Rathke囊肿的病理与临床、影像对照分析  

Rathke Cleft Cysts:Comparative Study of Pathology,Clinic and Imaging

作　　者：解中福[1] 靳松[1] 崔世民[1] 刘梅丽[1] 

机构地区：[1]天津市环湖医院放射科,天津300060

出　　处：《实用放射学杂志》2008年第12期1592-1594,1647,共4页Journal of Practical Radiology

摘　　要：目的探讨Rathke囊肿病理与临床和CT、MRI表现的相关性。方法回顾分析经手术病理证实的Rathke囊肿43例的病理和CT、MRI表现及临床特征。结果27例位于鞍内和鞍上,16例位于鞍内。CT平扫囊肿多呈边界清晰的"类圆形"或"哑铃"状肿物,其中9例低密度,9例高密度,8例等或稍高混杂密度,1例囊壁钙化;CT增强扫描有6例囊壁呈环形或边缘强化,其余无强化。MR检查18例T1WI呈低或等信号,T2WI呈高信号,6例T1WI和T2WI均显示高信号,4例T1WI高信号,T2WI呈混杂信号。4例囊肿内结节,T1WI呈高信号,T2WI呈低或混杂信号。MR增强检查有9例囊壁的外缘增强。术中见肿物呈囊状,10例囊液呈脑脊液样清亮液体,15例为胶冻状咖啡色黏液,12例呈豆渣样黏稠液,6例为深褐色油状黏液。组织学分析显示部分囊液中含有脂肪结晶和脱落皮屑样物,11例HE染色可见胆固醇裂隙、凝血及肉芽组织,16例PAS染色阳性,囊液内含有黏多糖和蛋白质类物质。结论典型的Rathke囊肿术前可以明确诊断,非典型Rathke囊肿的CT、MRI表现缺乏特异性。随着囊液组织成分的变化,影像学表现有一定的变化规律。Objective To study the correlation among pathological, clinical and the imaging features （CT and MRI） of the Rathke cleft cysts. Methods CT, MRI and clinical findings of Rathke cleft cysts in 43 patients confirmed by operation and pathology were retrospectively studied. Results 27 cysts located at intrasella and suprasella and 16 cysts entirely located at intrasella. Cysts were round or oval in shape with definite borders. The size of 30 cysts exceed 10mm in diameter. On CT scans reviewed, the cysts were low density in 9 cases,hyperdensity in 9 cases and isodensity or mixed density in 8 cases. The cyst＇ s wall with calcification was seen in one. On postcontrast CT scans, 6 cases showed circular and peripheral cyst＇ s wall enhancement and others were no enhancement. On MR imaging, the lesions were low or isodense on T1WI and hyper -intensity on T2WI in 18 cases, both were high signal intensity on T1WI and T2WI in 6 cases,high signal intensity on T1 WI and mixed signal intensity on T2WI in 4 cases. An intracystic nodule having high signal intensity on T1 WI, and low or mixed signal intensity on TEWI was observed in 4 cases. On contrast - enhanced MR imaging, enhancement of the cyst＇ s wall was shown in 9 cases. During surgery, the lesions were noted to have a cyst of semisolid consistency, and cystic contents were described from CSF -like cleat fluid in 10 cases, jellied -like brown mucoid fluid in 15 cases, caseous -like mucoid fluid in 12 cases, machine oil -like mucoid fluid in 6 cases. At histopathology, a part of cystic fluid included cholesterol crystal and necrotic debris. Cholesterol clefts and hemosiderin pigment, and granuloma were shown by staining with HE in 11 cases. The PAS staining was positive in 16 cases, cystic fluid contained partial mucopolysaccharides and protein. Conclusion Typical Rathke cysts can be dignosised in the preoperative, the findings of CT and MRI are not specific in atypical cysts. The imaging features were different with the fluid component of Rathke cleft cysts..

关 键 词：脑 RATHKE囊肿 体层摄影术 X线计算机 磁共振成像 病理学 

分 类 号：R742[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]