颅内血管外皮细胞瘤CT和MRI影像分析及治疗选择

目的:分析颅内血管外皮细胞瘤(HPC)的CT及MRI表现,提高对本病的认识,以便合理选择治疗方案方法:对经CT和MRI检查并经手术病理证实为HPC的5例患者进行分析。5例均行MRI平扫及增强扫描;5例CT行平扫,3例增强。结果:5例CT平扫为等高密度肿块,占位效应明显,无明显瘤周水肿。MRI扫描T1WI呈等低不均匀信号,T2WI呈不均匀等高信号,显示血管流空,增强后病灶均明显强化,4例不均匀,1例均匀强化,2例示脑膜尾征。结论颅内血管外皮细胞瘤具有一定的CT、MRI特征性表现:呈分叶状与脑膜相连,丰富的血管流空,血管周围围管性浓染,肿瘤内密度或信号常不均匀,无明显肿瘤内钙化,可见颅骨局限性骨吸收。HPC首选手术治疗,完整切除肿瘤,术后辅以放射治疗。     

颈动脉体瘤的CT、MRI诊断

目的 分析颈动脉体瘤的CT和MRI表现.资料与方法 经手术证实的颈动脉体瘤7例,7例均行CT平扫,其中5例行CT增强扫描;3例行MRI平扫,其中2例行MRI增强扫描.结果 7例病变均为单发.7例均位于颈动脉分叉水平,颈动脉分叉扩大.CT平扫病变均呈等密度.MRI示T1WI呈等信号1例,略高信号2例,T2WI为不均匀高信号,内可见血管流空,肿瘤边缘清晰;增强后显示所有病变明显强化.结论 CT和MRI可对颈动脉体瘤作出明确诊断.     

颅内血管外皮细胞瘤的MRI及CT诊断

目的:探讨颅内血管外皮细胞瘤的MRI及CT影像学特点,以提高诊断水平。材料和方法:回顾性分析经手术病理证实的颅内血管外皮细胞瘤4例。4例均行MRI扫描,其中2例并行CT扫描。结果:4例血管外皮细胞瘤分别位于前、中颅窝、右侧桥小脑角区及右顶部各1例,均呈明显分叶状。T1WI示肿瘤呈高或等、低混杂信号,T2WI示肿瘤呈等或等、高混杂信号。增强扫描示肿瘤实性部分高度增强,其中4例肿瘤周边均可见不同程度水肿带,3例见流空血管影,1例肿块内见坏死囊变灶、1例邻近颅骨骨质破坏,1例见幕上轻度脑积水。CT平扫示肿瘤呈高密度,未见瘤内钙化、邻近颅骨骨质增生及脑膜尾征等脑膜瘤常见征象。结论:MRI及CT表现对颅内血管外皮细胞瘤的诊断有一定的作用,最终诊断依靠病理。     

颅内血管平滑肌瘤的影像表现(附2例讨论)

目的探讨颅内血管平滑肌瘤的CT及MRI表现。资料与方法结合文献回顾性分析2例经手术病理证实的位于颅内鞍旁的血管平滑肌瘤的CT及MRI表现。2例均行MRI平扫及增强,1例行MRI动态增强,1例行CT平扫。结果 2例均位于右侧鞍旁。例1行CT平扫示中颅窝鞍旁类圆形稍高密度肿块,密度均匀,周围未见水肿,MRI平扫T1WI呈低信号,扩散加权成像(DWI)呈低信号,T2WI呈不均高信号,内可见条状低信号。病灶周围见薄层环状水肿带,增强扫描肿块明显均匀强化,局部可见脑膜尾征;例2 MRI平扫示鞍旁卵圆形肿块,T1WI呈等信号,T2WI呈高信号,右三叉神经受压,增强扫描早期示病灶中心斑片状强化,增强晚期示病灶逐渐从中心向周边强化。结论动态增强扫描呈中心性渐进性强化可能为颅内血管平滑肌瘤特征性表现,有助于其诊断与鉴别诊断。     

软组织转移瘤影像学诊断

目的探讨软组织转移瘤的影像学表现特点。方法选择经病理证实的软组织转移瘤35例,分析其CT和MRI表现特点。结果 CT检查31例,其中平扫13例,增强扫描15例,平扫并增强扫描3例。MRI平扫3例。19个肌肉内转移瘤CT平扫表现为等密度或略低密度肿块,边界不清,密度均匀或不均匀,最大径1.2~25.3cm;4例(21.52%)表现为弥漫性肌肉肿胀,密度均匀,与炎症相似;3例肿块内可见成簇的颗粒状或无定形钙化。9个皮下组织转移瘤CT平扫表现为多发或单发结节状或团块状等或略低密度灶,最大径0.5~5.2cm,边界清;2个表现为皮下组织内饼状软组织密度灶,边界不规则。CT增强扫描,病灶呈均匀或不均匀轻中度强化;其中7例(33.33%)呈环形强化,病灶中心不强化。3例MRI平扫表现为等长T1,不均匀长T2异常信号;2例边界清楚,1例边界不清。结论软组织转移瘤不罕见,在软组织肿瘤诊断中应注意鉴别。     

Imaging Features of Intracranial Angioleiomyoma (2 Cases Discussion)

目的 探讨颅内血管平滑肌瘤的CT及MRI表现.资料与方法 结合文献回顾性分析2例经手术病理证实的位于颅内鞍旁的血管平滑肌瘤的CT及MRI表现.2例均行MRI平扫及增强,1例行MRI动态增强,1例行CT平扫.结果 2例均位于右侧鞍旁.例1行CT平扫示中颅窝鞍旁类圆形稍高密度肿块,密度均匀,周围未见水肿,MRI平扫T1WI呈低信号,扩散加权成像(DWI)呈低信号,T2WI呈不均高信号,内可见条状低信号.病灶周围见薄层环状水肿带,增强扫描肿块明显均匀强化,局部可见脑膜尾征;例2 MRI平扫示鞍旁卵圆形肿块,T1WI呈等信号,T2WI呈高信号,右三叉神经受压,增强扫描早期示病灶中心斑片状强化,增强晚期示病灶逐渐从中心向周边强化.结论 动态增强扫描呈中心性渐进性强化可能为颅内血管平滑肌瘤特征性表现,有助于其诊断与鉴别诊断.     

胃间质瘤的CT和MRI诊断

目的:探讨胃间质瘤的CT和MRI的表现,以提高诊断正确率。材料和方法:回顾性分析13例经病理学及免疫组化证实的胃间质细胞瘤患者的临床资料和CT、MRI表现。13例均行CT平扫和增强扫描,其中4例行MRI平扫和增强扫描。结果:肿瘤均为单发,腔内型3例,腔外型6例,哑铃型4例,圆形或类圆形9例,分叶形4例,直径3.0~10.4cm,平均7.5cm。CT平扫示肿瘤呈均匀等密度3例,肿块周边呈等密度,中间呈略低密度或低密度9例,呈高、低、等混杂密度1例。增强扫描示3例呈中度明显增强,10例中度不均匀增强,以静脉期明显。MRI平扫示1例肿块信号均匀,3例肿块信号不均匀,增强扫描肿块信号均匀或不均匀增强。病理检查10例恶性,3例良性。结论:胃间质瘤CT、MRI具有一定的特征性表现,对诊断有一定的价值,但不能定性,确诊需要依靠电镜检查和免疫组化。     

泌尿生殖系统孤立性纤维瘤的CT与MRI表现

目的 探讨泌尿生殖系统孤立性纤维瘤(SFT)的CT与MRI表现.方法 回顾性分析6例经手术病理证实的SFT患者的影像学资料,6例均行CT检查,1例行MRI扫描.结果 6例SFT中,肾脏、前列腺、睾丸、子宫、阴道及尿道各1例,均为单发圆形或类圆形肿块,5例边界清楚,1例边界欠清,大小约1.0 cm ×0.9 cm～ 15.2 cm×14.1 cm,平均约8.3 cm×7.1 cm.CT平扫3例呈等稍低均匀密度,3例呈不均匀等密度,伴斑片状低密度区;增强扫描动脉期肿块不均匀明显强化,延迟期肿块进一步持续强化,3例内见坏死无强化区;4例肿块内或表面可见粗大供血血管.MRI 1例T1WI呈等稍低信号,T2 WI呈等稍低信号,其内见小斑片状高信号及粗大的流空血管.结论 CT或MRI表现为孤立性、类圆形、实性肿块,边界清楚,密度或信号均匀或不均匀,增强动脉期明显不均匀强化,延迟期肿块进一步持续强化,尤其看到肿块内粗大的供血血管时,应考虑SFT可能.     

双侧颈动脉体瘤的CT和MRI诊断

目的:探讨双侧颈动脉体瘤CT、MRl影像表现.材料和方法:回顾性分析9例双侧颈动脉体瘤的CT和MRI影像表现及其临床资料.结果:9例双侧颈动脉体瘤影像表现为双侧舌骨水平颈动脉鞘区肿块,平扫呈较均匀的等密度或中等信号,增强扫描肿块明显增强.螺旋CT薄层图像可见肿块周边迂曲扩张的供血动脉(5/6),颈内、外动脉间距增宽.MRI最为特征表现是肿块内或周边迂曲条状的血管流空影(10/13).结论:双侧颈动脉体瘤的CT和MRI表现具有特征性,术前可以做出定性诊断.     

眼眶血管内皮瘤及血管外皮瘤的MRI表现

目的探讨眼眶血管内皮瘤(hemangioendothelioma,HE)及血管外皮瘤(hemangiopericytoma,HPC)的MRI表现,旨在提高其影像学诊断水平。方法回顾性分析10例眼眶HE及HPC的MRI表现,均行MRI平扫及动态增强扫描。结果 10例中8例发生于眶隔后肌锥外间隙,2例发生于眶隔前;9例表现为形态规整的圆形或类圆形,边界清楚,1例可见分叶;平扫8例表现为等T1、长T2信号,7例可见点、条状血管流空信号;动态增强扫描显示肿瘤早期即出现明显强化,9例表现为明显均匀强化,1例强化不均匀,内部可见囊变区。结论眼眶HE及HPC为富血供脉管性肿瘤,具有一定的影像学特征,MRI平扫及动态增强扫描有助于其影像学诊断。     

颅脑血管外皮细胞瘤的CT、MRI与病理对照研究

目的：探讨颅脑血管外皮细胞瘤的临床、病理和ＣＴ、ＭＲＩ特征。材料与方法：收集经ＣＴ和ＭＲＩ诊断为脑膜瘤,经手术病理证实为血管外皮细胞瘤１２例,年龄３４￣５８岁。ＣＴ检查７例,均采用增强前、后常规扫描。ＭＲＩ检查１２例,采用ＳＥ序列增强前、后扫描。结果：１２例肿瘤全部发生在颅内脑外,７例ＣＴ平扫呈低等混合密度２例,呈等高混合密度５例;增强后扫描呈不均匀强化６例,均匀强化１例。骨窗显示病灶局部侵蚀性骨质破坏４例。ＭＲＩ平扫,Ｔ１ＷＩ呈等高不均匀信号１０例,呈等信号２例;Ｔ２ＷＩ呈不均匀等高信号１０例,呈等信号２例。１２例中７例显示脑膜尾征;增强后扫描１ 均呈不均匀强化。结论：血管外皮细胞瘤具有一定的ＣＴ、ＭＲＩ特征性表现：分叶状、丰富的血管流空、肿瘤内密度或信号不均匀、无肿瘤内钙化和骨质增生、局部颅骨呈溶骨性破坏。     

颅内血管外皮细胞瘤的MRI与病理结果(附13例报告)

目的 探讨颅内血管外皮细胞瘤的MRI表现，并与病理对照，分析误诊原因。资料与方法搜集术前MRI诊断脑膜瘤，而手术证实为血管外皮细胞瘤13例，所有病例均行MR平扫及增强扫描。结果 13例MRI示肿瘤位于颅内脑外，MR平扫TlWI呈高低不均信号9例，等信号4例；T2WI呈不均匀高信号9例，等信号4例；增强扫描11例呈不均匀强化。术后病理证实肿瘤来源于脑膜间质的血管外皮细胞。结论 颅内血管外皮细胞瘤MRI表现与脑膜瘤相似，但前者往往出现分叶征，有丰富的血管，肿瘤易出血、坏死致信号不均匀，无钙化及局部骨质反应性增生和有溶骨性破坏等特点，据此可资鉴别。病理免疫组织化学可确定肿瘤的起源。     

纵隔型肺癌的CT及MR表现分析

目的 探讨纵隔型肺癌CT及MRI诊断能力.方法 回顾分析15例经纤支镜、穿刺活检及手术病理证实为纵隔型肺癌的CT及MRI影像资料,15例全部行CT平扫,其中11例增强扫描,3例行MR平扫与增强扫描.分析CT及MRI图像上肿块的位置、大小、形态、边缘及其与纵隔和肺的关系.结果 15例纵隔型肺癌为单发肿块,5例小细胞型肺癌,8例鳞癌、腺癌及腺鳞癌各1例.肿块均位于纵隔胸膜下,与纵隔呈宽基底相贴,大多呈类圆形或椭圆形.边缘分叶12例,毛刺9例.肿块位于上纵隔8例,中纵隔5例,下纵隔2例.其中前中纵隔区12例,后纵隔3例.肿块与肿大淋巴结融合7例.癌肿邻近相应支气管变窄或闭塞9例.4例有胸廓骨转移性骨质破坏.结论 纵隔型肺癌易误诊,仔细分析CT及MRI表现,结合临床可作出较准确的诊断.     

原发性脑淋巴瘤的影像诊断与鉴别

目的 分析颅内原发性淋巴瘤CT和MRI的影像学表现，旨在提高对该病的诊断与鉴别诊断率。资料与方法 回顾性分析10例经病理证实的颅内原发性淋巴瘤的CT与MRI表现。结果 单发6例，多发4例，共计15个病灶，病理类型均为B细胞型非霍奇金淋巴瘤。CT表现等密度或稍高密度实质性肿块，无钙化，瘤周水肿相对较轻，占位效应轻，增强后瘤体呈均匀性轻、中度强化，无囊变及环表强化。MRI显示为长T1、长T2信号，增强后病灶明显强化。结论 原发性淋巴瘤的影像学征象、发生部位无特征性，但以实质性均匀性强化多见，且对室管膜下转移灶的检测，MRI优于CT。     

Intracranial hemangiopericytomas: MR and CT features.

PURPOSETo describe the MR and CT imaging features of hemangiopericytoma and to identify the characteristics that might distinguish them from meningioma.METHODSWe retrospectively reviewed the CT and MR findings in 34 pathologically proved cases of hemangiopericytoma. We evaluated the size, shape, and location of the tumor; the presence of hydrocephalus, edema, and mass effect; the type of dural attachment (broad-based or narrow-based) and bone changes (erosion, hyperostosis); and the tumor''s density, signal, and contrast-enhancement characteristics.RESULTSThirty of 34 tumors were 4 cm or more in greatest dimension, 32 were lobular, and only seven were in the posterior fossa. Hydrocephalus was present in 18, edema in 30, and mass effect in 33. Twenty-three had broad-based dural attachment and 11 had narrow-based attachment. All 26 unenhanced CT scans showed hyperdense tumors; 19 were heterogeneous and seven homogeneous. All 27 contrast-enhanced CT scans showed enhancement; 17 were heterogeneous and 10 homogeneous. Bone erosion was present in 17 of 29 hemangiopericytomas imaged with CT. None had hyperostosis or tumor calcifications. On T1-weighted MR images, 13 of 17 tumors were isointense with cortical gray matter; on T2-weighted image, 10 of 17 were isointense. All 14 tumors imaged with contrast enhanced T1-weighted MR imaging showed enhancement, and 13 of these were heterogeneous; eight of the 14 had a "dural tail" sign.CONCLUSIONIntracranial hemangiopericytomas are multilobulated, extraaxial tumors, sometimes associated with narrow-based dural attachment and bone erosion. Unlike with meningiomas, hyperostosis and intratumoral calcification are not present.     

肝脏血管平滑肌脂肪瘤的CT及MRI征象分析

目的 分析13例肝脏血管平滑肌脂肪瘤（AML）的CT及MRI表现,进一步提高诊断准确性。方法 所有病例均经手术病理证实。12例经CT检查,其中6例做过MRI检查,仅1例只做MRI检查。平扫后行增强动脉期和门脉期扫描,5例做了延迟期扫描。MRI检查行SE T1WI、快速自旋回波（FSE）T2WI和快速多层面干扰梯度回波（FMPSPGR）序列横断面动态多期增强扫描。结果 CT平扫11个病灶为低密度,1个为略高密度。动脉期所有病灶均有强化表现,8个病灶见到中心血管影。门脉期8个病灶有持续强化,有6个病灶见到中心血管影。MR T1WI上5个病灶为混杂信号,T2WI上所有病灶均为高信号,但信号强度各不相同。MR增强动脉期6个病灶有强化,1个病灶强化不明显。门脉期4个病灶有持续强化,3个为低信号。MR增强扫描中也有4个病灶显示中心血管影。结论 CT和MRI检查均可显示AML的特征,特别是病灶中脂肪成分和血管影高度提示AML的诊断。MR SE序列加脂肪抑制显示脂肪成分比CT更加敏感。CT和MR动态增强多期扫描可充分反映AML的强化特征,有助于提高AML的诊断准确性。     

Acoustic neuromas: evaluation by magnetic resonance imaging

Proton magnetic resonance imaging (MRI) examinations were performed in six patients with seven acoustic neuromas, and the results were compared with conventional tomography of the internal auditory canals, contrast-enhanced computed tomography (CT), and air CT cisternography. All tumors were identified with MRI. The three largest tumors (greater than 1 cm diameter) looked similar to the tumors seen on CT scans, although the extent of the tumor was better seen with MRI in two cases. The four small (less than or equal to 1 cm diameter) cerebellopontine angle and intracanalicular tumors were well seen with MRI, with appearances corresponding to those seen with air CT cisternography. No side effects were encountered with the MRI examinations. MRI is an accurate, noninvasive alternative to contrast-enhanced CT and air CT cisternography in the diagnosis of acoustic neuromas.     

Hepatic angiomyolipoma: various appearances on two-phase contrast scanning of spiral CT.

The purpose of this study was to describe and analyze the various appearances of hepatic angiomyolipoma (AML) on the two-phase contrast scans of spiral CT and find out the valuable signs suggesting the diagnosis. Spiral CT scanning of pre- and post-contrast arterial phase, portal venous phase were performed in 12 cases. We found that 11 of 12 lesions appeared as hypodense, the other one appeared as slightly hyperdense on pre-contrast CT scans. On the arterial phase, 11 lesions were markedly enhanced, with the central vasculature opacification in eight lesions; the only other lesion showed no marked enhancement, but with massive vessels seen within the lesion. On the portal venous phase, eight lesions remained in enhancement with the central vessels also seen in six lesions. Our results revealed that two-phase contrast scanning could demonstrate some characteristic features of AML, such as fat components within the lesions, hypervascular tumors, the absence of capsule. Especially the central vessels within the lesions suggested strongly the diagnosis of AML. As for atypical cases, the diagnosis remained difficult and should be differentiated from other hypervascular lesions by means of other imaging modalities or needle puncture biopsy.     

病理性肾损伤的影像学诊断及评价

目的:分析病理性肾损伤的影像学表现特征,评价CT和MRI对病理性肾损伤及其病因的诊断价值。方法:回顾性分析9例病理性肾损伤的临床资料及影像学表现,9例均有不同程度的外伤史,全部经CT检查(7/9增强),5例经MRI检查(4/5增强)。结果:病理性肾损伤的病因中,血管平滑肌脂肪瘤3例,肾癌2例,黄色肉芽肿性肾盂肾炎、多发肾囊肿、神经源性膀胱炎伴肾积水、先天性肾盂输尿管连接部狭窄伴肾积水各1例。8例经手术病理证实,1例经临床既往病史证实。CT和MRI检查均清楚显示原发病变及损伤表现。结论:CT和MRI检查对病理性肾损伤的价值显著,但对病因的定性诊断有局限性。     

颅内原发恶性淋巴瘤影像与临床(附27例报告)

目的　探讨少见的颅内原发恶性淋巴瘤的临床规律与影像特征。方法　总结分析经手术后病理证实的 2 7例颅内原发恶性淋巴瘤的临床规律与影像特点 ,其中全部病例行CT扫描 ,2 0例同时进行CT及MRI检查。结果　临床大多以头痛为首发症状 ,其次为癫痫发作、头晕、偏瘫等 ,40岁左右男性多发 ,幕上多见。CT平扫病灶多呈等或高密度 ,MRI上T1WI绝大多数呈等或稍低信号 ,而T2 WI多接近灰质信号。增强扫描肿瘤明显均匀强化 ,约 1/3病灶中央可有囊变坏死 ,可单发或多发。结论　结合临床及影像学改变 ,对原发性颅内恶性淋巴瘤可提出较准确的临床诊断