颅眶沟通性脑膜瘤的影像学分析
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摘要
目的探讨颅眶沟通性脑膜瘤的特征性影像学表现。方法回顾性分析31例经病理证实的颅眶沟通性脑膜瘤患者的影像资料,其中CT检查24例,MRI检查27例。结果颅眶沟通性脑膜瘤分为扁平肥厚型脑膜瘤、视神经鞘脑膜瘤和跨眶上裂脑膜瘤。5例扁平肥厚型脑膜瘤均呈扁平状软组织密度和受累骨质增生肥厚及脑膜尾征,三侧性肿块4例,双侧性肿块1例。眶内及颞窝肿块信号一致,但与颅内肿块信号不同。视神经鞘脑膜瘤19例,其中哑铃形10例,蝌蚪形7例,视神经鞘膜全程不均匀增厚2例,病变均呈软组织密度,其中钙化2例,但骨质均无改变。颅内及眶内病变信号一致,均出现双轨征及脑膜尾征。跨眶上裂脑膜瘤7例,均呈软组织密度并出现脑膜尾征,哑铃形6例,不规则形1例,邻近骨质增生硬化5例(其中1例合并骨质吸收),骨质无变化2例。行MRI检查的4例中,颅内及眶内肿块信号一致3例,不一致1例。结论不同亚型的颅眶沟通性脑膜瘤均有其特征性的表现,综合分析病变形态、位置、密度和信号特征及邻近脑膜和骨质的情况,提高诊断的准确率。
Objective To evaluate the imaging features of cranio-orbital meningioma. Methods CT and/or MRI of 31 patients were retrospectively analyzed. CT and MRI were performed in 24 and 27 cases respectively. Results Three types of cranio-orbital meningioma were divided, which included en plaque meningioma, optic nerve sheath meningioma, and superior orbital fissure meningioma. All 5 cases with en plaque meningioma presented flat soft tissue masses with hyperostotic changes and dural tail sign. Three and 2 masses were found in 4 and 1 case repectively. The intensity of orbital and temporal fossa masses were similar but were different with intracranial masses. Among 19 cases with optic nerve sheath meningioma, the shape was dumb-bell shape in 10 cases, tadpole shape in 7 case, and strip shape in 2 cases. Calcification occurred in 2 cases among 12 patients with CT examination. Orbital and intracranial masses had similar intensity and presented. All 18 cases with MRI examination presented tram-track and dural tail sign. All 7 cases with superior orbital fissure meningioma had soft tissue masses and dural tail sign. The shape of tumor was dumb-bell in 6 cases and irregular only in 1 case. Hyperostotic changes occured in 5 cases and 1 case had bony destruction among of them. Intensity of orbital and intracranial masses was similar in 3 cases and difference in 1 case among 4 patients with MRI examination. Conclusion Different types of cranio-orbital meningioma have their characteristic CT and MRI findings. Diagnostic accuracy must be promoted by comprehensive assessment of the shape, location, density, intensity, and changes of bone and dura.
Objective To evaluate the imaging features of cranio-orbital meningioma. Methods CT and/or MRI of 31 patients were retrospectively analyzed. CT and MRI were performed in 24 and 27 cases respectively. Results Three types of cranio-orbital meningioma were divided, which included en plaque meningioma, optic nerve sheath meningioma, and superior orbital fissure meningioma. All 5 cases with en plaque meningioma presented flat soft tissue masses with hyperostotic changes and dural tail sign. Three and 2 masses were found in 4 and 1 case repectively. The intensity of orbital and temporal fossa masses were similar but were different with intracranial masses. Among 19 cases with optic nerve sheath meningioma, the shape was dumb-bell shape in 10 cases, tadpole shape in 7 case, and strip shape in 2 cases. Calcification occurred in 2 cases among 12 patients with CT examination. Orbital and intracranial masses had similar intensity and presented. All 18 cases with MRI examination presented tram-track and dural tail sign. All 7 cases with superior orbital fissure meningioma had soft tissue masses and dural tail sign. The shape of tumor was dumb-bell in 6 cases and irregular only in 1 case. Hyperostotic changes occured in 5 cases and 1 case had bony destruction among of them. Intensity of orbital and intracranial masses was similar in 3 cases and difference in 1 case among 4 patients with MRI examination. Conclusion Different types of cranio-orbital meningioma have their characteristic CT and MRI findings. Diagnostic accuracy must be promoted by comprehensive assessment of the shape, location, density, intensity, and changes of bone and dura.
引文
[1] 刘力,宗绪毅,关树森.眶内脑膜瘤的诊断与治疗[J].中华医学杂志,2000;80(5):368-369.
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[4] 李吉臣,沈太春,张光奎.眶内脑膜瘤的CT诊断[J].实用放射学杂志,2007,23(8):1025-1027.
[5] Eddleman CS,Liu JK.Optic nerve sheath meningioma:current diagnosis and treatment [J].Neurosurg Focus,2007,23(5):4.
[6] 岳奎涛,吴春艳,李丽新,等.颅眶沟通性脑膜瘤的临床、病理与影像学征象分析[J].实用放射学杂志,2009,25(11):1551-1555.
[7] Leroy HA,Leroy-Ciocanea CI,Baroncini M,et al.Internal and external spheno-orbital meningioma varieties:different outcomes and prognoses [J].Acta Neurochir (Wien),2016,158(8):1587-1596.
[8] Turbin RE,Pokorny K.Diagnosis and treatment of orbital optic nerve sheath meningioma [J].Cancer Control,2004,11(5):334-341.
[9] 蒋光仲,宾精文.颅眶沟通性脑膜瘤的CT、MRI诊断[J].实用医学杂志,2012,28(15):2644-2645.
[2] 张瑾,张和平,陈小兵.颅眶沟通性脑膜瘤的CT和MRI诊断[J].医学影像学杂志,2010,20(9):1397-1398.
[3] 高爱英,王振常,杨本涛,等.眼眶扁平肥厚型脑膜瘤CT及MRI表现[J].中国医学影像技术,2004,20(2):186-188.
[4] 李吉臣,沈太春,张光奎.眶内脑膜瘤的CT诊断[J].实用放射学杂志,2007,23(8):1025-1027.
[5] Eddleman CS,Liu JK.Optic nerve sheath meningioma:current diagnosis and treatment [J].Neurosurg Focus,2007,23(5):4.
[6] 岳奎涛,吴春艳,李丽新,等.颅眶沟通性脑膜瘤的临床、病理与影像学征象分析[J].实用放射学杂志,2009,25(11):1551-1555.
[7] Leroy HA,Leroy-Ciocanea CI,Baroncini M,et al.Internal and external spheno-orbital meningioma varieties:different outcomes and prognoses [J].Acta Neurochir (Wien),2016,158(8):1587-1596.
[8] Turbin RE,Pokorny K.Diagnosis and treatment of orbital optic nerve sheath meningioma [J].Cancer Control,2004,11(5):334-341.
[9] 蒋光仲,宾精文.颅眶沟通性脑膜瘤的CT、MRI诊断[J].实用医学杂志,2012,28(15):2644-2645.