脑实质室管膜瘤MRI表现与病理对照分析

MRI Imaging Features and Pathological Analysis of Intraparenchymal Ependymoma

目的分析脑实质室管膜瘤(intraparenchymal ependymoma,IE)MRI表现特点,提高对其认识。方法回顾性分析我院2012年-2021年16例经手术病理证实的脑实质室管膜瘤的临床资料、MRI表现及病理结果。结果16例中,WHO 2级4例,WHO 3级12例。WHO 2级脑实质室管膜位于脑实质表浅部位,MRI表现均呈囊实性,2例呈单囊囊实性,2例呈多囊囊实性,囊腔位于肿块周边或偏于一侧,平扫实性成分呈T1WI等低信号,T_(2)WI呈等高信号,增强扫描囊壁及实性成分明显强化,边缘清晰。WHO 3级脑实质室管膜位于脑实质深部,与脑室紧密相连,分界不清,MRI表现以多囊囊实性或实性为主,多囊囊腔多位于周边或偏于一侧,囊腔呈TiWI呈低信号,T_(2)WI呈高信号,实性部分T1WI呈等低信号,T_(2)WI呈等高信号,内有斑片状T1WI稍高信号,T_(2)WI稍低信号,增强扫描多囊囊实型囊壁、实性成分明显强化,实性为主型呈花环状强化。结论脑实质室管膜瘤MRI表现与病理组织学分级相关,病理分级与病灶位置、信号、强化特点及与脑室关系有关。

Objective To explore the relationship between MRI features and pathologic grade of Intraparenchymal Ependymoma.Methods MRI data of 16 patients of intraparenchymal ependymoma confirmed by postoperative pathology in our hospital from 2012 to 2021 were analyzed retrospectively and compared with the pathological grade.Results Among the 16 patients,4 cases were confirmed as grade 2 pathologically.These lesions were located in the cerebral parenchymal cortex with clear boundaries.They showed mixed solid and cystic lesions on MRI.The solid components presented as iso-intense or hypo-intense on T1WI and presented as iso-intense or hyper-intense on T_(2)WI.There was remarkable enhancement in the solid part and the peripheral cystic wall.12 cases were confirmed as grade 3 pathologically.These lesions was located in the deep part of the brain parenchyma close to the ventricular,and the boundary of lesion is unclear.They showed polycystic or solid on MRI.The polycystic degeneration was in periphery or one side of the lesions,showing hypo-intense signals on T1WI and hyper-intense signals on T_(2)WI in cystic areas.Solid part of the tumor showed iso-intense or hypo-intense signals on T1WI and showed iso-intense or hyper-intense signals on T_(2)WI,with patchy slightly hyperintensity on T1WI and slightly hypointensity on T_(2)WI.On contrast-enhanced MR scan,the cystic wall and solid part was distinctly enhanced.Garland-like enhancement can be seen in solid mainly lesions.Conclusion For brain parenchymal ependymoma,there was a certain correlation beteween the MRI features and the pathological grade.The pathological grade is related to the location,signal,enhanced features of the lesions and also related to the positional relationship between the lesions and the ventricle.