中枢神经系统肿瘤的WHO分类及影像学诊断（二）ppt课件.pptVIP

少突胶质细胞肿瘤和混合型胶质瘤;1. 少突胶质细胞瘤(oligodendroglioma);Age and sex distribution of 130 patients with oligodendroglioma and anaplastic oligodendroglioma, based on combined biopsy series from the Universities of Düsseldorf (Germany) and Zürich (Switzerland).;神经影像 CT 扫描上表现为大脑皮质或皮质下白质内低密度或等密度影，边界清楚，常伴有钙化，但不作为诊断依据 MRI 上，肿瘤T1W 为低信号，T2W 为高信号，界限清晰，瘤周脑组织水肿不明显。由于瘤内出血和(或)囊变，部分肿瘤信号不均 巨检 少突胶质细胞瘤边界较清，质软，灰粉色。如果肿瘤广泛黏液变性可呈胶冻样 肿瘤常位于大脑皮质和白质，可见软脑膜浸润。钙化常见，特别在肿瘤周边和大脑皮质附近。还可见囊性变和肿瘤内出血 ;肿瘤伴出血;M/39，头痛头晕，性格改变;;;2. 间变型少突胶质细胞瘤(anaplastic 0ligodendroglioma);神经影像 由于存在坏死、囊变、内出血及钙化，间变型少突胶质细胞瘤影像学表现多样 CT和MRI 增强常呈斑片状或均匀强化，环状强化少见，提示预后不良 ;3. 少突星形细胞瘤(0ligoastrocytoma);4. 间变型少突星形细胞瘤(anaplastic oligoastrocytoma);室管膜肿瘤;1.室管膜瘤(ependymoma);Age and sex distribution of ependymoma, based on 298 cases. Data from Schiffer et al. {2024}.;A Ependymoma in a child, filling the entire lumen of the fourth ventricle. Note the displacement of the medulla, (B) the relatively clear demarcation from the cerebellar parenchyma and (C) the involvement of the ependymal lining in the neoplastic process.;神经影像 MRI 增强扫描肿瘤边界清楚，呈中度至明显的强化影，常伴有脑室或脑干移位及脑积水。幕上肿瘤可有囊性变，有时伴有瘤内出血和广泛钙化，少见向周围脑组织浸润和瘤周水肿 幕上实质性室管膜瘤同其他实质性胶质瘤难以鉴别。MRI 有助于判断肿瘤与周围结构的毗邻关系以及是否存在脑脊液播散 髓内室管膜瘤常可形成空洞 ;F/21，外伤后一过性意识障碍，伴头痛4天;;;;2. 间变型室管膜瘤(anaplastic ependymoma);Sagittal, gadolinium-enhanced, T1WI of an anaplastic ependymoma of the fourth ventricle.;3. 黏液乳头型室管膜瘤 (myxopapillary ependymoma);Age and sex distribution of myxopapillary ependymoma, based on 311 patients. Data from CBTRUS 1995??2002.;神经影像学 为髓内肿瘤，MRI 上肿瘤边界清楚，常伴明显强化，可有广泛囊性变和出血。有些病例出现椎管尾侧局部肿瘤播散 偶尔也可累及神经根或侵蚀骶骨 ;MRI of a myxopapillary ependymoma of the filum terminale (arrow) presenting as a hyperintense spinal mass.;4. 室管膜下瘤(subependymoma);Age and sex distribution of subependymoma, based on 167 cases. Data from CBTRUS 1995-2002.;神经影像学 肿瘤边界清楚，通常无增强，钙化和出血灶清晰 髓内室管膜下瘤为典型偏心性，可与脊髓室管膜瘤的中心性影像学特点相鉴别 ;A Subependymoma of the lateral ventricle originating from the roof of the lateral ventricle. B Subependymoma of the lateral ventricle.;