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中枢神经细胞瘤的影像学表现及病理分析

作者:郑红伟1 祁佩红1 薛 鹏1 陈 勇1 漆剑频2 胡道予2 关 键3

所属单位:1.河南省郑州人民医院放射科 (河南 郑州 450053) 2.华中科技大学同济医学院附属同 济医院放射科(湖北 武汉 430030) 3.中山大学附属第一医院放射科 (广东 广州 510080)

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摘要

目的探讨中枢神经细胞瘤的影 像学表现。方法 回顾性分析17例中枢神 经细胞瘤患者的影像学资料。结果 侧脑 室内12例,中脑2例,额叶1例,顶叶1 例,松果体1例。侧脑室内12例病灶均邻 近透明隔或Monro孔处,与透明隔或侧脑室 壁相连;CT上呈等、稍高密度,均伴囊变 坏死,3例伴钙化灶;MRI上实质呈等或稍 长T1稍长T2信号,均伴坏死囊变,且多位 于病灶周缘,8例边缘伴条索样结构与脑 室壁、透明隔粘连;增强后病灶实质多呈 轻度至中度强化,其中8例见坏死区明显 环状强化或T1WI略低信号区斑片状明显强 化,7例病灶内及边缘见流空或强化血管 影;12例均伴患侧脑室积水扩大,仅3例 伴间质水肿。5例脑室外病灶中,3例为实 性或偏实性肿瘤,实质呈等及稍长T1、T2 混杂信号,2例伴囊变坏死、出血及周围 水肿,不均匀明显强化,1例呈轻度均匀 强化;另2例偏囊性,呈长T1长T2信号, 周伴等信号环壁,其中1例伴等信号分隔 及周围水肿,增强后均明显环形强化。结 论 侧脑室内CNC影像学表现有一定的特征 性,综合分析CT及MRI表现并结合临床, 应首先考虑CNC,而侧脑室外CNC缺乏特征 性,最后确诊依赖病理。

Objective To investigate the imaging appearances of the central neurocytoma. Methods 17 cases which proved by pathology were retrospectively analyzed with imaging appearance. Results 12 lesions located in the lateral ventricle, 2 in midbrain,1 in frontal lobe, 1 in parietal lobe and 1 in pineal body.12 lesions located in the lateral ventricle all adjacent to Monro hole and septum pellucidum,The lesions presented as iso-density or slightly high density on CT with necrotic area and calcifications;with irrugular shape, present as hypo-intense and equal signal intensity on T1WI and inhomoge-neous hyperintense signal on T2WI,all lesions were associated with multiple cystic degen-eration in tumors, as well as there were multiple strip-like structures in the periphery, which adhered to the ventricle walls and callus in 8 patients.On post-contrast MR scan, the solid part of 8 lesions demonstrated moderate or obvious enhancement, the thick enhanced vessels were found in 7 patients;lateral ventricle widened in 12 cases, only 3 cases with interstitial edema. 5 cases out of lateral ventricle in MRI scans showed mix signal,without above characteristic appearances. Conclusion The imaging of CNC in the lateral ventricle has some characteristics, aggregate analysis CT,MRI and associated with patients history should be first considered CNC, CNC outside the lateral ventricle lack of specificity, and the final diagnosis still depends on pathology.

【关键词】中枢神经细胞瘤;磁共振成像; 计算机体层摄影术

【中图分类号】R739.41;R445.2;R814.42

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2015.08.004

前言

中枢神经细胞瘤(central neurocytoma,CNC)是一种比较少见的中 枢神经系统肿瘤,2007年WHO神经系统肿瘤分类将其归属于神经元和混 合性神经瘤(WHOⅡ级),占全部原发脑肿瘤的0.25%~0.5%[1,2]。现回顾 性分析17例CNC患者的临床影像资料,并结合文献及病理分析,探讨其 影像学表现。