颅内海绵状血管瘤的不典型影像学表现及误诊分析  

Atypical imaging manifestations and misdiagnosis analysis of intracranial cavernous hemangioma

作　　者：何莹[1] 毛翠平[1] 李兴华[1] 杨全新[1] Kifle Esayas Tiruneh 张秋娟[1] HE Ying;MAO Cuiping;LI Xinghua;YANG Quanxin;Kifle Esayas Tiruneh;ZHANG Qiujuan(Department of Medical Imaging,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学第二附属医院医学影像科,陕西西安710004

出　　处：《实用放射学杂志》2020年第10期1537-1540,共4页Journal of Practical Radiology

基　　金：陕西省自然科学基础项目(2012JQ4005)。

摘　　要：目的分析颅内海绵状血管瘤(ICA)的不典型影像学表现及误诊原因,提高对ICA影像学表现的认识。方法回顾性分析17例经手术病理证实的不典型ICA的MRI表现,包括发病部位、病变形态、病变信号特点,并结合手术及病理,分析不典型影像学表现的病理基础及术前误诊原因。结果17例ICA均为单发,其中15例位于脑内。病变长径3.2~8.4 cm,平均约4.3 cm。2例表现以囊性改变为主,均位于大脑半球皮层下区,1例呈大囊小结节样改变,结节部分边缘见极低信号环,1例为多发小囊样改变,病变边缘及部分囊内见极低信号。13例表现为含不同时期出血的混杂信号团块,4例呈结节并周围囊腔样出血改变,结节边缘见低信号环,3例表现为边界清楚的高低混杂信号并周围低信号环,6例表现为不规则形混杂信号病灶并周围环状低信号,增强扫描后仅1例可见强化,余强化不明显。2例位于脑外,1例位于右侧侧脑室枕角内,1例位于左侧颞部,病变信号混杂,均可见强化。结论当ICA表现不典型时,病变周围低信号环及病变内的极低信号对诊断有提示意义。Objective To analyze the atypical imaging manifestations of intracranial cavernous hemangioma(ICA)and the causes of misdiagnosis,and to improve the understanding of its imaging manifestations.Methods The MRI characteristics of atypical ICA in 17 cases confirmed by surgery and pathology were analyzed retrospectively,including the morphology and MR signals of the lesions.Combined with surgery and pathology,the pathological basis of atypical imaging manifestations and the causes of preoperative misdiagnosis were both analyzed.Results All the 17 cases of ICA were single,15 of which were intracerebral.The average major length of the lesion was about 4.3 cm,the largest was 8.4 cm,and the smallest was 3.2 cm.Among them,2 cases presented as cystic lesions.All lesions were located in the subcortical area of the cerebral hemisphere.One of the cystic lesions presented as large cystic and small nodular,and the nodular showed low signal ring.The other presented as multiple small cysts.13 cases showed mixed signal mass accompanied by hemorrhage at different periods,among them,4 cases showed nodular and peripheral cystic hemorrhage,3 cases showed high and low mixed signal with clear boundary and low signal ring,6 cases showed irregular mixed signal with peripheral low signal ring.Among all the lesions,only 1 case showed significant enhancement after contrast injection.The others showed no significant enhancement.2 cases were extracerebral,1 case was located in the occipital part adjacent with the right lateral ventricle,and 1 case was located in the left temporal region.The signals of these four lesions above were mixed and enhanced.Conclusion The ICA should be considered with the appearance of the low-signal ring around the tumor and low signal in the tumor,especially when the lesion is atypital.

关 键 词：海绵状血管瘤 磁共振成像 误诊分析 

分 类 号：R739.41[医药卫生—肿瘤] R445.2[医药卫生—临床医学]