原发性中枢神经系统恶性淋巴瘤临床诊疗初步经验

目的探讨原发性中枢神经系统淋巴瘤影像学特点及临床诊疗经验。方法对15例确诊为原发性中枢神经系统恶性B细胞型淋巴瘤患者的临床资料进行回顾性分析。结果颅内中枢神经系统原发性恶性淋巴瘤好发于脑深部组织如基底节区、小脑半球等，肿瘤T1加权像多为等或低信号，R加权像多呈高信号，也可以为等信号，DWI像呈高信号。增强扫描见病变明显均匀强化，边缘有多个小突起，似树枝状改变。10例患者行手术切除治疗，5例行组织活检．术后病理组织学及免疫组化检查证实为B细胞型淋巴瘤，术后14例行直线加速器电子线放疗及激素治疗，1个月后复查提示肿瘤明显变小；1例术后放弃放疗，给予激素治疗，肿瘤明显变小，但易复发。结论病变明显均匀强化及树枝状改变为原发性中枢神经系统淋巴瘤MRI特征，缺乏特异性；MRI表现及诊断性激素治疗有助于术前诊断，手术切除病理组织后行激素及放疗可延长患者生存期，但肿瘤容易复发。     

原发性脊膜黑色素细胞瘤一例并文献复习

目的报告一例经病理证实的原发性脊膜黑色素细胞瘤,并通过相关文献复习,探讨该疾病的临床特点、诊断、治疗及预后。方法回顾性分析该病例的临床表现、影像学特征、病理学特征等资料,结合相关文献,对该罕见疾病进行探讨。结果本例患者病变位于颈7~胸1节段椎管内,为髓外硬膜下病变,术前检查完善后行颈7椎板切除、椎管内占位性病变切除、脊椎内固定术。术后病理检验结果提示脊膜黑色素细胞瘤。结论原发性脊膜黑色素细胞瘤是一种罕见的中枢神经系统良性肿瘤,具有一定的复发率,并可能向恶性黑色素瘤转变,临床需要与恶性黑色素瘤、转移性黑色素瘤等相鉴别。目前主要的治疗方案是手术治疗,手术不能完全切除的患者,辅助放疗可以有效改善预后。     

原发性颈髓黑色素瘤的脑转移

中枢神经系统原发性恶性黑色素瘤少见,约占黑色素瘤总发病率的1％。而原发性脊髓黑色素瘤更为罕见,1906年Hirschberg首先报告1例,迄今为止,文献报告仅有37例(含本例),肿瘤多位于中或低胸段脊髓。Hayward提出,诊断原发性脊髓黑色素瘤应具备以下条件:①除中枢神经系统外无其它任何部位的原发或转移性黑色素瘤;②病变未累及神经根及硬膜;③病变应经病理证实。     

原发性颅内恶性淋巴瘤的临床特点及影像学诊断

目的 探讨原发性颅内恶性淋巴瘤的临床、影像学特征。方法 对25例经手术及病理证实的原发性颅内恶性淋巴瘤的临床、影像学表现及治疗进行了回顾性分析．结果 本病以中老年人多见，病程短．病情进展快．颅压高症状出现早，多位于幕上，可单发或多发，可侵及室管膜和软脑膜并沿之播散；CT扫捕多表现为等密度肿块，MRI显示T1加权像多呈低信号，T2加权像多呈高信号，CT和MRI增强扫捕病灶多呈均匀明显强化：对放疗、化疗敏感。结论 原发性颅内恶性淋巴瘤的临床、影像学表现与某些中枢神经系统病变有类似之处，鉴别比较困难，确诊主要依靠病理检查。最佳治疗方案是手术加放疗、化疗的联合治疗。     

自发性硬脊膜外血肿的诊断和治疗策略

目的探讨自发性硬脊膜外血肿的临床特征、治疗及影响预后的因素。方法对16例自发性硬脊膜外血肿患者的临床特征、手术治疗时机以及手术后神经功能恢复情况进行回顾总结,并结合文献分析影响预后的因素。所有自发性硬脊膜外血肿患者均行MRI检查。结果16例患者的硬脊膜外血肿分别位于下颈段（2例）、颈胸段（6例）、胸段（7例）及胸腰段（1例）。MRI检查T1WI表现为等信号或略高信号,T2WI以高信号为主,其中可见混杂低信号。12例施行手术治疗的患者中10例预后良好;4例保守治疗者中3例神经功能完全恢复。结论脊髓MRI检查是诊断自发性硬脊膜外血肿的首选方法,早期诊断和外科手术治疗是恢复神经功能、提高疗效的关键。手术疗效主要与自发性硬脊膜外血肿患者手术前的神经功能缺损程度和手术间隔时间有关;症状较轻者在密切观察下可予以保守治疗,其神经功能的恢复主要取决于神经功能缺损程度。目的探讨自发性硬脊膜外血肿的临床特征、治疗及影响预后的因素。方法对16例自发性硬脊膜外血肿患者的临床特征、手术治疗时机以及手术后神经功能恢复情况进行回顾总结,并结合文献分析影响预后的因素。所有自发性硬脊膜外血肿患者均行MRI检查。结果16例患者的硬脊膜外血肿分别位于下颈段（2例）、颈胸段（6例）、胸段（7例）及胸腰段（1例）。MRI检查T1WI表现为等信号或略高信号,T2WI以高信号为主,其中可见混杂低信号。12例施行手术治疗的患者中10例预后良好;4例保守治疗者中3例神经功能完全恢复。结论脊髓MRI检查是诊断自发性硬脊膜外血肿的首选方法,早期诊断和外科手术治疗是恢复神经功能、提高疗效的关键。手术疗效主要与自发性硬脊膜外血肿患者手术前的神经功能缺损程度和手术间隔时间有关;症状较轻者在密切观察下可予以保守治疗,其神经功能的恢复主要取决于神经功能缺损程度。     

原发性脑内恶性淋巴瘤15例临床分析

目的探讨原发性脑内恶性淋巴瘤的临床特点、诊断及治疗方法.方法回顾性分析15例原发性脑内恶性淋巴瘤的影像学表现、治疗结果及病理学特征.结果病变位于幕上12例,幕下3例;多发者8例.CT通常示低密度,瘤周中度水肿,均匀增强.MR通常示长T1长T2信号,均匀增强.术前无一例确诊.病理示大B细胞淋巴瘤弥漫型11例,局限型2例,小B细胞淋巴瘤1例,无裂细胞型1例;免疫组化:LCA阳性率为100%.中位生存期:肿瘤全切除后化疗加放疗16个月,肿瘤部分切除后化疗加放疗12个月,部分切除加化疗11个月.结论原发性脑内恶性淋巴瘤常发生于幕上大脑半球,术前误诊率高,预后差,综合治疗可提高生存期.     

椎管内原发性黑色素细胞肿瘤(附5例报告)

目的总结椎管内原发性黑色素细胞肿瘤的临床特点。方法分析5例椎管内黑色素细胞起源肿瘤病人的临床资料，结合文献，对其流行病学、病理类型、影像特征、诊治和预后等进行讨论。结果本组男3例，女2例；年龄31-47，平均38-2岁。椎管内肿瘤单发4例，多发1例；髓外硬膜下4例，髓内1例。短T1、短T2信号为其典型MRI特征。病理诊断为恶性黑色素瘤3例，黑色素细胞瘤2例。不同病理类型的治疗方法和预后迥然不同。结论早期诊断、显微手术全切除是获得良好预后的关键；应根据不同病理类型采取适宜的放、化疗措施。     

成人颅内髓上皮瘤1例报告及文献复习

目的总结颅内髓上皮瘤的临床特点。方法报告1例成人原发性颅内髓上皮瘤的临床和病理资料，结合文献，对这一罕见疾病的临床诊断、景仰学、组织病理学表现及治疗等进行复习。结果CT示肿瘤位于左侧枕叶凸面，术中证实肿瘤侵及硬膜，组织病理学及免疫组织化学表现支持髓上皮瘤的诊断。结论该病例为罕见的成人髓上皮瘤，影像表现及治疗效果与典型髓上皮瘤有所不同。     

尿路上皮癌颅内及软脊膜下广泛转移1例

目的探讨尿路上皮癌颅内及软脊膜下广泛转移的诊治。方法回顾性分析1例尿路上皮癌颅内及软脊膜转移病例。术前MRI提示颅内多发转移,颈胸腰多发软脊膜转移灶。术前PET/CT及全腹增强CT未发现原发病灶。选择全麻下行经前额纵裂入路三脑室前肿瘤切除术。结果术后病理提示分化差的转移癌,根据光镜形态及免疫表型首先考虑泌尿系统来源。术后给予安罗替尼靶向治疗后复查头颅及脊髓MRI提示肿瘤颅内肿瘤部分缩小,但软脊膜转移无明显变化,同时存在交通性脑积水。术后5个月后因肺部感染去世。结论不明原发性癌症需仔细确定肿瘤原发部位,以便进一步治疗。以转移为首发症状的尿路上皮癌,文献报道少见,而合并全脊髓软脊膜下广泛转移更罕见,总体预后不佳。     

原发性中枢神经系统恶性淋巴瘤22例临床分析

目的探讨原发性中枢神经系统恶性淋巴瘤（PCNSML）的临床和影像学特点。方法对22例PCNSML患者的临床资料进行回顾性分析。结果本组患者头痛16例、呕吐11例,肢体无力5例、麻木1例。病变位于幕上19例、幕下3例,其中多发病灶5例。CT表现为等或高密度病灶,瘤周轻度水肿。MRI显示T1加权像略低信号9例、等信号5例;T2加权像略高信号11例,等信号3例。CT和MRI强化扫描示均匀明显强化。手术前误诊17例。病理检查均为B细胞型恶性淋巴瘤。随访18例,5例多发病灶仅做活检的患者,均在6个月内死亡;肿瘤全切除加放疗6例,平均生存期27个月;部分切除加γ-射线聚焦治疗4例,平均生存期21个月;部分切除加放疗3例,平均生存期10个月;单纯全切除肿瘤1例,11个月后死于肿瘤复发;2例单纯肿瘤大部切除者在术后5个月和8个月死亡。结论PCNSML临床表现无特异性,术前误诊率高,CT和MRI表现有一定特点,确诊依靠病理检查。综合治疗可延长生存期。     

Primary spinal melanoma: a case report

Intra spinal primary melanoma is a rare entity. We report a new case, atypical in relation to its primary radicular location, and to its early metastatic intradural and extra-medullary location, six months later. MRI is the more valuable examination, showing a spontaneously hyper-intense lesion on T1-weighted MR images, intense enhancement after gadolinium administration, and decreased signal on T2-weighted MR images, thus suggesting a diagnosis of melanocytic or hemorrhagic lesion. Signal abnormalities are not specific and definitive diagnosis is established after histological analysis.     

脊髓转移瘤的MRI诊断

目的 探讨脊髓转移瘤(ISCM)的MRI特征及其病理机制,以提高对该病的认识.方法 搜集15例经手术病理证实及临床确诊的ISCM,回顾性分析其MRI表现.全部病例均行MRI平扫及钆喷替酸葡甲胺(Gd-DTPA)增强扫描.结果 15例转移瘤均为单发,位于颈髓3例,胸髓5例,胸腰段脊髓圆锥部7例.MRI表现:T1WI呈等信号12例,低信号3例;T2WI呈高信号14例.等信号1例;增强扫描肿瘤均呈明显强化,7例呈环形强化,4例结节状强化,4例不均匀强化.结论 ISCM的特征性MRI表现为脊髓内明显强化的环形或结节状病灶,结合临床病史可以明确诊断.     

A case of cystic metastatic intracranial amelanotic melanoma--analysis of findings in CT and MRI

A case of cystic intracranial metastatic amelanotic melanoma is presented. As far as we know, cyst formation in intracranial melanoma is rare, and only 15 cases of intracranial amelanotic melanoma have been reported until now. A 63-year-old man was admitted with headache and progressive visual disturbance. CT scan revealed a large low-density mass with ring-like enhancement in the left frontal lobe. Both T 1-and T 2-weighted MRI images revealed hyperintensity. A left frontotemporal craniotomy was performed. A yellowish mass was observed in the frontal lobe. The content of the cyst consisted of old hematoma, xanthochromic fluid and necrotic tissue, was evacuated and the cyst wall was totally resected. No abnormal pigmentation was noted in the cyst wall and surrounding brain tissue. The histological examination revealed amelanotic melanoma. Primary lesion was found on the left thigh later and resected. The patient died of further intracranial metastasis with repeated hemorrhage 5 months after the admission. Both CT and MRI findings of our case is atypical as an intracranial malignant melanoma. However, these are compatible with those of intracerebral hemorrhage in subacute stage. It is suggested that melanoma may make the diagnosis difficult when tumor hemorrhage modifies the images of CT or MRI.     

Intramedullary subependymoma of the cervical spinal cord: a case report with immunohistochemical study

Spinal subependymomas, which have a relatively benign nature, are very rare tumors. It is difficult to distinguish spinal subependymomas from other intramedullary spinal tumors based on neuroradiological findings. A case of cervical intramedullary subependymoma in a 63-year-old female is reported. The diffused enlargement of the spinal cord at C2 level involved the lesion with isointensity on a T1-weighted MRI and relatively high intensity on a T2-weighted MRI. Enhancement in the small part of the tumor was observed on a T1-weighted MRI with gadolinium administration. The tumor occupied the left side of the spinal cord, and was totally removed through a laminoplasty of C2. Immunohistochemistry was useful for pathological diagnosis. The clinical feature of this patient is described with the review of literatures.     

Transverse Myelitis Mimicking Intramedullary Spinal Cord Tumor

A 14-year-old girl presented with a 7-week history of progressive quadriparesis. Magnetic resonance imaging (MRI) demonstrated cord enlargement with changes in signal intensity on T1- and T2-weighted images, suggesting intramedullary tumor. Subsequently, she improved clinically with resolution of MRI findings.     

Intraventricular malignant meningioma: one case report.

We report a case of primary intraventricular malignant meningioma in a 74-year-old man who presented with progressive weakness of the left limbs and dizziness, The preoperative magnetic resonance (MR) imaging of the head initially suggested that a glioblastoma multiforme or a metastatic lesion might be present. But later, the excised tumor was histologically diagnosed as a primary malignant meningioma. So far, only a few cases of intraventricular malignant meningioma have been reported. The MR imaging of this tumor has rarely been described in the literature. In the present case, the mass lesion showed hyperintensity on the T1-weighted image (T1WI) and hypointensity on the T2-weighted image (T2WI) which was not commonly seen in meningioma. The unusual MR imaging of this case may be attributed to the intratumoral hemorrhage. Although intraventricular malignant meningioma is difficult to diagnose based on MR or computed tomographic images alone, the characteristics of the MR images in the present case may offer an option for preoperative differential diagnosis of intraventricular tumors.     

Magnetic Resonance Imaging of the Thalamus following Cryothalamotomy for Parkinson's Disease and Dystonia

Magnetic resonance imaging (MRI) was performed on 3 patients after cryothalamotomy, one of whom had bilateral cryothalamotomies. The time between surgery and MRI ranged from 23 days to 6.5 months. Images made 3 to 4 weeks after surgery showed a lesion of high signal intensity on both T1-weighted and T2-weighted images, and an additional central area of low signal intensity on T1-weighted images. Images obtained at 2, 4, and 6.5 months after surgery showed smaller lesions with low signal intensity on T1-weighted and T2-weighted images, a pattern consistent with resolving hematoma after cryothalamotomy.     

Acute severe spinal cord dysfunction in bacterial meningitis in adults: MRI findings suggest extensive myelitis

BACKGROUND: Bacterial meningitis is rarely complicated by acute spinal cord involvement (eg, myelitis, ischemic infarction, spinal abscess, or epidural hemorrhage). In spinal cord dysfunction, magnetic resonance imaging (MRI) is the imaging modality of choice. Still, MRI findings of myelitis due to bacterial meningitis in adults have not been reported. METHODS: Spinal MRIs were obtained during the acute stage of meningitis and on follow-up in 3 adults with bacterial meningitis that was complicated by paraparesis or tetraparesis and bowel and bladder incontinence. The causative pathogens were Streptococcus pneumoniae and Neisseria meningitidis; in 1 patient, the pathogen was not identified. RESULTS: In all cases, spinal MRI ruled out a compression of the cord by an extramedullary mass but demonstrated hyperintensities on T2-weighted images that predominantly involved the gray matter and extended from the cervical to the lumbar cord. Leptomeningeal and discrete nodular intramedullary enhancement on T1-weighted images was detected only in 1 patient. Follow-up examinations revealed that hyperintensities resolved completely in 1 patient, while a central cavitation developed in the cervical spinal cord of another, and the MRI findings were progressive during the first 4 weeks in the third patient. In all cases, severe paresis and bowel and bladder incontinence persisted. CONCLUSION: We demonstrate for the first time the MRI findings of adults with acute spinal cord involvement during bacterial meningitis. Magnetic resonance imaging showed central intramedullary hyperintensities on T2-weighted images that extended from the cervical to the lumbar cord, indicating myelitis. Clinical follow-up examinations suggest that myelitis during bacterial meningitis has an unfavorable prognosis.     

Isolated primary craniopharyngioma in the cerebellopontine angle

Between January 2000 and January 2011, we diagnosed three patients with isolated craniopharyngioma in the cerebellopontine angle (CPA). Brain MRI revealed cystic lesions with various imaging characteristics, including hypointensity on T1-weighted (T1W) images and hyperintensity on T2-weighted (T2W) images. The first patient's lesion showed rim enhancement after gadolinium administration. The second patient's lesion showed mixed signal intensity on both T1W and T2W images. The third patient's MRI showed a well-defined cystic lesion in the right CPA that compressed the brainstem. This lesion was hyperintense on T1W images and hypointense relative to cerebrospinal fluid on T2W images, and was peripherally enhanced after gadolinium administration. All three patients underwent surgical intervention through a suboccipital retrosigmoid craniotomy/craniectomy and lesions that did not adhere to adjacent tissues were removed completely. Histopathological examination confirmed the tumors to be adamantinomatous craniopharyngioma. The post-operative course was uneventful for all patients uneventful and no tumor recurrences were detected at the last follow-up. Primary CPA craniopharyngioma can be completely removed surgically, provided it does not densely adhere to vital structures.     

A case of primary central nervous system lymphoma with the onset of impotence]

A 51-year-old man suffered from impotence for 10 months. Five months before he developed difficulty in urination and walking because of his both leg weakness. He was admitted to the hospital because of urinary incontinence, paraplegia and occipital headache. Neurologic examination revealed neck stiffness and Lhermitte's sign. The cranial nerves were intact with the exception of choked disc. He had weakness of lower extremities and right arm, and sensory loss on the right side including face. The plantar responses were extensor bilaterally. MR images revealed diffuse swelling in the cervical and thoracic spinal cord on a T 1-weighted image without enhancement by Gd-DTPA and diffuse high intensity of the spinal cord on a T 2-weighted image. MR image of the brain revealed the low intensity in the left temporal and occipital lobe with slightly enhancement by Gd-DTPA, the high intensity in the left temporal and occipital lobe white matter on a T 2-weighted image. Diagnosis of malignant lymphoma (B cell type) was made by brain biopsy. Combined chemotherapy was performed and his symptoms resolved and the lesions on MRI disappeared. The number of cases of primary spinal intramedullary malignant lymphoma was very rare and the majority of the cases had weakness or sensory impairment in the lower extremities in the initial symptoms. This is the first case which had impotence as the initial symptom. In addition, it must be taken into consideration of this disease when the patient has myelopathy with unknown etiology.