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8例脊索样脑膜瘤的影像学诊断分析*

作者:王雪松 吴建刚 周 扬 扬小君

所属单位:四川省攀枝花市第二人民医院影像中心(四川 攀枝花 617068)

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摘要

目的 总结8例脊索样脑膜瘤的影 像学特点。方法 收集我院神经外科2013 年1月至2016年3月期间收治的脊索样型脑 膜瘤患者8例作为研究对象进行回顾性分 析,均经病理证实。其中6例行CT平扫,8 例行MRI平扫及增强扫描。分析患者CT表 现及MRI平扫及增强扫描的影像学特点, 以期为脊索样脑膜瘤的临床诊断提供参 考。结果 6例行CT扫描患者的CT表现为等 密度4例、稍低密度1例、等低混杂密度1 例。MRI主要表现为平扫T1WI上稍低信号 6例、等信号2例;T2WI上稍高信号5例、 等信号2例、明显高信号1例。增强扫描后 不均匀强化7例、均匀强化1例。3例出现 瘤周不同程度水肿,4例增强扫描见“脑 膜尾征”,1例强化周边呈“蜂窝”状, 周边脑组织受到侵犯。结论 脊索样脑膜 瘤为罕见类型的脑膜瘤,肿瘤影像强化形 式具有一定特征性,具有一定恶性肿瘤特 点,可侵及脑实质,一般无骨质破坏,利 于相关影像学检查的确诊。

Objective To summarize the imaging characteristics of 8 cases with chordoid meningioma. Methods Eight patients with chordoid meningioma who were treated in the department of neurosurgery in our hospital between January 2013 and March 2016 were selected as subjects and were retrospectively analyzed. All were confirmed by pathology. Among them, 6 cases underwent CT plain scan, and 8 cases underwent MRI plain scan and enhanced scan. The imaging features of CT, MRI plain scan and enhanced scan were analyzed to provide reference for the clinical diagnosis of chordoid meningioma. Results The findings of 6 patients undergoing CT showed equal density in 4 cases, slightly lower density in 1 case and equal-low mixed density in 1 case. The main manifestations of MRI were slightly low signal in 6 cases and equal signal in 2 cases on T1WI, slightly high signal in 5 cases, equal signal in 2 cases, obvious high signal in 1 case on T2WI. After enhanced scan, there were 7 cases with inhomogeneous enhancement and 1 case with homogeneous enhancement. 3 cases gad varying degrees of edema around the tumor. Enhanced scan showed 4 cases with dural tail sign, 1 case with honeycomb-like peripheral enhancement and involved surrounding brain tissues. Conclusion Chordoid meningioma is a rare type of meningioma. Its image enhancement pattern has certain characteristics, with certain characteristics of malignant tumor. It can invade brain parenchyma, usually without bone destruction, which is good for imaging diagnosis.

【关键词】脊索样脑膜瘤;CT;MRI;影 像特点

【中图分类号】R739.45;R445.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.04.010

前言

脑膜瘤为起源于脑膜上皮的颅内肿瘤之一,在颅内原发性肿瘤 中所占比例约为13%~20%。脑膜瘤组织亚型较多,约为15种[1],其 中9种属于WHO分类Ⅰ级肿瘤、3种属Ⅱ级、3种属Ⅲ级。WHOⅠ级脑膜 瘤生长缓慢;Ⅱ级具有侵袭性,归入低度恶性;Ⅲ级则恶性程度较 高。脊索样脑膜瘤属Ⅱ级脑膜瘤亚型,在脑膜瘤中较为少见,仅占 0.5%~1.0%[2],但若手术无法完全切除,则具有高复发和高进展危险 性[3]。术前通过有效检查手段明确诊断及肿瘤相关信息为完全切除基 础,也是改善患者预后、降低术后复发率的关键。本研究以我院神经 外科2013年1月至2016年3月期间收治的8例脊索样型脑膜瘤患者为例, 对脊索样脑膜瘤的影像学特点进行总结,现报道如下。