颅内血管内皮瘤的影像学和病理学特征

The imaging and pathologic characteristics of intracranial hemangioendothelioma

目的探讨颅内血管内皮瘤（HE）的MRI和CT表现与病理学结果的关系。方法回顾性分析2008年1月至2016年6月泰州市人民医院神经外科收治的7例颅内HE患者的影像学和病理学资料。所有病例均行MRI检查，3例行CT检查，1例行磁共振血管成像（MRA）检查。将影像学表现与病理学结果做对照分析。结果7例患者中，病灶位于右侧颅骨2例（额骨、顶骨各1例），小脑幕2例，大脑镰1例，右侧海绵窦1例，右侧颞叶1例。病灶直径为2．1～5．3cm，平均（4．1±1．1）cm。MRI TIWI病灶以等信号或低信号为主，伴多发斑点状或小类圆形高信号；T2WI病灶呈不均匀高信号改变，伴多发扩张迂曲的流空血管影。增强后病灶均有延迟强化趋势，呈蜂窝状明显强化。1例行MRA检查显示肿瘤周围异常增多血管影。CT平扫病灶呈稍高密度，其内多枚点状或小圆形高密度灶。病理学结果显示，7例颅内HE患者中，上皮样HE4例，网状型HE2例，卡波西型HE1例。组织学检查示病灶可见内皮细胞增生，伴显著异常的血管病变，并含有黏液性基质或致密纤维性间质。结论颅内血管内皮瘤的MRI和CT影像学表现具有一定的特征性，其神经影像学表现与病理学基础密切相关。

Objective To investigate the neuroradiological features of MRI and CT of intracranial hemangioendothelioma （HE） and their relationship to histopathological characteristics. Methods We conducted a retrospective analysis of 7 patients with pathologically confirmed intracranial HE who were admitted to Department of Neurosurgery, Taizhou People＇s Hospital from January 2008 to June 2016. Their imaging features and pathological results were studied. All patients were performed MRI examinations. Among them 3 patients underwent CT scan and 1 patient underwent MRA examination. Results Among the 7 patients, 2 had lesions on the right side of the skull （ 1 on the frontal bone and 1 on the parietal bone）, 2 in the tentorium, and 1 in the cerebral falx, 1 in the right cavernous sinus, and 1 in the fight temporal lobe. The diameters of the lesions measured 2. 1 -5.3 cm with an average of （4. 1 ± l. 1 ） era. Most appeared isoor hypointense on T1-weighted MRI, with a multiple fleck pattern or small punctate hyperintensities. Lesions appeared as inhomogeneous hyperintense regions on T2-weighted MRI, with multiple enlarged and tortuous blood flow voids. After contrast-enhanced scanning, lesions in all 7 cases had delayed enhancements, which showed a honeycomb-like marked enhancement. One case underwent MRA examination and the result showed abnormal increase of vascular imaging around the tumor. The CT scans showed a high- density region with many small round higher-density foci. Of the 7 cases, 4 were epithelial HE, 2 were retiform HE, and 1 was Kaposiform HE. Histological examination revealed endothelial cell proliferation, with vascular lesions and mucous matrix or dense fibrous mesenchyme. Conclusion MRI and CT Imaging findings of intracranial HE include certain characteristics, which might be closely related to its pathologic basis.