退行性毛细胞型星形细胞瘤的MRI表现及误诊分析  

MRI Findings and Misdiagnosis of Degenerative Pilocytic Astrocytoma

作　　者：宋奎龙 黄聪 李建业 王宇军 SONG Kui-long;HUANG Cong;LI Jian-ye;WANG Yu-jun(Department of Radiology,Hangzhou Wenzhong Hospital of Traditional Chinese Medicine,Hangzhou 310011,China;Department of Radiology,the 926th Hospital of PLA Joint Support Force,Kaiyuan,Yunnan 661699,China;Department of Radiology,Gutian County Hospital,Gutian,Fujian 352200,China;Department of Radiology,the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310006,China)

机构地区：[1]杭州文仲中医院医学影像科,杭州310011 [2]解放军联勤保障部队第九二六医院放射科,云南开远661699 [3]福建省古田县医院放射科,福建古田352200 [4]浙江中医药大学附属第一医院放射科,杭州310006

出　　处：《临床误诊误治》2022年第10期18-21,25,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的总结退行性毛细胞型星形细胞瘤(PA)的MRI表现并分析其误诊原因。方法对2016年1月-2022年7月收治的经术后病理检查确诊11例退行性PA的临床、MRI及病理资料进性回顾性分析。结果本组11例均为颅内单发病灶,4例(36.4%)位于幕下,7例(63.6%)位于幕上。9例主要临床表现为头晕、头痛,1例反复发呆,1例体检发现颅内肿块。MRI主要表现为囊实性、实性或囊性肿块,T2WI及液体衰减反转恢复序列检查肿块周围或内部可见条状或环状低信号影,增强扫描强化方式多样。11例术前均误诊,6例误诊为室管膜瘤,2例误诊为海绵状血管瘤,2例误诊为节细胞胶质瘤,1例误诊为间变型星形细胞瘤。11例均行手术治疗,术后病理检查均证实为PA,肿瘤组织中可见明显退行性变,表现为明显血管透明变性、扩张、血管瘤样变,出现陈旧性出血及含铁血黄素沉积,其中3例伴有钙化。11例术后无特殊情况后出院,9例随访9~17个月未见复发,2例失访。结论退行性PA多发生于中青年患者,MRI表现与典型PA不同,认识其发病年龄、发病位置和MRI特点,有助于鉴别诊断。Objective To summarize the MRI findings of degenerative pilocytic astrocytoma(PA)and to analyze the cause of misdiagnosis.Methods The clinical,MRI and pathological data of 11 patients with degenerative PA diagnosed by postoperative pathology from January 2016 to July 2022 were retrospectively analyzed.Results All the 11 cases were single intracranial lesions,4 cases(36.4%)were located in the infratentorial area,and 7 cases(63.6%)were located in the supratentorial area.The main clinical manifestations were dizziness and headache in 9 cases,repeated daze in 1 case,and intracranial mass in 1 case.MRI mainly showed cystic solid mass,solid or cystic mass.T2WI and fluid-attenuated inversion recovery sequence examination showed strip or ring hypointense shadow around or inside the mass.All the 11 cases were misdiagnosed before operation,including 6 cases of ependymoma,2 cases of cavernous hemangioma,2 cases of ganglioglioma and 1 case of anaplastic astrocytoma.All 11 cases underwent surgery,and PA was confirmed by postoperative pathological examination.There were obvious degenerative changes in tumor tissue,which were manifested as obvious vascular hyaline degeneration,dilatation,hemangiomatosis,old bleeding and hemosiderin deposition,and calcification in 3 cases.Eleven cases were discharged without special conditions after operation,9 cases were followed up for 9-17 months without recurrence,and 2 cases were lost to follow-up.Conclusion Degenerative PA mostly occurs in young and middle-aged patients.MRI findings are different from typical PA.Understanding the age of onset,location of onset and MRI characteristics of degenerative PA is helpful for differential diagnosis.

关 键 词：毛细胞型星形细胞瘤 磁共振成像 误诊 室管膜瘤 海绵状血管瘤 节细胞胶质瘤 间变型星形细胞瘤 

分 类 号：R730.264[医药卫生—肿瘤]