幕上血管母细胞瘤的MRI表现及误诊分析
|
摘要
目的探讨幕上血管母细胞瘤(hemangioblastoma,HB)的MRI特点并分析误诊原因。方法搜集经手术病理证实的11例幕上HB,均行MRI平扫及增强检查,其中3例行CT平扫检查,1例行氢质子磁共振波谱扫描,回顾性分析其MRI表现及误诊原因。结果实质肿块型7例,囊实性4例。MRI平扫,实性部分T1WI呈稍低或低信号,T2WI呈稍高或高信号。MRI增强扫描,瘤体实性部分显著性强化,其中均匀强化7例,不均匀强化伴囊变4例。8例瘤体或瘤周见流空血管影。CT平扫呈等或稍低密度。11例术前均误诊,其中误诊为脑膜瘤4例,胶质瘤2例,嗅神经母细胞瘤1例,血管外皮瘤1例,转移瘤1例,颅咽管瘤1例,海绵状血管瘤1例。误诊主要原因是少见发病部位及其MRI表现不典型。结论幕上HB少见,MRI表现不典型,易误诊,肿块实性部分显著性强化伴有流空血管影有助于诊断。
Objective To evaluate MRI features of supratentorial hemangioblastoma( HBs) and to analyze causes of misdiagnosis. Methods The MRI findings and diagnostic errors of 11 cases of supratentorial hemangioblastoma( HBs)confirmed by surgery and pathology were analyzed retrospectively. Pre-and Post-contrast MR scan were performed in all patients,and pre-contrast CT scan was performed in 3 patients,and proton magnetic resonance spectroscopy(1H-MRS) was performed in 1 patient. Results Seven cases were solid masses. Four cases were predominantly solid mass that showed some cystic changes. The solid lesions showed slightly or hypointense signal relative to gray matter on T1 WI,slightly or hyperintense on T2 WI. After contrast administration,solid components of seven tumors obviously enhanced homogeneously and four cases enhanced heterogeneous1 y. Vascular signal void around or in the mass was seen in eight cases. Three patients accepted unenhancement CT scan showed isodense or slightly-hypodense masses. Eleven cases was misdiagnosised,including Meningiomas( n = 4),high-grade gliomas( n = 2),olfactory neuroblastoma( n = 1),hemangiopericytoma( n =1),metastasis( nn = 1),craniopharyngioma( n = 1),cavernous hemangioma( n = 1). The main causes of misdiagnosis were atypical sites and atypical MRI findings. Conclusion HBs is a rare intracranial tumor shows uncharacteristic MRI findings and easy to be misdiagnosed. It is very helpful to make a definite diagnosis when the solid components of tumors were obviously enhanced with vascular signal void around the mass.
Objective To evaluate MRI features of supratentorial hemangioblastoma( HBs) and to analyze causes of misdiagnosis. Methods The MRI findings and diagnostic errors of 11 cases of supratentorial hemangioblastoma( HBs)confirmed by surgery and pathology were analyzed retrospectively. Pre-and Post-contrast MR scan were performed in all patients,and pre-contrast CT scan was performed in 3 patients,and proton magnetic resonance spectroscopy(1H-MRS) was performed in 1 patient. Results Seven cases were solid masses. Four cases were predominantly solid mass that showed some cystic changes. The solid lesions showed slightly or hypointense signal relative to gray matter on T1 WI,slightly or hyperintense on T2 WI. After contrast administration,solid components of seven tumors obviously enhanced homogeneously and four cases enhanced heterogeneous1 y. Vascular signal void around or in the mass was seen in eight cases. Three patients accepted unenhancement CT scan showed isodense or slightly-hypodense masses. Eleven cases was misdiagnosised,including Meningiomas( n = 4),high-grade gliomas( n = 2),olfactory neuroblastoma( n = 1),hemangiopericytoma( n =1),metastasis( nn = 1),craniopharyngioma( n = 1),cavernous hemangioma( n = 1). The main causes of misdiagnosis were atypical sites and atypical MRI findings. Conclusion HBs is a rare intracranial tumor shows uncharacteristic MRI findings and easy to be misdiagnosed. It is very helpful to make a definite diagnosis when the solid components of tumors were obviously enhanced with vascular signal void around the mass.
引文
1黄文清.神经肿瘤病理学[M].第2版.北京:军事医学科学出版社,2000,572-584.
2 Pandey S,Sharma V,Pandey D,et al.Supratentorial haemangioblastoma without von Hippel-Lindau syndrome in an adult:A rare tumor with review of literature[J].Asian J Neurosurg,2016,11:8-14.
3 Kosty J,Staarman B,Zimmer LA,et al.Infundibular Hemangioblastoma in a Patient with Neurofibromatosis Type 1:Case Report and Review of the Literature[J].World Neurosurg,2016,88:693.e7-12.
4路莉,李晶英,谢丽响,等.幕上血管母细胞瘤二例[J].放射学实践,2014,21:1233-1234.
5陈星荣,沈天真.血管母细胞瘤[J].中国医学计算机成像杂志,2003,9:208.
6 Louis DN,Ohgaki H,Wiestler OD,et al.World Health Organization histological classification of tumours of the central nervous system[J].International Agency for Research on Cancer,France,2016.
7 Ordookhanian C,Kaloostian PE,Ghostine SS,et al.Management Strategies and Outcomes for VHL-related Craniospinal Hemangioblastomas[J].J Kidney Cancer VHL,2017,4:37-44.
8丁兴华,周良辅,杜固宏.中枢神经系统血管母细胞瘤312例临床分析及长期随访[J].中华神经外科杂志,2005,121:83-87.
9于涓瀚,宋敏,邱雪杉,等.中枢神经系统血管母细胞瘤临床病理特征[J].现代肿瘤医学,2016,24:545-548.
10左德献,李正阳,吾太华,等.颅后窝血管母细胞瘤MRI分型与手术疗效的关系[J].临床神经外科杂志,2017,1:1672-1677.
11 Kano H,Shuto T,Iwai Y,et al.Stereotactic radiosurgery for intracranial hemangioblastomas:a retrospective international outcome study[J].J Neurosurg,2015,122:1469-1478.
12梁德壬.幕上血管母细胞瘤的影像诊断[J].临床放射学杂志,2010,29:295-298.
13 Wanebo JE,Lonser RR,Glenn GM,et al.T he natural history of hemangioblastomas of the central nervous system in patients with von Hippel-L indan disease[J].J Neurosurg,2003,98:82-94.
14 Rumboldt Z,Gnjidic Z,Talan-Hranilovic J,et al.Intrasellar hemangioblastoma:characteristic prominent vessels on MR imaging[J].AJR,2003,180:1480.
15王亚蓉,李玮,王玮,等.中枢神经系统血管母细胞瘤的MRI表现及其病理基础[J].第四军医大学学报,2009,30:2431-2434.
16郭丽萍,李文菲,牛晨,等.血管母细胞瘤的MRI及MRS特点分析[J].现代肿瘤医学,2016,24:1125-1129.
2 Pandey S,Sharma V,Pandey D,et al.Supratentorial haemangioblastoma without von Hippel-Lindau syndrome in an adult:A rare tumor with review of literature[J].Asian J Neurosurg,2016,11:8-14.
3 Kosty J,Staarman B,Zimmer LA,et al.Infundibular Hemangioblastoma in a Patient with Neurofibromatosis Type 1:Case Report and Review of the Literature[J].World Neurosurg,2016,88:693.e7-12.
4路莉,李晶英,谢丽响,等.幕上血管母细胞瘤二例[J].放射学实践,2014,21:1233-1234.
5陈星荣,沈天真.血管母细胞瘤[J].中国医学计算机成像杂志,2003,9:208.
6 Louis DN,Ohgaki H,Wiestler OD,et al.World Health Organization histological classification of tumours of the central nervous system[J].International Agency for Research on Cancer,France,2016.
7 Ordookhanian C,Kaloostian PE,Ghostine SS,et al.Management Strategies and Outcomes for VHL-related Craniospinal Hemangioblastomas[J].J Kidney Cancer VHL,2017,4:37-44.
8丁兴华,周良辅,杜固宏.中枢神经系统血管母细胞瘤312例临床分析及长期随访[J].中华神经外科杂志,2005,121:83-87.
9于涓瀚,宋敏,邱雪杉,等.中枢神经系统血管母细胞瘤临床病理特征[J].现代肿瘤医学,2016,24:545-548.
10左德献,李正阳,吾太华,等.颅后窝血管母细胞瘤MRI分型与手术疗效的关系[J].临床神经外科杂志,2017,1:1672-1677.
11 Kano H,Shuto T,Iwai Y,et al.Stereotactic radiosurgery for intracranial hemangioblastomas:a retrospective international outcome study[J].J Neurosurg,2015,122:1469-1478.
12梁德壬.幕上血管母细胞瘤的影像诊断[J].临床放射学杂志,2010,29:295-298.
13 Wanebo JE,Lonser RR,Glenn GM,et al.T he natural history of hemangioblastomas of the central nervous system in patients with von Hippel-L indan disease[J].J Neurosurg,2003,98:82-94.
14 Rumboldt Z,Gnjidic Z,Talan-Hranilovic J,et al.Intrasellar hemangioblastoma:characteristic prominent vessels on MR imaging[J].AJR,2003,180:1480.
15王亚蓉,李玮,王玮,等.中枢神经系统血管母细胞瘤的MRI表现及其病理基础[J].第四军医大学学报,2009,30:2431-2434.
16郭丽萍,李文菲,牛晨,等.血管母细胞瘤的MRI及MRS特点分析[J].现代肿瘤医学,2016,24:1125-1129.