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颅内皮样囊肿破裂 的CT、MRI诊断

作者:荆彦平1 张 俊1 高峥嵘1 骆 宾1 南晓东1 徐新峰1 张 焱2 程敬亮2

所属单位:1.河南科技大学附属黄河三门峡医院MRI科 (河南 三门峡472000) 2.郑州大学第一附属医院MRI科(河南 郑州 450052)

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摘要

目的 探讨颅内皮样囊肿破裂的 CT、MRI表现,以提高对本病的进一步认 识。方法 回顾性分析经手术病理证实的 12例颅内皮样囊肿并破裂病例,均行MRI SE序列T1WI、T2Wl、T2Wl Flair及DWI序 列扫描,其中3例行T1WI压脂增强扫描, 4例行脑CT平扫。结果 12例中,皮样囊肿 位于桥小脑角区5例,桥前池2例,颞极1 例,鞍旁 2例,鞍上2例,病变呈不规则 形或类圆形,CT表现为低密度,T1WI为高 信号或混杂高信号,T2WI为不均匀高信 号,T2Wl Flair为不均匀高信号,DWI扩 散受限,压脂增强扫描不强化。皮样囊肿 破裂CT、MRI表现在脑沟、脑池或脑室内 有低密度脂肪滴影,CT值-70-140HU,或 短T1的脂肪滴影,T2WI信号略有衰减,压 脂T1Wl增强呈极低信号。2例侧脑室内见 脂滴,3例位于大脑纵裂池,3例位于侧裂 池,2例位于侧裂池及大脑纵裂池,2例脂 滴位于环池。结论 颅内皮样囊肿破裂具 有较特征性CT、MRI表现,能较好地显示 病变的生物学特征,有助于鉴别诊断及指 导制定治疗方案。

Objective To study the value of MRI and CT in the diagnosis to rupture of intracranial dermoid cyst, and to improve the understanding of its imaging findings. Methods In the 12 cases of rupture of intracranial dermoid cyst proved by pathology and surgery were retrospectively analyzed, were performed MRI SE T1WI, T2Wl, T2Wl flair and DWI sequence scan, of which three cases T1WI pressure fat enhancement scan, 4 cases brain CT scan. Results Among the 12 cases with intracranial dermoid cyst, located in the CPA 5 cases, 2 cases were identified in the pons before pool, temporal pole is 1 case, beside to the saddle in 2 cases and 2 cases on the saddle, the lesion showed irregular or like-round masses, CT characterized by low density, T1WI for high signal or mixed signal, T2WI for heterogeneous high signal, T2Wl flair for heterogeneous high signal, DWI restricted diffusion, the press fat enhancement scan is not improved. CT and MRI revealed low density fat drop shadow in the sulci, pool or ventricle for rupture of intracranial dermoid cyst, CT value in -70~140HU, or short T1 fat drop shadow, T2WI signal attenuation slightly, the press fat T1Wl enhancement has very low signal, 2 cases lipid droplets in the lateral ventricular, 3 cases located in the longitudinal crack pool, 3 cases located in lateral fissure pools, 2 cases located in lateral fissure pools and longitudinal crack pool, the other 2 cases of lipid droplets in ring pool. Conclusion The rupture of intracranial dermoid cyst show characteristic manifestations on CT and MRI, can show structures and extent of the lesion very well, which is helpful in differential diagnosis and guide treatment plan.

【关键词】皮样囊肿;破裂;磁共振成像

【中图分类号】R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.01.005

前言

 颅内皮样囊肿是一种起源于异位胚胎上皮组织的良性先天性病 变, 临床上不常见,仅占颅内肿瘤的0.04%~0.6%[1]。颅内皮样囊肿 破裂更少见,文献报道不多。 本文收集颅内皮样囊肿破裂病例12例, 总结其影像学表现,以提高对本病的进一步认识。