血管瘤型脑膜瘤的磁共振成像表现及病理特征分析

Analysis of MRI Findings and Pathological Features of Angiomatous Meningioma

目的探讨血管瘤型脑膜瘤的磁共振成像(MRI)表现及病理特征。方法选择于2018年7月-2019年6月间天津医科大学总医院滨海医院收治的经手术病理证实为血管瘤型脑膜瘤患者8例,对其行MRI及MRI增强扫描,分析其MRI表现和病理特征。结果 8例患者肿瘤均为单发,其中3例位于大脑镰旁,4例位于大脑凸面,1例位于蝶骨嵴。6例患者的脑膜瘤呈椭圆或圆形,2例呈分叶状,边界清楚,有软组织肿块;MRI平扫显示8例患者T1WI均呈稍低信号,T2WI均呈高信号,有7例瘤内见血管流空影,6例能见脑膜尾征,仅有1例可见囊变、坏死。增强扫描后,瘤组织显著强化,有7例可见脑膜瘤周水肿;病例结果显示,8例患者脑膜瘤组织由管径粗细不一,管壁厚薄不均的丰富血管组成,波形蛋白染色和上皮膜抗原阳性。结论血管瘤型脑膜瘤的MRI表现具有特征性,脑膜瘤形状呈圆形或椭圆形,边界清晰,其MRI信号分布均匀,以T2WI高信号为主,可见血管流空影,多具有脑膜尾征和瘤周水肿,临床可通过MRI提高术前诊断的准确率,有助于制定手术方案,降低手术风险。

Objective To investigate the MRI findings and pathological features of angiomatous meningioma. Methods 8 patients with angiomatous meningioma confirmed by operation and pathology from July,2018 to June,2019,were selected. MRI and MRI enhanced scanning were performed, and their MRI findings and pathological features were analyzed. Results All the tumors in 8 patients were single, including 3 cases near the cerebral falx, 4 cases in the convex surface of the brain and 1 case in the sphenoid crest. The meningiomas in 6 cases were oval or round, 2 cases were lobulated, the boundary was clear, and the soft tissue masses were found in 8 cases. MRI plain scan showed that T1 WI was slightly lower in all 8 cases. All of them showed high signal intensity on T2 WI. 7 cases had empty images of vascular flow, 6 cases had meningeal tail sign, and only 1 case had cyst degeneration and necrosis. After enhanced scan, the tumor tissue was significantly enhanced, and peri-meningioma edema was found in 7 cases. The results showed that the meningioma tissue was composed of abundant blood vessels with different diameter and thickness, vimentin staining and positive epithelial membrane antigen. Conclusion The MRI findings of angiomatous meningioma are characteristic. The shape of meningioma is round or oval, the boundary is clear, the MRI signal distribution is uniform, mainly T2 WI high signal intensity, and most of them have meningeal tail. Sign and peri-tumor edema can improve the accuracy of preoperative diagnosis by MRI, which is helpful to make surgical plan and reduce the risk of operation.