儿童鞍区占位性病变的MRI诊断及鉴别诊断

MRI Diagnosis and Differential Diagnosis of Sellar Region Lesions in Children

目的:分析儿童鞍区占位的MRI表现,探讨不同病理情况的影像特点,以提高定性诊断水平。方法:病理证实的儿童鞍区占位性病变37例纳入研究,男15例,女22例,年龄1～14岁,平均6.4±3.7岁,采用GE1.5T或3.0T超导MR成像仪,完成冠状面T1WI、T2WI和矢状面T1WI平扫,横断面、冠状面和矢状面T1WI增强,2名高级职称医师共同回顾性分析MRI表现。结果:颅咽管瘤l5例(40.5%),10例囊性,5例囊实性;囊性部分呈长T1长T2信号,实性部分呈等T1等T2信号,增强扫描后囊性部分囊壁呈弧形或环行强化,实性部分呈不均匀明显强化。Rathke囊肿10例(27.0%),位于腺垂体与神经垂体之间,6例呈长T1长T2信号,4例呈短T1短T2信号。胶质瘤4例(10.8%),均呈长T1长T2信号,增强后明显强化。结论:儿童鞍区肿瘤种类繁多,但根据病灶所发生的部位和信号特征,并结合临床表现,多数能术前作出明确诊断。

Purpose：To study the MRI features of sellar region lesions in children and discuss the image characteristics of different pathological conditions,to improve the diagnosis level.Methods：Thirty-seven patients with pathological proved sellar lesions were included in the study（15 males and 22 females,aged 1-15 years old,mean 6.4 ± 3.7 years old）.GE 1.5T or 3.0T superconducting MR scanner was used.The sequences included coronal T1WI and T2WI,sagittal T1WI,coronas,axial and sagittal T1WI enhancement.Retrospective analysis of MRI images was done by two senior doctors.Results：Fifteen cases were craniopharyngiomas,account for 40.5%,10 cases of craniopharyngiomas were cystic,5 cases of craniopharyngioma were solid-cystic.The cystic part was often hypointense on T1WI and hyperintense on T2WI and the solid part was isointense on T1WI and T2WI;the wall of the cystic part presented curvilinear or circular enhancement and the solid part presented nonhomogeneous enhancement after contrast administration.Ten cases were Rathke＇s cleft cysts,account for 27.0%,which were located between the pituitary and neurohypophysis.Six cases of Rathke＇s cleft cysts showed hypointense on T1WI and hyperintese on T2WI,4 cases of Rathke＇s cleft cysts showed hyperintense on T1WI and hypointense on T2WI.Four cases were gliomas,account for 10.8%,and the gliomas showed hypointense on T1WI and hyperintese on T2WI and with enhancement.Three cases were arachnoid cysts,account for 8.1%,they showed hypointense on T1WI and hyperintese on T2WI and without enhancement.Conclusion： Children＇s sellar region lesions had a wide ranges,however,according to the site of lesions that occur and their signal characteristics,combined with clinical manifestations,most case can be make a definite diagnosis before surgery.