脑膜瘤CT、MR表现与病理-超微结构和免疫组化对照研究

CT、MR Features and Pathology of Meningioma-Contrast Study of Uitrastructure and Immunohistochemistry

目的 提高 CT、MR对脑膜瘤的诊断水平。方法 5 2 9例经 CT检查 5 1 5例 ,MR检查78例 ,均经手术病理证实。按 1 990年 WHO脑膜瘤新分类进行光镜分类 ,配合 JEM- 1 0 0透射电镜观察超微结构 ,作 6种肿瘤的免疫组织化学检测波形蛋白 ( Vimentin) ,胶质纤维酸性蛋白( GFAP) ,角蛋白 ( Keratin) ,S- 1 0 0蛋白 ,上皮膜抗原 ( EMA) ,黑色素瘤抗原 ( HMB45 )。结果 对CT显示混合密度、囊性低密度区 ;MR呈长 T1、长 T2等信号与电镜所见瘤细胞空泡状 ,突起交织形成囊状超微结构的微囊型脑膜瘤为密切关系。其它良、恶性脑膜瘤的 CT、MR表现与电镜显示肿瘤超微结构均为密切关系。对病理分类的 1 2种良、恶性脑膜瘤检测显示 Vimentin和 EMA均为阳性。结论 对 CT、MR可疑脑膜瘤和电镜较难确诊者 。

Objective To improve the diagnostic level of meningioma in CT and MR.Methods CT and MR features were analyzed in 515 and 78 of 529 cases,respectively.All were verified by operative pathology and classified according to WHO new classification of meningioma in 1990.Ultrastructure was observed by JEM 100 transmission electron microscop(TMB).6 kinds of tumous immunohistochemistry such as Vimentin,glial fibrillary acidic protein (GFAP),Keratin,S 100 protein,epithelial membranous antigen (EMA) and melanoma antigen(HMB45) were detemined.Results There was close relation between mixed or cystic low density in CT,isointensive signal of long T1 or T2 in MR and ultrastructure as vacuolar like cell and cystic process of microcyctic meningioma in electron microscope (EM).There was marked significance between CT or MR feature in other benign or malignant meningioma and ultrastructure of the tumor in EM.Vementin and EMA in 12 kinds of meningioma by pathological classification were showed positive.Conclusion Ultrastructure and immunohistochemistry of the tumor should be done when meningioma was doubt by CT or MR and diagnosed diffcultly by EM.