青少年幕上脑实质室管膜瘤CT及MRI影像表现与病理类型的相关性研究

Study of the Relationship Between Juvenile Supratentorial Intraparenchymal Ependymoma CT and MRI Imaging Findings and Pathological Types

目的分析青少年幕上脑实质室管膜瘤的CT及MRI影像表现特点,研究其与病理分级的相关性,以提高CT、MRI在青年室管膜瘤中的应用价值。方法筛选幕上脑实质室管膜瘤患者42例作为研究对象。所有患者均经手术及病理证实为幕上脑实质室管膜瘤,术前行MRI、螺旋CT平扫及增强扫描。结果 42例患者中Ⅱ级者10例,Ⅲ级者32例,CT及MRI影像学检查明确Ⅱ级者8例,Ⅲ级者28例,另有4例无法确定,影像学检查分级评价结果与病理检查结果比较无显著差异,不具有统计学意义(P>0.05);CT及MRI影像中,42例均为颅内囊实性占位病变,其中25例囊变位于病灶周边。MRI示42例病灶囊性部分呈长T1与长T2表现,实性为不均匀等T1、等T2信号,DWI表现为中高信号;CT检查实性病变为稍高密度,增强扫描33例呈不均匀及分房分隔样强化,9例实性部分强化较均匀,囊壁均可见环形强化;脑水肿影像评估无明显水肿及轻度16例,中度10例,重度15例,表示脑水肿及水肿程度与病理分级并无相关性,不对病理分级产生影响。结论幕上脑实质室管膜瘤患者术前行CT及MRI检查对评估其病理分级及具体病情具有一定意义,对临床手术治疗具有指导价值。

Objective To analyze CT and MRI imaging features of juvenile supratentorial intraparenchymal ependymoma,and study its correlation with the pathological grade,in order to improve the CT value and the value of MRI in evaluating Ependymoma.Methods forty-two（42） cases of patients with supratentorial intraparenchymal ependymoma were selected from January 2008 to June 2015 in our hospital.All patients were confirmed by surgery and pathology of supratentorial intraparenchymal ependymoma,preoperative MRI,spiral CT scan and enhanced scans.Results In the 42 cases of patients,10 cases had grade Ⅱ and 32 cases had grade Ⅲ tumor.CT and MRI Imaging examinations were used to determine grade Ⅱ tumors in 8 cases and grade Ⅲ tumors in 28 cases.Another 4 patients were unable to be determined by imaging examination grading evaluation results and pathological examination results which had significant difference,P〈0.05,with statistical significance.CT and MRI imaging findings in 42 patients were saccular solid space occupying lesions,in which 25 cases had cystic lesions in the periphery of the lesion.MRI showed 42 cases of patients with cystic parts of the lesion which showed long T1 and long T2 manifestations.Solid parts were uneven in T1 and T2signal and DWI showed a high signal.Solid lesions in CT examination had slightly high density;enhancement in 33 patients was uneven.9 cases had solid parts showing homogenously strong enhancement.Cyst walls showed ring enhancement.The evaluation of brain edema imaging showed a mild pattern in 17 cases,moderate in 10 cases and severe in 15 cases.Cerebral edema and the pathological grade had no correlation,no pathological grading.Conclusion CT and MRI examination have significance in evaluating the pathological grading and the specific condition of supratentorial intraparenchymal ependymoma patients and this has a guiding value in clinical treatment.