脑膜瘤影像病例分析

Casediscussion Byheadgroup 2012 12 06 Female 53YHistory chiefcomplaint unconsciousnessforhalfanhour thenheadacheanddizzinessafteraccidentwhentravelbybusnauseaPasthistory dizzinessabilityofmemory reaction understandingandlanguagelowerthanbeforeforhalfayear CT MR Finaldiagnosis transitionalmeningioma Recordofoperation tensionofbraintissuenothighlocation baseofrighttemporalgrayplentybloodsupplyadhesionsbetweentumorwithbraintissueandcerebralduramaterintherighttemporallobe meningioma WHOIlowhyperplasiapotentialityandhealingbysurgicalablationWHOIIlowhyperplasiapotentialitybutinfiltrativegrowth easytorecurWHOIIInuclearatypiaandactivekaryokinesisinpartofareainhistology MeningiomaWHO MeningothelialFibrous fibroblastic Transitional mixed PsammomatousAngiomatousMicrocysticSecretoryIymphoplasmacyte richMetaplastic EhordoidclearcellAtypical PapillaryRhabdoidanaplastie malignantmeningioma Simposonclassification 1肿瘤全切除 包括肿瘤黏着硬脑膜及受侵的静脉窦壁9 2肿瘤全切除 肿瘤黏着硬脑膜电灼未切除16 3肿瘤全切除 肿瘤黏着硬脑膜电灼未切除 肿瘤硬脑膜外侵犯硬脑膜窦 侵犯部分未切除29 4肿瘤部分切除39 5开颅减压肿瘤活检或未活检 DDX typicalmeningiomaatypicalmeningiomaoligodendroglioma anaplasticoligodendroglioma typicalmeningioma CTscanisoorhighdensitynodularormassuniformdensity localcalcificationwidebasementskullchange thickening thinning damage MRIscanisoorslightlylongT1signal isoorslightlylongT2signal highsignalinDWIlowsignalinADCuniformsignalduraltailsignMRSNAAlack Cho Cr Alaappear commonpathologytype transitionalordesmocytemeningiomanoorslightperitumoralbrainedema F 47Y atypicalmeningioma nonuniformdensityorsignalcysticchange nodularatwall calcificationnonuniformenhanced ring shapedenhancedapparentperitumoralbrainedemamultiplecommonpathologytype syncytiumorangioreticulomameningioma oligodendroglioma 脑内肿瘤 发生于皮层或皮层下的胶质母细胞瘤及胶质肉瘤多发生于脑表浅部位 可累及脑膜 但其囊变坏死明显 多呈厚壁环形强化 可见强化不规整瘤结节 钙化与瘤周水肿的发生率均较高 History chiefcomplaint progressiveheadacheanddizzinessfortwoweeksweaknessinlowerlimbsonedayagopregnantwomen 34weeks Pasthistory headacheanddizzinesstwoweeksagowithoutreasons increasegraduallyweaknessinlowerlimbsfortwotimes symptomsdisappearafterrest Recordofoperation hightensionofcerebralduramaterlocation temporallobegray localdarkred brittletextureplentybloodsupply cysticchange liquefaction necrosis Finaldiagnosis anaplasticoligodendrogliomalocalwithtendencyofglioblastomaformation 29 year oldmanwithmixedmalignantoligoastrocytoma A C AxialT2 weighted A contrast enhancedT1 weighted B andrCBV C MRimagesshowalesionintheanteriorleftmesialtemporallobethatishyperintenseontheT2 weightedimageandminimallyenhancingontheT1 weightedimage Thelesiondemonstratesintense