成人髓母细胞瘤的MRI征象分析

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目的探讨成人髓母细胞瘤的MRI征象,以提高对该病的认识及术前诊断准确率。方法回顾性分析12例(男7例,女5例,年龄18~57岁,平均34.1岁)经手术病理证实的成人髓母细胞瘤患者MRI资料。所有患者均行MRI平扫及增强扫描,7例加做扩散加权成像(DWI),观察病灶的位置、大小、形态、边界、信号特点、强化特征。结果 12例中,单发病灶11例,1例为多发,共13个病灶;小脑半球5个,小脑半球-蚓部3个,小脑蚓部4个,第四脑室1个;7个广基底贴于脑表面或小脑幕,1例跨左小脑幕累及幕上,1例经桥臂累及脑干。1个病灶T1WI及T2WI均呈等信号,12个病灶T1WI呈低或稍低信号,T2WI呈等或稍高信号;DWI呈稍高或高信号。12个病灶出现不同程度囊变,裂隙状或斑片状至大囊变;增强扫描11个病灶不均匀强化,9个呈轻中度强化,4个明显强化;脑膜尾征3例,1例见蛛网膜下腔种植转移,12个病灶瘤周无或轻度水肿。结论成人髓母细胞瘤以小脑半球、小脑半球-蚓部多见,且紧贴脑表面或小脑幕,可多发,易囊变,DWI呈高信号,增强扫描呈不均匀轻中度强化,无或轻度瘤周水肿,较少出现蛛网膜下腔种植转移,MRI表现具有一定的特征性,有助于诊断。 Objective To investigate the MRI features of adult medulloblastoma in order to improve the understanding of the disease and the accuracy of preoperative diagnosis. Methods The MRI data of 12 patients (7 males, 5 females, aged 18-57 years, mean 34.1 years) with pathologically confirmed adult medulloblastoma were retrospectively analyzed. All patients underwent MRI plain scan and enhanced scan. Seven patients were treated with diffusion weighted imaging (DWI). The location, size, morphology, boundary, signal characteristics and enhancement features were observed. Results Of the 12 cases, 11 were single lesions and 1 was multiple. There were 13 lesions in all, including 5 cerebellum hemispheres, 3 cerebellar hemispheres and vermis, 4 cerebellar vermis and 1 fourth cerebral ventricle. Affixed to the surface of the brain or the cerebellum, 1 case involved the left supratentorial sac involving the screen, 1 case involving the brainstem via the bridge. One lesion showed equal signal on T1WI and T2WI. Twelve lesion showed low or slightly low signal on T1WI and equal or slightly higher signal on T2WI. DWI showed slightly higher or higher signal. Twelve lesions showed varying degrees of cystic deformity, fissure or patchy to large cystic degeneration; 11 lesions enhanced enhanced scanning unevenly, 9 were mild to moderate enhancement, 4 were significantly enhanced; three cases of meningeal tail syndrome, 1 case See subarachnoid planting metastasis, 12 lesions no or mild tumor edema. Conclusions Adult medulloblastoma is more common in the cerebellum and cerebellar hemispheres than the vermis and closely follows the surface of the brain or the cerebellum. It can be multiple and easily deformable, with high signal intensity on DWI and uneven enhancement on mild to moderate enhancement. Or mild peritumoral edema, less subarachnoid plantar metastasis, MRI performance has a certain characteristic, contribute to the diagnosis.
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