大脑半球生殖细胞瘤CT及MRI表现.docVIP

大脑半球生殖细胞瘤CT及MRI表现 　 作者：梁有禄，黄永杰，宋国武 【关键词】 生殖细胞瘤；大脑半球；断层摄影,X线计算机；磁共振成像 ［摘 要］ 目的：探讨大脑半球生殖细胞瘤的CT、MRI表现特征并对其进行鉴别诊断。方法：报道1例患者的CT、MRI影像资料，并结合文献进行回顾性分析。结果：本例肿瘤位于左顶枕叶，CT平扫为高密度，周围水肿及占位效应明显；其MRI表现为：T1WI、T2WI均呈等信号为主，其内有囊变坏死，周围水肿明显；GdDTPA增强扫描肿瘤呈不均匀明显强化。CT、MRI表现与该部位其他常见肿瘤不易鉴别，经手术病理证实为恶性生殖细胞瘤。结论：大脑半球生殖细胞瘤罕见，其CT、MRI表现有一定的特征性，是其诊断的重要依据。 　　［关键词］ 生殖细胞瘤；大脑半球；断层摄影，X线计算机；磁共振成像 　　CT and MRI Findings of Germinoma of Cerebral Hemispheres 　　Abstract：Objective To discuss the CT and MRI characteristics and differential diagnosis of the germinoma of cerebral hemispheres.Methods A case of the germinoma of cerebral hemispheres of CT and MRI features was analyzed in conjunction with review of literatures.Results The germinoma of this case,which was located in left parietalocciptal lobe,CT tumors was hyperattenuation and showed most edema with spaceoccupying effect;the characteristic MRI appearances of it were as follows:On T1WI,the lesions were isointense while isointense on T2WI,cystic degeneration was seen in it,the germinoma of cerebral hemispheres showed edema.The lesions showed inhomogeneous GdDTPA enhancement in most of the tumors.It is difficult to differentiate it form other intracranial tumors of cerebral hemispheres by image.The diagnosis was comfirmed by biopsy.Conclusion Germinoma of cerebral hemispheres are rare and it are of CT and MR characteristics.MRI can play an important role in the diagnosis. 　　Key words：Germinoma;Cerebral hemisphere;Tomography；Xray computed;MRI 生殖细胞瘤（germinoma）是颅内少见肿瘤。仅占颅内肿瘤的1%以下，好发于儿童和青少年，幼儿和老年人少见。主要发生在松果体区，其次是鞍区，发生于丘脑基底节区较少［1，2］，而发生于大脑半球者极为罕见。吕发金等［3］曾作过个案报道。复习近十多年来的国内外文献，笔者未发现有关大脑半球生殖细胞瘤的深入报道。本文报道1例左顶枕叶恶性生殖细胞瘤并结合文献，分析该区域生殖细胞瘤的CT和MRI表现并对其进行鉴别诊断，以提高对本病的认识。 　　1 材料与方法 　　1995年至2005年我院收治的经病理学及实验性放疗证实的颅内生殖细胞瘤14例，男9例，女5例，平均年龄为19岁，其中位于松果体区10例，鞍上区2例，丘脑或基底节区1例，大脑半球1例（本例）。本例患者：男，60岁，头痛0.5 a，加重半个月伴呕吐3 d入院，视物模糊，视野检查提示右侧同向偏盲。CT检查用GE Prospeed Ⅱ型双排螺旋CT机行横断面平扫检查，层厚、层间距5 mm~10 mm；MRI检查采用GE signa 1.5T超导型磁共振扫描仪，用标准头线圈，行T1WI、T2WI及T1WI增强扫描，常规轴位、冠位平扫，矢、冠及轴位增强扫描，静脉注射对比剂GdDTPA 0.3