实性中枢神经细胞瘤MRI表现及误诊分析

MRI Manifestations and Misdiagnosed Analysis of Solid Central Neurocytoma

目的探讨实性中枢神经细胞瘤(CNC)MRI表现及误诊原因、防范措施。方法对2012年1月—2019年8月收治的经术后病理检查证实的实性CNC 9例的临床资料进行回顾性分析。结果9例中7例临床主要表现为头晕、头痛,2例无明显临床表现经体检发现。MRI检查显示9例均为侧脑室内单发肿块,位于右侧脑室3例,左侧脑室6例;瘤体大小不一、形态多样,可呈圆形、椭圆形或不规则形,部分病灶可见分叶;病灶边界均较清晰;肿瘤T1WI以低和等低信号为主;T2WI以稍高信号为主,部分内见条状、条片状低信号;T2 FLAIR呈高信号;增强扫描6例明显不均匀强化,1例不强化,1例不均匀轻度强化,1例明显均匀强化。7例(77.8%)术前误诊,误诊为脑室内星形细胞瘤3例,室管膜瘤2例,室管膜下瘤和脉络膜丛乳头状瘤各1例。误诊时间3~10(5.7±2.6)d。9例均行手术治疗,术后病理检查皆证实为CNC,5例合并钙化,2例合并出血;均术后恢复良好后出院。结论实性CNC MRI表现与脑室内星形细胞瘤、室管膜瘤、室管膜下瘤和脉络膜丛乳头状瘤等相似,术前易误诊。接诊医师要提高对CNC的认识,当临床遇及脑室内肿瘤患者时,应结合CT和MRI等检查详细对病情进行分析,并认真鉴别诊断,以减少或避免CNC误诊误治。

Objective To investigate magnetic resonance imaging(MRI)manifestations,misdiagnosed causes and preventive measures of solid central neurocytoma(CNC).Methods Clinical data of 9 patients with solid CNC confirmed by postoperative results of pathological examination was retrospectively analyzed.Results Among the 9 patients,main clinical manifestations were dizziness and headache in 7 patients,and 2 patients had no obvious clinical manifestations.MRI examination showed that all the 9 patients had solitary mass in the lateral ventricle,among whom there were 3 patients located in the right ventricle and 6 patients in the left ventricle.Tumors were varied in size and shape,and the tumors might be round,oval or irregular,and some of the lesions were lobulated.The boundary of focus was clear.The tumors were mainly low and iso-low signal intensity on T1W1 and mainly slightly high signal intensity on T2W1,and some of them showed strip and patchy low signal intensity.T2 FLAIR showed high signal intensity.There were 6 patients with obvious inhomogeneous enhancement,1 patient with no enhancement,1 patient with inhomogeneous mild enhancement and 1 patient with obvious uniform enhancement by contrast-enhanced scan.A total of 7 patients(77.8%)were misdiagnosed before operation among whom 3 patients misdiagnosed as having astrocytoma in cerebral ventricles,2 as having ependymoma,1 as having subependymoma and 1 as having choroid plexus papilloma.Misdiagnosed duration was 3-10 d(5.7±2.6)d.All the 9 patients underwent surgeries,and CNC was confirmed by postoperative pathological examinations,among whom there were 5 patients combined with calcification and 2 patients with hemorrhage.They were discharged after recovery well.Conclusion MRI manifestations of solid CNC is similar to those of astrocytoma in cerebral ventricles,ependymoma and choroid plexus papilloma,and therefore is more likely to be misdiagnosed before operation.CNC understanding should be improved for surgeons.For patients with tumors in cerebral ventricles,surgeons should analyze the conditions in detail combined with examinations such as CT and MRI,and make careful differential diagnosis so as to reduce or avoid misdiagnosis and mistreatment of CNC.