幕上肿瘤鉴别诊断.pptVIP

IMAGING OF SUPRATENTORIAL NEOPLASMS CHI S. ZEE, M.D PROFESSOR OF RADIOLOGY AND NEUROSURGERY DIRECTOR OF NEURORADIOLOGY TUMOR IMAGING PROTOCAL Sag T1 WI Axial T1 WI Axial T2 WI Axial FLAIR Post-contrast T1 WI in three planes Diffusion weighted imaging and diffusion tensor imaging MR proton spectroscopy Perfusion imaging if needed MR Proton Spectroscopy Choline is the key metabolite in brain tumor (a constituent of the phospholipid composition of cell membranes) Inverse correlation of cho level with ADC value NAA level correlates with neuronal tissue Lactate is believed to be due to glycolytic activity Lipids are associated with cellular breakdown and necrosis Perfusion Imaging Regional CBV is calculated from signal intensity loss engendered by the passage of contrast Perfusion imaging probably reflects tumor angiogenesis Regional CBV correlates with tumor vascularity and mitotic activity Diffusion Tensor Imaging Presurgical planning with diffusion tensor imaging using tractography Involvement of white matter tracts by infiltrating tumor Anatomically intact white matter tracts may be present in abnormal appearing areas INTRA-AXIAL NEOPLASMS Glioblatoma multiforme胶母 (WHO gade VI) Anaplastic Astrocytoma (WHO grade III) Infiltrating Astrocytoma (WHO grade II) Well-defined Astrocytoma星行细胞瘤 (WHO grade I) Oligodendroglioma少突胶织细胞瘤 Ependymoma室管膜瘤 Ganglioglioma神经节细胞瘤 Dysembryoplastic neuroepithelial tumor PNET胚胎发育不良性神经上皮肿瘤 Lymphoma淋巴瘤 Metastasis转移瘤 CEREBRAL GLIOMAS GBM (55%) Astrocytoma (20%) Ependymoma (6%) Oligodendroglioma (5%) Choroid plexus papilloma (3%) ASTROCYTOMAS (WHO grade 1) Pilocytic astrocytoma Pleomorphic xanthoastrocytoma Giant cell astrocytoma SUBEPENDYMAL GIANT CELL ASTROCYTOMA Occurs almost exclusively in patients with tuberous sclerosis in their late teens and early twenties 10 to 15 % of patients with tuberous sclerosis develop SGCA Arise from subependymal nodules located wall of the lateral ventricle overlying the head of caudate nucleus LOW GRA