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中枢神经系统原始神经外胚层肿瘤的MRI表现及病理对照

作者:常晓腾1 陈自谦2 张俊祥1 席继辉2 王 蕾2

所属单位:1.蚌埠医学院医学影像学系(安徽 蚌埠 233000) 2.南京军区福州总医院医学影像中心(福建 福州 350025)

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摘要

目的探讨中枢神经系统原始神 经外胚层肿瘤的MRI特点,以此提高CNS PNET的诊断率。方法 回顾性分析12例经 病理证实的CNS PNET的MRI资料。结果 本 组12例患者均行MRI平扫加增强,其中男6 例,女6例,年龄分布为1-48岁。病灶多 位于大脑半球深部,以颞叶多见,1例颅 内播散。实性肿块7例,囊实性5例,肿块 边缘较清楚,瘤周轻微水肿; MRI平扫信 号欠均匀,实质部分T1WI呈低及等低信 号,T2WI呈高及稍高信号,DWI呈高信号, 囊性部分T1WI呈低信号,T2WI呈高信号; 增强扫描5例呈环形强化,7例呈不均匀强 化。结论 原始神经外胚层肿瘤的MRI表 现具有一定特点,但确诊仍需依赖病理诊 断。

Objective To explore the MRI features of primitive neuroectodermal tumors of central nervous system (CNS PNET) in order to improve the diagnosis of MRI in CNS PNET. Methods MRI imaging data of twelve cases with CNSPNET which confirmed by pathology were analyzed retrospectively. Results The 12 cases both underwent MRI plain scan and enhancement, 6 males and 6 females, aged from 1 to 48 years. The lesions were commonly found in the deep cerebral hemisphere, and more commenly in the temporal lobe, and one case spreaded in the cerebral. In the 12cases,7 were solid mass and 5 were cystic and solid mass, all the tumors had clear boundary as well as slight peritumoral edema. MRI images showed the solid part of the tumors to be middle or hypointense on T1 weighted images and hyperintense on T2 weighted images as well as hyperintense on DWI images. The cystic component to be hypointense on T1 weighted images and hyperintense on T2 weighted images. The enhancement images showed that 5 cases had a ring enhancement, and the other 7 cases had a heterogeneous enhancement. Conclusion Certain MRI features may suggest the diagnosis of CNS PENT, but still rely on pathological diagnosis.

【关键词】原始神经外胚层肿瘤;脑肿瘤;磁共振成像;病理

【中图分类号】R739.41;R814.42;R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.10.002

前言

中 枢 神 经 系 统 原 始 神 经 外 胚 层 肿 瘤 ( C N S p r i m i t i v e neuroectodermal tumors,CNS PNET)是一种较少见的高度恶性的肿 瘤。本病多见于儿童青少年,成年人亦有发病,男性多见,男女发病 比例为1.7:1。肿瘤细胞能够表达原始神经外胚层细胞的形态及标记 物,具有分化为神经元、胶质细胞和室管膜细胞的潜能。肿瘤浸润性 生长,容易沿脑脊液进行播散和转移。本病发病率低,预后差,临床 及影像表现多样,容易发生误诊。本研究回顾性分析12例经手术病理 证实的CNS PNET的临床资料及MRI表现,并以病理为对照,旨在进一步 了解本病的影像学特点,提高影像诊断准确率,为临床诊断及治疗提 供依据。