最新放射诊断科孙柏龄

1、clinical brain tumor of mri 放射診斷科孫柏齡放射診斷科孫柏齡 2007.04.20case 1 l17-year-old female with a clinical suspicion of cerebellar mass.your diagnosis is la t1w image (fig. 1) shows a hypointense, approximately 7cm x 4cm mass in the right cerebellar hemisphere, with a moderate amount of mass effect on the 4t

2、h ventricle and cerebellum. lthe mass is hyperintense on the t2w image (fig. 3). lthe cystic portion of the mass has signal intensity similar to csf on the t1w images and t2w images, but is hyperintense to csf on the proton density weighted image (fig. 2) due to increased protein content. lfollowing

3、 gadolinium administration, t1w images (fig. 4-6) show intense homogeneous enhancement of a mural nodule in the superior aspect of the mass. lalthough septations within the mass show faint enhancement, the cystic portion of the mass does not show enhancement. ljuvenile pilocytic astrocytoma. lcerebe

4、llar juvenile pilocytic astrocytomas are the most common infratentorial neoplasm in the pediatric age group. lalthough they commonly form well-defined lobular masses which contain cysts and a vascular mural nodule, they may occasionally present a solid mass without a cystic component and may simulat

5、e other pediatric posterior fossa masses. lthey have an increased incidence in type i neurofibromatosis. lthey have an excellent prognosis following complete resection. lthe differential diagnosis includes medulloblastoma and ependymoma in a child. case 2l3-year-old presents with headache and ataxia

6、.your diagnosis is? lependymoma. laxial ct image demonstrates a right cerebellar and fourth ventricle mass which is somewhat higher in attenuation than the remaining brain parenchyma. lin addition, there is marked dilatation of the temporal horns indicating hydrocephalus. laxial t1 and t2 weighted i

7、mages as well as a sagittal image following the intravenous administration of contrast demonstrates an approximately 4 cm fourth ventricular mass with probable extension toward the outlets of the fourth ventricle. lthere is very little enhancement following the intravenous administration of contrast

8、. lependymomas are the third most common brain tumor in children and account for approximately 15% of posterior fossa malignancies. lthey classically arise from ependymal cells lining the fourth ventricle. commonly, the tumor expands the fourth ventricle and extends through the foramen of magendie a

9、nd through the foramina of luschka. lthe tumors are often calcified and may demonstrate a large cystic component. linhomogeneous enhancement is usually seen. because of their location, seeding throughout the subarachnoid space can be seen. lsupratentorial ependymomas, however, are usually more aggre

10、ssive and have a poorer prognosis. las stated above, ependyomomas are the third most common posterior fossa tumor in childhood behind juvenile pilocytic astrocytomas and medulloblastomas.case 3l10-year-old presented with 10 days of vomiting, unsteady gait, slurred speech, headache, and diplopia.your

11、 diagnosis isdiagnosis: lmedulloblastoma (pnet).findings: la sagittal noncontrast t1w image (image 1) reveals a mildly hypointense mass arising in the 4th ventricle with expansion posteriorly to displace and distort the vermis. lan axial t1-weighted image after contrast (image 2) demonstrates the lo

12、ss of definition of the peripheral borders of the enhancing 4th ventricular mass. lno additional abnormalities in the periventricular or subarachnoid space are identified. lthe mass is hyperintense to gray and white matter on an axial t2-weighted image (image 3). there is a shunt under the right occ

13、ipitotemporal scalp.discussion: lmedulloblastoma represents about 25% of childhood intracranial tumors, with approximately 50% presenting in the first decade. lmedulloblastoma occurs only in the posterior fossa, although it has been grouped with histologically similar tumors arising elsewhere as a p

14、rimitive neuroectodermal tumor (pnet).lmedulloblastoma generally involves the 4th ventricle and vermis, with a lateral location more common in the desmoplastic variant and in older patients. lon mr, medulloblastoma involves the 4th ventricle and vermis, although eccentric extension to involve the ce

15、rebellar hemispheres is not rare. lit is nonspecifically hypo- to isointense on t1w images and hyperintense on t2w images. hyperisohypomoderatemininalnodule enhance, cyst dose notuncommoncommonuncommonvermis4th ventricle ependyomahemisphericintermediateintermediatebright5-122-1010-2010-20%15%60-80%n

16、oyes(luschka, magendie)notestlwhat is the most common infratentorial neoplasm in the pediatric age group? q&a1.請問medulloblastoma、ependymoma、astrocytoma在 ct上表現特徵差異為何?答: medulloblastoma由於密度比較高，所以ct表象比較亮鯊白螂眑俙媣汪遺渀涬靻轮鵕摲翕迖輷硁鱳賖坔廀戓埡虲量竟餝濆筘鮆戧噰襅鴥鋏继舤攍丑哝筟萸螭葇鵆帀偈帴堷袣诙汒贀祿暛倷嶴次鄃請珍磨胐葥鴛牠輼紆寭晑埒悕肐黧尤饓怴殶譵榦谧舼眆羕茸塽辿艴鳕岮饯袦蚃涗添

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