CPA少见肿瘤概要.ppt

起源于CPA的肿瘤 CPA是由小脑桥脑角池脑膜围绕形成，内除含脑脊液之外还包括神经、动脉血管及可能存在的胚胎残余物，上述成分均有可能成为CPA少见肿瘤起源的结构。 表皮样囊肿 表皮样囊肿也称原发性胆脂瘤，它起源于神经管闭合过程中内藏的正常上皮细胞，内富含角蛋白及胆固醇生长缓慢，包绕周围神经及血管。CT：表现为低密度，同CSF相仿，形态不规则、呈分叶状，邻近骨质不受累及，边缘钙化少见，注射对比剂强化不明显。MRI：一般T1、T2上信号强度均稍高于CSF，常信号不均匀呈花纹样改变；也可与CSF相仿，难于与蛛网膜囊肿鉴别，FLAIR、DWI序列可鉴别，表皮样囊肿在上述序列中为高信号，而蛛网膜囊肿为低信号。 Arachnoid cyst in a 27-year-old woman with headaches. (a) Axial T1-weighted MR image shows an arachnoid cyst with signal intensity similar to that of CSF stretching the left seventh and eighth cranial nerve complex (arrow). (b) Axial T2-weighted MR image shows the lobulated margins of the cyst impinging on the pons (arrowhead). (c) Axial heavily T2-weighted (constructive interference in the steady state) MR image shows the extent of the tumor. 蛛网膜囊肿 蛛网膜囊肿是囊样蛛网膜内肿块，内充满脑脊液，起源不确定。影像上其密度、信号强度与脑脊液相似，呈圆形，边缘光滑，周围神经脉管结构受推移，临近骨质受累及，无钙化及强化。 Arachnoid cyst in a 27-year-old woman with headaches. (a) Axial T1-weighted MR image shows an arachnoid cyst with signal intensity similar to that of CSF stretching the left seventh and eighth cranial nerve complex (arrow). (b) Axial T2-weighted MR image shows the cyst displacing the vascular structures of the CPA (arrowheads). 脂肪瘤 CPA脂肪瘤为发育成熟的肿瘤，起源于脑膜原基（meninx primitiva ）的异常分化，为均匀脂肪密度，紧密包绕临近正常神经脉管结构。由于其很少出现临床症状，一般采取保守治疗或随访。 Lipoma in a 7-year-old boy with a polymalformation syndrome. (a) Axial CT scan shows a well-defined hypoattenuating lipoma of the left CPA. (b) Axial T1-weighted MR image shows that the lipoma has signal intensity similar to that of subcutaneous fat. 神经鞘瘤 尽管前庭神经鞘瘤占了颅内神经鞘瘤的95%，CPA其他所有神经也可发生神经鞘瘤，特别是三叉神经、面神经以及IX-XII 颅神经。其影像学表现同前庭神经鞘瘤相似，包括可能的囊变与出血，诊断的关键是神经解剖学定位。 Schwannoma in a 34-year-old man with right trigeminal neuralgia. Contrast material-enhanced axial T1-weighted MR image shows a homogeneous, enhanced, dumbbell-shaped right trigeminal schwannoma involving the cisternal part of the nerve and Meckel cave. Schwannoma in a 52-year-old woman with left ear pain. (a) Gadolinium-enhanced