脑膜血管外皮细胞瘤的MRI诊断  

MRI diagnosis of meningeal hemangiopericytoma

作　　者：常双会[1] 张帆[1] 胡秋菊[1] 卢光明[1] 

机构地区：[1]南方医科大学南京临床医学院(南京军区南京总医院)医学影像科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2010年第4期382-386,共5页Journal of Medical Postgraduates

基　　金：国家基础研究973基金(2006CB705707)

摘　　要：目的脑膜血管外皮细胞瘤(meningeal hemangiopericytom a,M-HPC)属于血管外皮细胞瘤(HPC)范畴,在临床上属于少见的脑膜肿瘤,文中探讨M-HPC的MRI特征,以提高对该病的诊断水平。方法回顾性分析12例经手术、病理证实的M-HPC患者的MRI资料,总结M-HPC的MRI诊断要点及相关鉴别诊断。结果患者肿瘤均为单发病灶,发生部位:肿瘤位于大脑镰4例、蝶骨嵴3例、鞍上1例、跨中、后颅窝生长1例、鞍旁2例、肿瘤突入颞下窝、位于顶叶表浅部位1例。肿瘤形状:10例肿瘤呈不规则分叶状,2例呈类圆形。MRI特点:9例呈混杂等长T1等长T2信号,病灶内可见血管流空信号及多发坏死囊变区,增强实质部分显著强化;3例呈等T1等T2信号,增强显著均匀强化。9例与硬膜窄基底相连,可见硬膜尾征;5例可见瘤周水肿,占位效应明显;7例进行扩散加权成像(diffusion weighted image,DWI),表现为低信号或混杂等偏低信号;2例进行磁共振波谱(magnetic resonance spectroscopy,MRS)分析和磁共振灌注成像(perfusion weightedimaging,PWI),表现为肿瘤胆碱(Choline,Cho)峰明显升高,肌酸(Creatine,Cr)峰及N-乙酰天门冬氨酸(N-acetylaspar-tate,NAA)明显降低或消失;肿瘤实质区血供丰富,呈高灌注状态,对比剂首过期间信号明显下降。结论M-HPC为富血供的恶性肿瘤,MRI呈不规则分叶状,且易发生囊变等特征性表现,这对于术前的正确诊断尤为重要。Objective Meningeal hemangiopericytoma （M-HPC）, one of the hemangiopericytomas （HPC）, is a rare meningioma clinically. This study aimed to explore the MRI features of M-HPC and improve the diagnosis of the disease. Methods We retrospectively reviewed the MRI findings of 12 cases of M-HPC confirmed by surgical pathology, and analyzed the key MRI features and differential diagnosis of the disease. Results All the 12 M-HPC cases were singular lesion, 4 located in the cerebral falx, 3 in the sphenoidal crest, 1 in the supersellar, 1 across the middle and posterior cranial fossa, 1 in the superficial part of the parietal lobe, and 2 arising from the parasellar and intruding into the infratemporal fossa. In shape, 10 cases were irregularly lobulated and the other 2 spherical. MRI depicted an inhomogeneous tumor with low to intermediate T1 and intermediate to high T2 signal intensities, vascular flow void and multiple necrotic cysts in the lesion, and marked inhomogeneous enhancement after injection of Gd-DTPA. Dural tail sign was present in 9 cases, the tumor connecting the dural narrow base, and peritumor edema was found in 5. Diffusion weighted imaging （DWI） revealed intermediate to high signal intensity in 7 cases. On MR spectroscopy （MRS） and perfusion weighted imaging （PWI）, 2 cases presented a marked increase in choline, an obvious reduction or Absence of creatine and N-acetylaspartate （NAA）. MR perfusion imaging revealed rich blood supply in the solid part of the tumor and remarkably diminished signal intensity at the first-pass stage of the contrast agent. Conclusion M-HPC is a malignant tumor with rich blood supply. Its typical MRI manifestations are being irregularly lobulated in shape and tending to be cystic in nature, which are particularly important for its preoperative diagnosis.

关 键 词：脑膜血管外皮细胞瘤 MRI 诊断 

分 类 号：R739.45[医药卫生—肿瘤]