BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less ...BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.展开更多
目的以断层解剖学为依据,研究正常成人M ecke l腔(M C)硬膜壁及其内部结构的CT和M R I表现。方法40例M C区正常成人,其中20例行横轴位和冠状位SE T1W I、FSE T2W I及SE T1W I-C+;另20例同时行冠状位和横轴位CT和CT-C+。分析M C壁及其内...目的以断层解剖学为依据,研究正常成人M ecke l腔(M C)硬膜壁及其内部结构的CT和M R I表现。方法40例M C区正常成人,其中20例行横轴位和冠状位SE T1W I、FSE T2W I及SE T1W I-C+;另20例同时行冠状位和横轴位CT和CT-C+。分析M C壁及其内部结构的CT和M R I表现、显示率。结果①外侧壁CT和M R I显示率高,前壁、内侧壁、上壁和后壁M R I较CT显示率高,CT和M R I平扫呈等密度/信号,增强扫描明显强化,下壁CT和M R I均不能显示;②三叉神经节位于M C前外下部,冠状位较横轴位显示佳,增强扫描可强化;③三叉神经节周围静脉丛CT和M R I平扫不能显示,增强扫描呈高密度/高信号;④三叉神经池在CT上呈低密度,在M R I上呈长T1长T2信号;⑤神经纤维在FSE T2W I上呈点状或短条状等信号。结论本文提供了国内正常成人M C的CT和M R I表现,可为临床相关诊断和治疗提供理论依据;M R I在显示M C结构和形态方面具有优势。展开更多
文摘BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.
文摘目的以断层解剖学为依据,研究正常成人M ecke l腔(M C)硬膜壁及其内部结构的CT和M R I表现。方法40例M C区正常成人,其中20例行横轴位和冠状位SE T1W I、FSE T2W I及SE T1W I-C+;另20例同时行冠状位和横轴位CT和CT-C+。分析M C壁及其内部结构的CT和M R I表现、显示率。结果①外侧壁CT和M R I显示率高,前壁、内侧壁、上壁和后壁M R I较CT显示率高,CT和M R I平扫呈等密度/信号,增强扫描明显强化,下壁CT和M R I均不能显示;②三叉神经节位于M C前外下部,冠状位较横轴位显示佳,增强扫描可强化;③三叉神经节周围静脉丛CT和M R I平扫不能显示,增强扫描呈高密度/高信号;④三叉神经池在CT上呈低密度,在M R I上呈长T1长T2信号;⑤神经纤维在FSE T2W I上呈点状或短条状等信号。结论本文提供了国内正常成人M C的CT和M R I表现,可为临床相关诊断和治疗提供理论依据;M R I在显示M C结构和形态方面具有优势。
