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MRI在鞍旁海绵状血 管瘤与脑膜瘤诊断 价值分析*

作者:孔令常1 张龙洲2 甄英伟2 周国胜2

所属单位:1.河南省郑州市中医院神经外科 (河南 郑州 450000) 2.郑州大学第一附属医院 (河南 郑州 450000)

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摘要

目的 分析MRI在鞍旁海绵状血管 瘤与脑膜瘤诊断价值。方法 回顾性分析 我院自2014年4月-2018年4月收治的鞍旁 海绵状血管瘤及脑膜瘤患者的临床资料及 MRI影像,分析不同性质鞍旁肿瘤的MRI 征像差异。结果 20例患者经手术病理明 确7例鞍旁海绵状血管瘤,13例鞍旁脑膜 瘤。MRI扫描均可明确病灶位置、大小、 形态、受累毗邻组织及其与周围毗邻组 织的结构关系。鞍旁海绵状血管瘤MRI扫 描,与脑白质比较T1WI等信号或稍低信号 表达,信号均匀,DWI等信号,MRI增强扫 描均可见明显强化,以稍低信号表达为 主。鞍旁脑膜T1WI病灶接近脑灰质信号, 为等信号或高信号;T2WI均提示等信号; DWI显示等信号或稍高信号;行MRI增强扫 均可见明显强化表达,可伴典型“脑膜尾 征”。结论 鞍旁海绵状血管瘤与脑膜瘤 MRI及DWI扫描信号表达差异明显,且鞍旁 脑膜瘤可见“脑膜尾征”,或可成为术前 鉴别鞍旁海绵状血管瘤与鞍旁脑膜

Objective To analyze the diagnostic value of MRI in parasellar cavernous hemangioma and meningioma. Methods The clinical data and MRI images of patients with parasellar cavernous hemangioma and meningioma treated in our hospital from April 2014 to December 2018 were retrospectively analyzed, and the MRI features of parasellar tumors of different natures were analyzed. Results In 20 cases of patients, 7 cases of parasellar cavernous hemangioma and 13 cases of parasellar meningioma were confirmed by surgical pathology. MRI scan could identify lesion location, size, shape and involved adjacent tissues and its structural relationship with the surrounding adjacent tissues. Compared with the white matter of the brain, MRI scan of the parasellar cavernous hemangioma showed equal signal or slightly low signal expression in T1WI with signal uniformity, and equal signal in DWI, and MRI enhanced scans showed significant enhancement mainly with slightly low signal expression. Parasellar meningioma lesions are close to the gray matter signal inT1WI (equal signal or high signal), and there was equal signal in T2WI and equal signal or slightly high signal in DWI, and MRI enhanced scan showed obvious enhanced expression, with typical "dural tail sign". Conclusion The signals expression of MRI and DWI scansare significantly different in the parasellar cavernous hemangioma and meningioma, and the "dural tail sign" can be seen in the parasellar meningioma, or it can be used as high-value basis to identify parasellar cavernous hemangioma and parasellar meningioma before operation, therefore it is worthy of further exploration.

【关键词】MRI;鞍旁海绵状血管瘤; 脑膜瘤;诊断价值

【中图分类号】R739.45;R732.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.06.008

前言

海绵状血管瘤、脑膜瘤均是常见的鞍旁肿瘤性病变,两者起病均 较为隐匿,早期无明显症状,随瘤体生长最终压迫毗邻结构组织并出 现头痛、视力减退、面部感觉缺失、内分泌失调等症状,两者临床症 状不具典型差异,加之两者均具丰富血供,极易发生误诊[1]。同时, 海绵状血管瘤与硬脑膜、海绵窦粘连十分紧密,而海绵窦周围组织结 构极为复杂,术中大出血风险高;后者肿瘤仅附着于硬脑膜,因这一 病理学差异,其手术方式也不一致,一旦误诊则可导致不良后果[2-3]。 鉴于此,为进一步补充及完善鞍旁海绵状血管瘤与脑膜瘤的诊断鉴 别,本研究回顾性分析我院近年来收治的20例海绵状血管瘤及脑膜瘤 患者的MRI影像资料,具体报道如下。