Diagnosis of ependymal intraventricular cysts of the third ventricle by computed tomography

Summary The radiological features of seven patients with surgically verified intraventricular ependymal cyst of the third ventricle are presented. In two patients the pre-operative diagnosis was made by ventriculography, in two by ventriculography and computed tomography (CT), and in the last three patients CT alone was sufficient for correct diagnosis: ventriculography was no longer necessary. The third ventricle is indistinguishable from a cyst with an oval or nearly round configuration with a width-to-length ratio varying between 0.53 and 0.91 (mean 0.79). The density of cerebrospinal fluid within the thired ventricle/cyst is a little higher than that of the lateral ventricles. A cyst can also be seen within the suprasellar cistern. The septum pellucidum is not widened, and the internal cerebral veins are pushed up between the lateral ventricles. These diagnostic signs show up well in coronal CT sections. The round third ventricle together with the rounded and enlarged frontal horns of the lateral ventricles often give an impression of the head of Mickey Mouse.     

A cliniconeuroradiologic approach to third cranial nerve palsies

Sixty-three patients with third cranial nerve palsies (CNPs), either isolated (31) or in association with other neurologic deficits (32), underwent neuroophthalmologic and neuroradiologic evaluation. Discrepancies between the clinical and radiologic evaluations were analyzed and useful clinical presenting symptoms were identified. Microvascular infarction secondary to diabetes mellitus and/or hypertension was the most common cause in patients with isolated third CNP, and extensive neuroradiologic evaluation is not indicated in this subgroup. The overall diagnostic yield of high-resolution CT for isolated third CNPs was low (30%), but improved to 60% if diabetes and hypertension were excluded. However, CT was highly sensitive (90%) in those patients with third CNPs associated with additional neurologic deficits. The status of the pupil in and of itself cannot be the sole determinant as to whether angiography is indicated to exclude an aneurysm. Careful ophthalmologic observation and relating the severity of pupillomotor dysfunction to extraocular ophthalmoplegia is mandatory to determine the logical sequence of radiologic evaluation. Retroorbital pain taken in isolation is a nonspecific presenting symptom and has differential diagnostic value only if it is correlated temporally with the onset of third CNP and the presence or absence of additional cranial nerve deficits.     

颅内神经上皮性囊肿的CT及MRI诊断(附13例报告)

目的 提高ＣＴ、ＭＲＩ对颅内神经上皮性囊肿的诊断水平。方法 １３例经ＣＴ及ＭＲＩ检查,并经手术光学显微镜配合免疫组织化学（简称免疫组化）检查证实。结果 ＣＴ及ＭＲＩ显示囊肿位于第３脑室前上部３例,第４脑室４例,桥小脑角２例,侧脑室三角区１例,额叶与侧脑室前角１例,鞍区、小脑蚓部各１例。ＣＴ显示囊性低密度１１例,等密度（脑组织密度）、高密度（高于脑组织密度）各１例,ＭＲＩ检测（５例）Ｔ１ＷＩ呈低信号     

Atypical Rathke's cleft cyst associated with ossification.

We report a case of symptomatic Rathke's cleft cyst with ossification. CT scans showed curvilinear calcification on the wall of the cyst. MR images revealed a cystic sellar lesion with a nodular solid mass extending to the floor of the third ventricle. This case shows that calcification of the suprasellar cyst does not always suggest craniopharyngioma. Rathke's cysts should be histologically differentiated from craniopharyngiomas because their treatments are different.     

颅内表皮样囊肿的CT诊断

目的:分析表皮样囊肿的CT表现并提高其诊断准确性。材料与方法:11例患者,其中,男性6例,女性5例,年龄介于25～65岁,均经采用GE1600C型扫描仪以OM为基线横断扫描,于平扫后行增强扫描。结果:11例患者的病灶均呈囊性低密度,其中,圆形病灶见于3例,扁平不规则形且境界欠清的病灶见于8例。后者中,1例的病灶位于枕大池,压迫四脑室并引起幕上脑积水。1例的病灶位于鞍上池及环池。其余患者的病灶均位于桥小脑角池且有沿蛛网膜下腔生长的趋势。结论:只要掌握表皮样囊肿的上述CT表现,便容易将其与蛛网膜囊肿,皮样囊肿,以及颅内其他囊性肿块相鉴别。     

脑脉络膜裂囊肿的CT和MRI诊断

目的:探讨脑脉络膜裂囊肿的CT、MRI表现及其诊断价值。材料和方法:回顾性分析19例脑脉络膜裂囊肿的CT和MRI表现。结果:19例病灶均位于脉络膜裂内,右侧12例和左侧7例。CT示病灶呈边界清楚的类圆形囊性,MRI显示病灶圆形或类圆形,长T1、T2信号,在各序列均与脑脊液信号一致;CT和MRI复查均未见病灶形态和信号发生变化。结论:CT和MRI均可检出脑脉络膜裂囊肿,但在明确诊断和鉴别诊断方面,MRI优于CT。     

Computed tomographic diagnosis of suprasellar masses by intrathecal enhancement.

Ten suspected suprasellar mass lesions were evaluated by CT cisternography (CTC). In each case the cisterns could be defined. Suprasellar mass lesions were found in six. Precise assessment of the anterior, lateral, posterior, and superior extent, made by metrizamide CTC, was verified at surgery. In two masses the intravenously enhanced scan was not diagnostic, while a lesion was visualized by intrathecal (metrizamide) CT. The major diagnostic entity was an enlarged third ventricle. When a chiasmic lesion is suspected and the conventional scan is negative, metrizamide CTC is the examination of choice.     

Radiologic Manifestations of Colloid Cysts: A Pictorial Essay

Colloid cysts are among rare benign tumours of the third ventricle. Although the most frequent symptoms are headache and syncope, arrest hydrocephalus or sudden death could appear with colloid cysts. The aim of this pictorial essay was to increase awareness of the clinical presentation, computed tomography (CT) and magnetic resonance (MR) imaging spectrum, and treatment options of the colloid cysts. The data of 11 patients with histopathologically and/or clinically proven colloid cyst were analysed, retrospectively; and the neuroradiologic appearances of the cysts were evaluated. The CT and MR appearance of colloid cysts may change, depending on the viscosity or the cholesterol content of the cysts. However, the cystic content is the most important factor that could affect the success of treatment. Cysts that are especially rich in protein and cholesterol tend to be hyperdense on CT, hypointense on T2-weighted sequences and hyperintense on T1-weighted sequences. These cysts are viscous, and the success of aspiration is significantly low. In the diagnosis and evaluation of small-sized cysts that have an ingredient similar to cerebrospinal fluid, 3-dimensional sequences might be useful. The radiologic appearances of colloid cysts could play an important role in directing these patients to alternative surgical modalities, including resection.     

颅内皮样囊肿的MRI和CT诊断

目的:回顾性分析颅内皮样囊肿的MRI和CT表现。方法:搜集10例经手术病理证实颅内皮样囊肿病例资料,对其MRI和CT表现、病因、病理和临床特征进行分析。10例均行MRI检查,6例同时作CT扫描。结果:病灶位于后颅窝4例,其中2例合并枕部粗隆处皮毛窦。病灶位于鞍旁3例,位于前颅窝、第三脑室后及前囟各1例。9例MRI表现T1WI为不均匀稍低信号,T2WI为高信号影,1例T1WI与T2WI均为高信号。6例CT表现为欠均匀低密度影。其中2例CT和MRI可见蛛网膜下腔脑沟内和双侧脑室内散布的脂肪滴。结论:颅内皮样囊肿有较典型的MRI及CT表现,特别是皮样囊肿破裂有影像学和临床特征性表现,可实现术前正确诊断,MRI优于CT诊断。     

含囊腔的周围型肺癌的 MDCT 特征分析

目的：分析含囊腔的周围型肺癌的 MDCT 特征,提高诊断准确性。方法回顾性分析经病理或临床证实的21例含囊腔的周围型肺癌患者的临床资料、病理类型、TNM 分期、MDCT 表现,部分行 PET-CT 检查的,测量 SUMmax,随访的病例,评价病灶的动态变化。结果共21例(病理诊断证实腺癌11例、鳞癌6例),囊腔为主型2例(9.52%);囊性与磨玻璃密度混合型3例(14.29%);囊性与实性密度混合型14例(66.67%);囊性与磨玻璃、实性密度混合型2例(9.52%)。有软组织结节的20例,结节位于腔外5例(23.81%);结节位于腔内1例(4.76%);多房囊腔与结节混合型14例(66.67%);囊腔壁环形增厚1例(4.76%)。MDCT 征象出现60%以上的有：圆形/类圆形14例(66.67%),分叶征17例(80.95%),腔内血管穿行16例(76.19%),胸膜凹陷征17例(80.95%);出现率90%以上的征象有：多囊19例(90.48%)、不规整19例(90.48%),囊腔内见分隔19例(90.48%)。支气管通入囊腔内8例(38.10%)。病灶 CT 净增值范围14.2~40 HU,平均(28.27±7.27)HU。PET-CT SUVmax 范围4.5~9.8,平均6.05,均呈明显摄取。2例患者随访出现囊腔增大,囊壁增厚。1例患者随访囊腔缩小,实性成分增多。结论囊腔内壁不规整、腔内分隔及血管穿行是诊断含囊腔周围型肺癌的重要征象。     

小儿肝脏未分化性胚胎性肉瘤的CT观察

目的 分析总结小儿肝脏未分化性胚胎性肉瘤的CT表现特点,以提高对本病的认识,从而能够早期诊断、积极治疗。方法 回顾性分析6例未分化性胚胎性肉瘤（UES）的临床、病理及影像特征,并结合文献加以讨论。6例患儿行腹部平扫,5例并行增强扫描。结果 平扫显示病灶边界清楚,3例病变为单囊,3例为多房囊腔,内有厚薄不均的分隔。囊性区内可见少许不规则软组织密度影,位于囊腔边缘或分隔周围。1例于病灶边缘见针尖钙化。增强后,可见肿瘤有一致密的,即病理上的纤维假包膜。实性部分轻度强化,囊性区不强化。4例超声图像表现为混合回声的实性包块内可见大小不等的无回声区。6例均经病理证实。结论 CT多表现为单囊或多囊性病灶,边界清楚,内有不同程度的实性部分,可见强化边。而超声图像则多表现为实性为主,其不一致性亦为本病的重要特点。     

侧脑室内室管膜下瘤的MRI诊断

目的 研究侧脑室内室管膜下瘤的MRI表现，以提高对该病的神经放射学认识。资料与方法 搜集8例经手术病理证实的侧脑室内室管膜下瘤，男5例，女3例，发病年龄16-47岁，平均32．9岁。着重分析肿瘤的好发年龄、部位，MRI信号特点，肿瘤增强情况。结果 左侧脑室内4例，右侧脑室内3例，双侧脑室内1例，除1例位于双侧脑室体部及三角区外，其余病例皆发生于侧脑室室问孔附近，肿瘤漂浮在侧脑室中。肿瘤最大直径4cm，最小1cm。T2WI肿瘤呈均匀高信号；T1WI肿瘤呈等、低信号，肿瘤内部可见小囊状低信号区。增强扫描，肿瘤无强化或有轻微强化。结论 室管膜下瘤的MRI表现具有特征性，术前MRI检查可以对其作出明确的定位定性诊断。     

肝包虫病的MRI诊断

目的:分析肝包虫病的MRI表现，评价MRI对肝包虫病的诊断价值。资料与方法:回顾分析18例经MRI诊断及手术病理证实的肝包虫病影像学资料。结果:18例共发现肝包虫囊肿29个。单房型包虫囊肿6个,MRI表现为边缘光滑的圆形或类圆形病灶，T1 WI呈均匀低信号，T2WI呈高信号，囊壁可清晰显示为低信号；多房型包虫囊肿22个，包虫囊肿内可见多个子囊和不同程度的基质，整个囊肿形态呈车轮状或桑葚状；实质钙化型包虫囊肿1个。MRI术前诊断准确性为94．4％。结论:MRI对肝包虫病有较高的诊断价值，可作为CT及B超等影像学检查方法的有效补充。     

Nonparasitic splenic cysts: a report of 52 cases with radiologic-pathologic correlation

We reviewed 52 cases of splenic cysts on file at the Armed Forces Institute of Pathology. There were 24 true (epidermoid) and 28 false (posttraumatic) cysts. The history and clinical presentations, including pain, splenomegaly, or mass, were similar in both groups. Radiologic manifestations included splenomegaly and the occasional identification of a distinct mass by conventional radiography even in the absence of calcification. The lesions produced a photopenic defect on nuclear scintigraphy and were avascular on angiography. Sonography and CT demonstrated a cystic lesion with occasional septations, wall trabeculation, and low-level internal echoes. Three false cysts demonstrated solid and cystic components on sonography and CT, corresponding to organizing hematoma within the cyst. Splenomegaly or a splenic mass of a predominantly cystic nature with no clinical evidence of echinococcus suggests the diagnosis of splenic cyst. Reliable radiologic distinction between true or false splenic cyst does not seem possible. Complex mass may represent a "transition" between hematoma and false splenic cyst.     

Computed tomography of cystic lung diseases

A cystic lesion in the lung is defined as a well-demarcated epithel-lined cavity, that can be mostly filled with air, water, as well as solid material content. This definition includes a wide variety of diseases such as bronchogenic cyst, abscess formation, lymphangioleiomyomatosis, Langerhans cell histiocytosis, emphysema, bronchiectasis, and pneumatoceles. Despite the difficulties in differential diagnosis, there are some diagnostic criteria for CT-scanning helping the radiologist to differentiate between these cystic entities. Moreover, clinical informations are extremely important. The most important clinical parameters include age, sex, clinical history and symptoms. Thus, a better understanding of classic CT appearance of cystic lung disease will allow more definitive diagnosis and could, in some cases, avoid biopsy.     

Cystic pelvic mass in a patient having recurrent carcinoma of the cervix

The diagnostic difficulties encountered with atypical tumor growth are reported in a 29-year-old female with recurrent carcinoma of the uterine cervix. Following a Wertheim-Meigs procedure and resection of local tumor recurrence eight months later, a second recurrence was detected on CT as a purely cystic lesion in the left pelvic wall. Although the size of the cyst subsequently increased, the patient remained asymptomatic until slight pain developed in the left leg 28 months after initial therapy. One month later, limping was noticed; plain radiography showed a large osteolytic lesion of the left hip and on I.V.U., a dilatation of the left renal collecting system was observed. Pelvic CT showed only minimal solid tissue components within a large cyst. Multiple needle aspirations of the cyst and cytological examinations of the fluid obtained showed no evidence of tumor cells. A definitive histological diagnosis of metastasizing squamous cell carcinoma was only reached after surgery.     

颅内包虫病的CT诊断

目的探讨颅内包虫病的CT表现。方法分析经手术、病理证实的6例颅内包虫病的CT征象,其中单发脑内包虫囊肿3例,多发1例,硬膜外包虫囊肿1例,肝脑多发泡型棘球蚴病1例。结果颅内包虫病一般表现为典型囊肿性病变,轮廓清晰、锐利,CT值与脑脊液相似,囊内容物密度均一,囊壁无或轻度增强。脑泡型棘球蚴病无特异CT征象,有时表现酷似脑胶质瘤。结论CT是诊断颅内包虫病简捷、准确的影像学检查方法,密切结合临床资料正确诊断多无困难。     

Cysticercosis of the brain shown by magnetic resonance imaging

Fifteen patients in whom the diagnosis of cysticercosis of the brain was suggested by computed tomography (CT) were further studied with magnetic resonance imaging (MRI). Besides lesions in the substance of the hemispheres, cysts were found adjacent to and within the ventricles, the brainstem, cerebellum and subarachnoid space. Magnetic resonance imaging showed brain involvement out of proportion to what was shown by CT. The eccentrically placed mural nodule within a cyst, the pathognomonic lesion of cysticercosis, was seen in all cases with MRI. The various stages of development of the cysticercus larva were seen in one individual. An attempt is made to illustrate the various stages of development by means of MR images, and a possible pathological explanation is offered. The authors believe that MRI provides diagnostic information in this disease and dispenses with the need for enhanced CT examination.     

眶骨良性肿瘤与瘤样病变的CT诊断

目的分析眶骨良性肿瘤与瘤样病变的CT表现,提高对此类病变的认识。方法回顾32例经手术、病理和临床证实的眶骨良性肿瘤与瘤样病变,包括良性肿瘤17例、瘤样病变15例。结果骨瘤9例,呈均一致密影、海绵骨样密度或磨砂玻璃样改变;骨化性纤维瘤5例,表现为边界清晰的膨胀性骨性肿块,内有骨化、囊变等;2例表皮样囊肿呈囊性密度;1例软骨瘤以钙化、骨化为主;骨纤维异常增殖症10例,受累骨不规则膨大,磨砂玻璃样密度伴囊变,边界不清;郎格罕氏细胞组织细胞增生症3例,不规则骨质破坏,边缘清晰;1例动脉瘤样骨囊肿表现为膨胀性肿块,有薄骨壳;1例石骨症眶骨增厚,呈均一致密影。结论眶骨良性肿瘤与瘤样病变的CT表现各具特征性,CT扫描能清晰显示病变范围、密度、边界以及与邻近结构的关系。     

分离型脑裂畸形与先天性脑穿通畸形囊肿的CT鉴别诊断

目的：提高ＣＴ对分离型脑裂畸形与先天性脑穿通畸形囊肿的鉴别能力。材料与方法：搜集３６例具有大脑半球低密度灶与侧脑室及蛛网膜下腔相通ＣＴ征象，临床资料符合先天性脑发育畸形者。依据畸形的发病机制分析其影像特征，以病灶边缘有带状灰质密度衬边为确诊脑裂畸形的依据，鉴别分离型脑裂畸形与脑穿通畸形囊肿。结果：脑裂畸形１０例；脑穿通畸形囊肿２６例。分析病灶形态发现脑裂畸形与脑穿通畸形囊肿有特征性差异，前者病灶形态为两边内凹的双抛形，最窄处离开脑腔、室端；而后者为球形或扇形，最窄处位于脑腔、室端。前者多伴发其他畸形（主要为透明隔缺如），后者均为单一畸形。结论：分离型脑裂畸形与先天性脑穿通畸形囊肿的病灶形态具有特征性差异，有助于避免当灰质衬边带影显示不清时可能导致的误诊。另外，由于脑裂畸形在胚胎期发生较脑穿通畸形囊肿早，因此畸形较严重，且伴发其他畸形的可能性明显增多。