儿童大脑皮质室管膜瘤的影像学分析

Imaging Analysis of Cerebral Cortical Ependymoma in Children

目的:总结儿童大脑皮质室管膜瘤(CE)的临床及影像学特征。方法:搜集本院经手术及病理证实的5例儿童CE以及发表文献中的17例,共22例,分析及总结其临床及影像学特征。结果:22例患儿中,男、女各11例。发病年龄为9个月~14岁,平均(6.99±4.00)岁。临床症状表现为癫痫者7例(31.8%),头痛、呕吐7例(31.8%),肢体无力4例(18.2%),其余的包括上肢抖动、昏厥、发热、腹泻等。肿瘤位于右侧大脑半球15例(68.2%),位于左侧大脑半球7例(31.8%),其中位于额叶5例(22.7%),额顶叶5例(22.7%),顶叶4例(18.2%),颞叶4例(18.2%),另外额颞叶、颞顶叶、颞枕叶及枕叶各1例。瘤体为实性者10例(45.5%),囊-实性9例(40.9%),囊性伴壁结节3例(13.6%)。10例(45.5%)实性部分伴有不同程度的钙化。9例患儿中,5例(55.6%)瘤周无水肿,4例(44.4%)轻度水肿。所有病例均有不同程度的强化。13例(59.1%)为WHOⅢ级,9例(40.9%)为WHOⅡ级。结论:儿童CE男女性别比例相当,好发于右侧大脑半球,好发于额、顶叶,常见的临床表现为癫痫发作及头痛、呕吐。瘤体可为实性、囊-实性或囊性伴壁结节。影像学特征包括钙化多、囊变多、不均质强化及瘤周水肿轻。CT与MRI相互补充,CT显示钙化优,MRI更有助于显示瘤周水肿、强化程度及鉴别肿瘤的良恶性。

Purpose:To summarize the clinical,CT and MRI findings of cerebral cortical ependymomas in children.Methods:We studied and analyzed the clinical and imaging data of 22 children with cerebral cortical ependymoma retrospectively,of which 5 cases were confirmed by surgical and pathological results in our hospital,and the other 17 cases were from published literature.Results:Of the 22 children,11 were boys and 11 were girls.The age of onset ranged from 9 months to 14 years,with an average age of(6.99±4.00)years.Seven(31.8%)patients presented with epilepsy,7(31.8%)with headache or vomiting,and 4(18.2%)with limb weakness.Fifteen(68.2%)tumors were located in the right hemisphere,and 7(31.8%)in the left hemisphere.Among them,5(22.7%)in the frontal lobe,5(22.7%)in the fronto-parietal lobe,4(18.2%)in the parietal lobe,4(18.2%)in the temporal lobe,1 in the fronto-temporal lobe,1 in the temporo-parietal lobe,1 in the temporo-occipital lobe,and 1 in the occipital lobe.Solid tumors were seen in 10 cases(45.5%),cystic-solid tumors in 9 cases(40.9%),and cystic with wall nodule in 3 cases(13.6%).Ten cases(45.5%)were accompanied with calcification in different degrees.Of the 9 children,5 cases(55.6%)had no edema around the tumor and 4(44.4%)had mild edema.All cases had different degrees of enhancement.Thirteen cases(59.1%)were WHO gradeⅢand 9 cases(40.9%)were WHO gradeⅡ.Conclusion:Cerebral cortical ependymomas in children has the same sex distribution between boys and girls.It is more likely to occur in the right hemisphere.It usually occurs in frontal or parietal lobe.The most common clinical manifestations are epilepsy,headache and vomiting.The tumor body can be solid,cystic-solid or cystic with wall nodules.Imaging features include calcification,cystic change,heterogeneous enhancement and wild peritumoral edema.CT and MRI complement each other.CT shows calcification better,and MRI is more helpful to show peritumoral edema,enhancement degree and differentiate between benign and malignant tumors.