脑和脊髓血管母细胞瘤CT和MRI诊断

CT and MRI diagnosis of cerebral and spinal hemangioblastomas

目的 :分析脑和脊髓血管母细胞瘤的CT、MRI及MR灌注成像 (PWI)表现 ,着重讨论血管母细胞瘤的PWI特点。方法 :对 44例经手术后病理证实的血管母细胞瘤患者的影像资料进行回顾性分析。其中 3 1例行CT平扫和增强扫描 ,16例行MRI平扫和增强 (其中 5例同时行PWI ,3例曾行CT检查 )。结果 :44例患者中囊腔结节型 3 3例 (其中大囊小结节 2 7例 ,单纯囊性 6例 ) ,实质型 10例 ,43例均为单发 ,1例多发 (小脑半球病灶为大囊小结节 ,颈髓为单纯囊性 )。血管母细胞瘤位于小脑半球 3 3例 ,小脑蚓部 8例 ,脑干 1例 ,胸髓 1例 ,1例多发 (病灶分别位于小脑半球和颈髓 )。所有壁结节及实质型肿瘤均显示明显强化 ;5例血管母细胞瘤实质部分PWI均呈明显高灌注表现 ,血管母细胞瘤的SRRmax和rCBV分别为 ( 87.3 2± 3 .18) %和 70 4.68± 46.74,肿瘤与脑白质的rCBV之比为 13 .79± 0 .99,两者的MTT之差为 ( 0 .99± 0 .3 9)s。结论 :CT、MRI均可用于血管母细胞瘤的诊断 ,MRI因在显示肿瘤壁结节和流空血管方面优势明显 ,价值高于CT。

Objective:To study the imaging features of cerebral and spinal hemangioblastomas with CT,MR scanning and MR perfusion weighted imaging (PWI).Methods:All 44 patients were pathologically proved cerebellar or spinal hemangioblastomas.Plain and contrast enhanced CT were performed in 31 patients, and plain and contrast enhanced MRI were performed in 16 patients. Additional PWI was performed in 5 patients, and both CT and MRI were performed in 3 patients.Results:Among the 44 cases,27 appeared as large cyst with mural nodule,6 as simple cyst,10 as solid mass. 43 showed single lesion and 1 multiple lesions. 44 hemangioblastomas were displayed on CT and MRI.The lesions located in cerebellar hemisphere (n=33), cerebellar vermis(n=8), brain stem(n=1),thoracic spinal cord (n=1),and both cerebellar hemisphere and cervical spinal cord (n=1).On contrast enhanced scans, all mural nodules and solid tumors showed marked homogeneous enhancement with a clear border. On PWI in 5 patients, the mural nodules (n=3) and solid tumors (n=2) demonstrated marked hyperperfusion. SRR ax and rCBV were (87.32±3.18)% and 704.68±46.74,respectively.The ratio of rCBV between hemangioblastoma and white matter was 13.79±0.99,and the difference of MTT between them was (0.99±0.39)s.Conclusion:Both CT and MRI can be used in the diagnosis of hemangioblastoma. MRI appeares more valuable than CT due to its ability in the demonstration of the mural nodule and flow void of the vessels. PWI may be of some value in differential diagnosis of hemangioblastoma.