased MI (odds ratio, 1.436; 95% confidence interval, 1.127–1.900; p=0.004) was the only significant factor for predicting malignant transformation. ConclusionAn increased MI within atypical meningiomas might be used as a predictor of malignant transformation. Tumors at high risk for malignant transformation might require more attentive surveillance and management than other atypical meningiomas.     

Thoracic spine meningioma mimicking intramedullary tumor

This report presents a case of a meningioma of the thoracic spine with a wide range of symptoms in a 23-year-old woman. The factor, which was making difficult the proper diagnosis, was atypical for a meningioma MRI--scan, mimicking intramedullary tumour. The tumour was removed radically with a favourable clinical outcome. Clinical history, surgical treatment and neuropathologic findings are described. A review of pertinent literature is included.