幕下肿瘤鉴别诊断+.ppt

IMAGING OF INFRATENTORIAL NEOPLASMS CHI S. ZEE, M.D. UNIVERISTY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE TUMOR IMAGING PROTOCAL Sag T1 WI Axial T1 WI Axial T2 WI Axial FLAIR Post-contrast T1 WI in three planes Diffusion weighted imaging MR proton spectroscopy Perfusion imaging if needed Diffusion Weighted Image on Tumor imaging Differentiation of infiltrating tumor from vasogenic edema Tumor grading 肿瘤级别 ADC Maps Tumor shows lower signal intensity than edema 肿瘤信号比水肿低得多 The anisotropy difference between tumor and edema is attributed to intact myelin fibers in vasogenic edema in contrast to tumor ADC and Tumor Cellularity High grade (highly cellular) gliomas display low ADC values, similar for lymphoma, PNET Low grade tumor display high ADC values MR Proton Spectroscopy Preoperative diagnosis and grading of brain tumor Therapeutic monitoring of brain tumor Radiation necrosis versus tumor recurrence INTRA-AXIAL NEOPLASMS IN CHILDREN PNET Astrocytoma 星形细胞瘤 Ependymoma 室管膜瘤 Braintem glioma 神经胶质瘤 PNET Cerebellar PNET ~ 15% child brain tumor up to 1% adult brain tumor. 30 – 40% posterior fossa neoplasm in children Primitive neuroepithelial cells of the roof of the fourth ventricle that migrate superolaterally to the external granular layer of the cerebellum. Child – usually midline along the roof of 4th ventricle. Adults – laterally in cerebellar hemisphere. Seeding to spinal canal/cauda equina ~ 40%. May occur in association with Gorlin’s syndrome or Turcot’s syndrome. Gorlin’s Turcot’s Basal cell nevi Odontogenic keratocysts Falx calcification Colonic polyps CNS malignancy (medulloblastoma or GBM) CEREBELLAR ASTROCYTOMA Approximately 75% are benign juvenile pilocytic astrocytomas with peak incidence in the first decade of life 25% are diffuse ,infiltrative, fibrillary astrocytomas with peak incidence in young adults Juvenile pilocytic astrocytoma BRAINSTEM GLIOMA Consists of 15% of all posterior fossa neoplasms in children Most