脑实质型表皮样囊肿的MRI表现及相关病理学基础与临床  

Intraparenchymal Epidermoid Cyst: MRI Findings, Pathology Basis and Clinic

作　　者：欧光乾 夏贤武[2] 刘含秋 姚振威 吴诗熳 OU Guang-qian;XIA Xian-Wu;LIU Han-qiu;YAO Zheng-wei;WU Shi-man(Department of Radiology,Traditional Chinese Hospital Attached to Southwest Medical University;Department of Radiology,Taizhou City Hospital;Department of Radiology,Huashan Hospital Attached to Fudan University)

机构地区：[1]西南医科大学附属中医医院放射科 [2]台州市立医院放射科 [3]复旦大学附属华山医院放射科

出　　处：《中国医学计算机成像杂志》2018年第4期287-291,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨脑实质型表皮样囊肿的MRI表现以及相关病理学基础,以提高其术前MRI诊断准确性。方法:搜集经手术病理证实的脑实质型表皮样囊肿9例,回顾性分析其MRI表现及相关病理学基础。9例均行MRI平扫与增强扫描,平扫序列包括T1WI、T2WI、FLAIR、DWI,并测量病灶、脑脊液、脑白质ADC值,分别比较病灶与脑脊液、病灶与脑白质ADC值两者间差异。结果:9例均单发,4例位于额叶,2例位于小脑半球,1例位于小脑蚓部,1例位于颞叶,1例位于小脑半球及枕叶跨天幕生长。病灶形态不规则,边界较清晰,无灶周水肿;T1WI脑脊液样低信号;T2WI呈脑脊液样高信号;FLAIR以低信号为主,边缘见少许带状高信号;DWI呈高信号。IPEC的ADC值介于脑脊液与脑白质之间,IPEC与脑白质、脑脊液的ADC值差异均具有统计学意义(P<0.001)。7例病灶未强化,2例病灶部分边缘轻度强化。大体标本示肿瘤有包膜、边界清楚,无血供,质软,内容物呈灰白或灰黄、豆渣样碎片状物质。镜下病理改变,囊壁为角化或非角化鳞状上皮,囊内为胶状碎屑、固态胆固醇结晶及类脂质成分。结论:表皮样囊肿的病理学基础确定了其特征性的MRI表现,尤其是DWI,充分认识其MRI表现与病理改变的相关性能提高其术前诊断及鉴别诊断准确性,为术前评估、准备提供可靠的参考价值。Purpose： To explore the MRI findings and related pathology of the intraparenchymal epidermoid cyst OPEC）, in order to improve the MRI diagnosis. Methods： Nine IPEC cases confirmed by surgery and pathology results were enrolled. The MR2 findings and related pathology were analyzed retrospectively. All the cases were performed MRI plain and contrast enhanced scan, the plain scan sequences include TlWI, T2WI, FLAIR, and DWI. ADC values of IPEC, eerebrospinal fluid （CSF） and white mater （WM） were measured. The differences of ADC value between IPEC and CSF, and between IPEC and WM were compared. Result： All the eases were with single lesion, 4 eases located in the frontal lobe, 2 cases in the cerebellar hemisphere, 1 ease in the cerebellar vermis, 1 ease in the temporal lobe, 1 ease in the cerebellar hemisphere and occipital lobe through the tentofium of cerebellum. The shape of IPEC was irregular, the boundary was clear, and no edema around the lesion. All the lesions were CSF-like hypointense on T1WI, CSF- like hyperintense on T2WI, hypointense and surround with banding hyperintense on FLAIR, hyperintense on DWI. The mean ADC value of IPEC was between CSF and WM. There were statistical significant differences between IPEC and CSF, and between IPEC and WM. Seven cases showed no enhancement, 2 cases showed slight peripheral enhancement. The general specimens appeared as soft cystic mass with smooth capsule, without vessel. The cyst was filled with gray or gray-yellow bean dregs-like fragment materials. Pathology exam demonstrated that the capsule of the IPEC was the squamous epithelium （keratinization or not）, the content in the cyst included gelatineous fragments, solid cholesterol crystal, and adipoid material. Conclusion： The pathology changes are the foundation of the MR/findings of IPEC, especially the DWI. Familiar with them can improve the diagnosis and differential diagnosis accuracy, and provide reliable reference value for preoperative evaluation and preparation.

关 键 词：脑 表皮样囊肿 磁共振成像 弥散 病理 

分 类 号：R445.2[医药卫生—影像医学与核医学]