小脑囊性肿瘤性病变的MRI影像特点
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摘要
目的分析不同种类小脑囊性肿瘤性病变的MRI表现特点,探讨发生于小脑的囊性肿瘤性病变的MRI表现规律,以提高诊断水平。方法回顾性分析2010年8月至2016年2月安徽医科大学第一附属医院经手术病理证实的23例小脑肿瘤患者的影像学资料,分析评价病变的囊变程度、部位、大小、边界、周围水肿、占位效应、梗阻性脑积水的情况。探讨不同种类小脑囊性肿瘤性病变的MRI影像学表现特点及规律。结果发生于小脑的囊性病变23例,其中髓母细胞瘤12例(52%),血管母细胞瘤8例(35%),毛细胞型星形细胞瘤3例(13%)。髓母细胞瘤有囊变者8例,但范围均较小,血管母细胞瘤8例均表现为大囊小结节,毛细胞型星形细胞瘤3例囊变范围均较大,结节较血管母细胞瘤结节大;3种肿瘤边界清晰、周围无或仅I度水肿、占位效应较轻、肿瘤体积较大时易引起梗阻性脑积水,增强扫描髓母细胞瘤囊性部分不强化、实性部分中至重度强化,血管母细胞瘤与毛细胞型星形细胞瘤囊变部分不强化,结节重度强化,血管母细胞瘤囊壁无强化,2例毛细胞型星形细胞瘤囊壁可见强化。结论 MRI图像可以清楚的显示肿瘤位置、囊变程度及占位效应等,具有重要的诊断价值。髓母细胞瘤小脑蚓部多见,囊变多见,但囊变范围较小,占位效应较轻;血管母细胞瘤和毛细胞型星形细胞瘤小脑半球多见,囊变多见,囊变范围较大;血管母细胞瘤有典型的大囊小结节MRI表现,囊壁强化少见,毛细胞型星形细胞瘤有典型的大囊大结节表现,囊壁强化多见。
Objective To discuss and investigate the MRI features of cerebellum cystica tumours in order to improve the accuracy of diagnosis. Methods Twenty-three cases of cerebellum cystica tumours with MRI proved by surgery and pathology were analyzed retrospectively. The main evaluation index are cystic extent,diseased region,size,periphery,surrounding edema,mass effect,noncommunicating hydrocephaly and so on. Results Among the 23 cases of cerebellum cystica tumours,there were 12 cases of medulloblastoma( 53%),8 cases of hemangioblastoma( 35%),and 3 cases of pilocytic astrocytoma( 13%); among these tumours,medulloblastoma with cystic was in eight cases,but the scope was small,hemangioblastoma cystic became large but with small nodules in 8 cases,and astroastrocytoma had larger cystic components and larger nodules than hemangioblastoma. Enhancement scanning showed cystic part of medulloblastoma was not enhanced,solid part showed moderate to severe enhancement,cystic part of hemangioblastoma and pilocytic astrocytoma was not strengthened,nodules were obviously improved,hemangioblastoma capsule wall had no enhancement,while pilocytic astrocytoma capsule wall was strengthened in two cases. Three kinds of tumor boundary was clear,with no or only one degree edema,the placeholder effect was lighter,and the larger tumor size easily caused obstructive hydrocephalus. Conclusion MRI images have important diagnostic value since they can clearly show the tumor location,cystic change degree and the placeholder effect,and so on. Medulloblastoma can be seen more in cerebellar vermis,capsule occurs more but in smaller scale. Hemangioblastoma and pilocytic astrocytoma can be seen more in cerebellar hemispheres,with more cystic change and bigger area; hemangioblastoma has typical MRI feature,with large cystic and small nodule,and rare reinforcement in capsule wall; pilocytic astrocytoma has a typical big cystic and big nodule and frequent reinforcement of capsule wall.
Objective To discuss and investigate the MRI features of cerebellum cystica tumours in order to improve the accuracy of diagnosis. Methods Twenty-three cases of cerebellum cystica tumours with MRI proved by surgery and pathology were analyzed retrospectively. The main evaluation index are cystic extent,diseased region,size,periphery,surrounding edema,mass effect,noncommunicating hydrocephaly and so on. Results Among the 23 cases of cerebellum cystica tumours,there were 12 cases of medulloblastoma( 53%),8 cases of hemangioblastoma( 35%),and 3 cases of pilocytic astrocytoma( 13%); among these tumours,medulloblastoma with cystic was in eight cases,but the scope was small,hemangioblastoma cystic became large but with small nodules in 8 cases,and astroastrocytoma had larger cystic components and larger nodules than hemangioblastoma. Enhancement scanning showed cystic part of medulloblastoma was not enhanced,solid part showed moderate to severe enhancement,cystic part of hemangioblastoma and pilocytic astrocytoma was not strengthened,nodules were obviously improved,hemangioblastoma capsule wall had no enhancement,while pilocytic astrocytoma capsule wall was strengthened in two cases. Three kinds of tumor boundary was clear,with no or only one degree edema,the placeholder effect was lighter,and the larger tumor size easily caused obstructive hydrocephalus. Conclusion MRI images have important diagnostic value since they can clearly show the tumor location,cystic change degree and the placeholder effect,and so on. Medulloblastoma can be seen more in cerebellar vermis,capsule occurs more but in smaller scale. Hemangioblastoma and pilocytic astrocytoma can be seen more in cerebellar hemispheres,with more cystic change and bigger area; hemangioblastoma has typical MRI feature,with large cystic and small nodule,and rare reinforcement in capsule wall; pilocytic astrocytoma has a typical big cystic and big nodule and frequent reinforcement of capsule wall.
引文
[1]白敏,赵秀芹,狄玉进,等.小脑半球肿瘤的MRI诊断与鉴别诊断[J].医学影像学杂志,2006,26(2):131-133.
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[6]BECKER R L,BECKER A D,SOBEL D F.Adult medulloblastoma:review of 13 cases with emphasis on MRI[J].Neuroradiology,1995,37(2):104-108.
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[8]LOUIS D N,OHGAKI H,WIESTLER O D,et al.The 2007WHO classification of tumours of the central nervous system[J].Acta Neuropathol,2007,114(2):97-109.
[9]唐晓年,毛伯镛,余定庸,等.髓母细胞瘤Cyclin D1、P16的表达及其与临床病理特点和预后的关系[J].中华神经外科杂志,2004,20(5):377-380.
[10]TAKEUCHI H,KUBOTA T,SATO K,et al.Ultrastructure of capillary endothelium in pilocytic astrocytomas[J].Brain Tumor Pathol,2004,21(1):23-26.
[11]晋丹丹,王嗣伟,等.III型Von Hipple-Lindau综合征1例[J].安徽医学,2014,35(10):1471.
[12]张海兵,倪建明,徐骁,等.血管母细胞瘤的影像诊断[J].实用放射学杂志,2009,25(4):461-464.
[13]莫友发,张玉忠,张雪林,等.颅内血管母细胞瘤MRI诊断[J].影像诊断与介入放射学,2005,14(3):134-137.
[14]钟文招,陈武标,刘文慈,等.颅内毛细胞型星形细胞瘤的CT、MRI诊断[J].实用放射学杂志,2010,26(8):1096-1099.
[15]余永强.中枢神经系统肿瘤磁共振分类诊断[M].北京:人民卫生出版社,2014:124.
[16]张小玲,鱼博浪.囊性脑转移瘤的CT和MRI诊断[J].实用放射学杂志,2006,12(4):402-404.
[2]李晏,黄飚,刘红军,等.小脑髓母细胞瘤的MRI表现[J].放射学实践,2009,24(11):1191-1194.
[3]赵本胜,余永强,钱银锋,等.毛细胞型星形细胞瘤的CT和MRI表现[J].临床放射学杂志,2007,26(6):539-542.
[4]舒锦尔,蒋春景,卢金华,等.小脑囊性病变的MRI诊断[J].医学影像学杂志,2011,21(4):507-510.
[5]郑穗兰,刘斌.MRI诊断与临床[M].合肥:安徽科学技术出版社,2014:78.
[6]BECKER R L,BECKER A D,SOBEL D F.Adult medulloblastoma:review of 13 cases with emphasis on MRI[J].Neuroradiology,1995,37(2):104-108.
[7]钱银锋,余永强.2007年WHO中枢神经系统肿瘤分类及影像学[J].实用肿瘤学杂志,2008,22(2):166-169.
[8]LOUIS D N,OHGAKI H,WIESTLER O D,et al.The 2007WHO classification of tumours of the central nervous system[J].Acta Neuropathol,2007,114(2):97-109.
[9]唐晓年,毛伯镛,余定庸,等.髓母细胞瘤Cyclin D1、P16的表达及其与临床病理特点和预后的关系[J].中华神经外科杂志,2004,20(5):377-380.
[10]TAKEUCHI H,KUBOTA T,SATO K,et al.Ultrastructure of capillary endothelium in pilocytic astrocytomas[J].Brain Tumor Pathol,2004,21(1):23-26.
[11]晋丹丹,王嗣伟,等.III型Von Hipple-Lindau综合征1例[J].安徽医学,2014,35(10):1471.
[12]张海兵,倪建明,徐骁,等.血管母细胞瘤的影像诊断[J].实用放射学杂志,2009,25(4):461-464.
[13]莫友发,张玉忠,张雪林,等.颅内血管母细胞瘤MRI诊断[J].影像诊断与介入放射学,2005,14(3):134-137.
[14]钟文招,陈武标,刘文慈,等.颅内毛细胞型星形细胞瘤的CT、MRI诊断[J].实用放射学杂志,2010,26(8):1096-1099.
[15]余永强.中枢神经系统肿瘤磁共振分类诊断[M].北京:人民卫生出版社,2014:124.
[16]张小玲,鱼博浪.囊性脑转移瘤的CT和MRI诊断[J].实用放射学杂志,2006,12(4):402-404.