鞍旁肿瘤的MR诊断及鉴别诊断

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1、万方数据一302一神经影像学鞍旁肿瘤的MR诊断及鉴别诊断李坚1姚振威2曹代荣1【摘要】目的：探讨鞍旁肿瘤的MR影像学表现，提高诊断准确率。方法：回顾性分析64例经手术病理证实的鞍旁肿瘤MR影像学表现，所有病例均行MR平扫及增强扫描。结果：64例中脑膜瘤17例，侵袭性垂体瘤14例，神经鞘瘤9例，海绵状血管瘤6例，转移瘤6例，表皮样囊肿6例，脊索瘤4例，淋巴瘤2例。鞍旁脑膜瘤信号和强化表现与颅内其他部位脑膜瘤类似；侵袭性垂体瘤累及鞍旁，颈内动脉海绵窦段被包绕；神经鞘瘤以三叉神经鞘瘤多见，旱哑铃形跨颅中、后窝生长；海绵状血管瘤呈鞍内向鞍旁生长的哑铃形肿块

2、，增强后强化显著，均匀强化或不均匀周边强化逐渐向内充填；鞍旁转移瘤多为双侧性，常见于鼻咽癌颅内侵犯；表皮样囊肿T。WI信号高于脑脊液，DWI上呈高信号改变；脊索瘤为不均匀信号，伴斜坡骨质破坏；鞍旁淋巴瘤可为双侧性，伴颅中窝底骨质破坏。结论：鞍旁肿瘤MR表现各有特点，把握其特征可作出正确诊断。【关键词】鞍旁；肿瘤；磁共振成像中图分类号：R739．4R445．2文献标志码：A文章编号：1006—5741(2009)一04—0302—07MRDiagnosisandDifferentialDiagnosisofParasellarTumorsLIJian

3、I，YAOZhen一"醪，CAODai—ron]【AbstractlPurpose：Tostudyimagingfindingsoftheparasellartumorsandtoimprovediagnosticac-curacy．Methods：Imagingfindingsof64patientswithparasellartumorsprovedbypathologywerere。viewedretrospectively．Allpatientswereundergonenon—contrastedandcontrastedMRimag-i

4、ng．Results：Amongthem，therewere17meningiomas，14invasivepituitaryadenomas，9schwannomas，6carvernoushemangiomas，6metastatictumors，6epidermoidcysts，4chordomasand2malignantlym—phomas．Meningiomasinparasellarhadthesalnesignalchangesandenhancementasinotherlocations．Invasivepituitaryade

5、nomasinvolvedparasellarandinternalcarotidarteryWassurrounded．Amongschwannomas，trigeminalnervetumorswerecommonwithdumbbellconfigurationcrossedmiddle—pos-teriorcranimnfossa．Cavernoushemangiomaswhichinvolvesbothsellarandparasellarweredumb-bell——shapedandhadhomogenousevidentenhanc

6、ementorprogressivefilling——inheterogeneouseu-hancement．Parasellarmetastatictumorswerebilateral，mostlyarisedfromnasopharynalcarcinomas．EpidermoidcystsshowedhyperintensitythancerebralspinefluidonTlWIandshowedhyperintensityonDWI．Chordomashadheterogeneoussignalswithclivuslyticdest

7、ruction．Theparasellarmalignantlym-phomaswereoftenbilateralwithbonedestructionofmediancranialfossa．Conclusion：Allparasellartu-morshadtheirimagefeatures．Familiarwiththemwillimprovethediagnosis．【Keywords】ParaseUar；Tumor；Magneticresonanceimaging鞍旁解剖结构复杂，病变种类繁多，正确认识病变的影像学特点有助于诊断和鉴别

8、诊断，也有助于神经外科医生更好地选择手术人路和方式，制定最佳的治中国医学计算机成像杂志．2009．15：302—308作者