儿童非中线不典型髓母细胞瘤的MRI表现及误诊分析  

MRI findings and misdiagnosis of non-midline atypical medulloblastoma in children

作　　者：马秋红 刘雨晴 易婷 金科 Ma Qiuhong;Liu Yuqing;Yi Ting;Jin Ke(Department of Radiology,The Affiliated Children′s Hospital of Xiangya School of Medicine,Central South University(Hunan Children′s Hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)放射科,长沙410007

出　　处：《中国医师杂志》2025年第2期215-219,共5页Journal of Chinese Physician

基　　金：湖南省卫生健康委科研计划课题(202209012935)。

摘　　要：目的探讨儿童非中线不典型髓母细胞瘤(MB)的MRI影像特征并分析误诊原因,以提高对该病的认识及诊断水平。方法回顾性分析2018年9月-2023年8月经湖南省儿童医院病理证实的12例非中线不典型MB患儿的临床及影像学资料,12例行MRI平扫,11例行增强扫描,10例行扩散加权成像(DWI)及磁敏感加权成像(SWI)。观察肿瘤部位、形态、瘤周水肿、大小、信号特点(有无囊变、出血)、扩散、强化特点及分析误诊原因。结果12例中单发者9例,肿瘤位于小脑半球4例,桥小脑角区(CPA)2例,脑干及CPA 2例,左侧顶叶1例;多发者3例,1例位于右侧桥臂及小脑半球(2个肿块),1例双侧小脑半球多发病灶,1例小脑蚓部团块状及左侧小脑半球多发结节状病灶;6例形态不规则,6例呈类圆形;3例无囊变,9例不同程度囊变(5例大囊变,4例小囊变);3例出血,均无钙化,10例DWI均呈不同程度弥散受限;11例行增强扫描呈轻度至明显强化;2例瘤周无水肿,10例瘤周轻中度水肿;11例合并幕上脑积水及间质性脑水肿,1例无脑积水;5例合并小脑扁桃体下疝;9例术前误诊。其中3例术前误诊为高级别胶质瘤,3例误诊为低级别胶质瘤(其中1例诊断为毛细胞星形细胞瘤),2例误诊为室管膜瘤,1例误诊为非典型畸胎瘤/横纹肌样瘤。结论儿童非中线不典型MB的MRI表现多样,结合发病部位、年龄及病灶信号特征,在排除性诊断后将非中线不典型MB纳入诊断范围,提高该病术前诊断正确率。ObjectiveTo investigate the magnetic resonance imaging(MRI)features of non-midline atypical medulloblastoma(MB)in children and analyze the causes of misdiagnosis,so as to improve the understanding and diagnosis of MB.MethodsThe clinical and imaging data of 12 cases with non-midline atypical MB confirmed by pathology in Hunan Children′s Hospital from September 2018 to August 2023 were retrospectively analyzed.12 cases underwent MRI plain scan,11 cases underwent enhanced scan,and 10 cases underwent diffusion weighted imaging(DWI)and magnetic sensitivity weighted imaging(SWI).The location,morphology,peritumoral edema,size,signal characteristics(cystic lesion or hemorrhage),diffusion and enhancement of the tumor were observed,and the causes of misdiagnosis were analyzed.ResultsAmong the 12 cases,9 cases were single,4 cases were located in the cerebellar hemisphere,2 cases were in the cerebellopontine angle(CPA),2 cases were in the brain stem and CPA,and 1 case was in the left parietal lobe.There were 3 cases of multiple lesions,1 case was located in the right pontine arm and cerebellar hemisphere(2 masses),1 case was multiple lesions in bilateral cerebellar hemisphere,and 1 case was multiple nodular lesions in the cerebellar vermis mass and left cerebellar hemisphere.6 cases were irregular in shape and 6 cases were quasi-circular.There were 3 cases without cystic change and 9 cases with varying degrees of cystic change(5 with large cystic change and 4 with small cystic change).3 cases of hemorrhage,no calcification,10 cases of DWI showed varying degrees of limited diffusion;11 cases of enhanced scanning showed mild to obvious enhancement;There were 2 cases without peritumoral edema and 10 cases with mild to moderate peritumoral edema.There were 11 cases with supratentorial hydrocephalus and interstitial cerebral edema,and 1 case without hydrocephalus.5 cases complicated with subtonsillar hernia;9 cases were misdiagnosed before operation.Among them,3 cases were misdiagnosed as high-grade glioma,3 as low-grade glioma

关 键 词：髓母细胞瘤 磁共振成像 儿童 

分 类 号：R73[医药卫生—肿瘤]