中枢神经系统肿瘤的WHO分类及影像学诊断（一）ppt课件.pptVIP

中枢神经系统肿瘤的WHO分类及影像学诊断;WHO分类;星形细胞肿瘤;弥漫浸润型星形细胞瘤diffusely infiltrating astrocytomas;特点;1. 弥漫型星形细胞瘤(diffuse astrocytoma);Age distribution of diffuse astrocytoma WHO grade II, based on biopsies of 529 patients from the Tumour Registry of the University of California, SanFrancisco (courtesy of Ms Nancy Drungilas) and the Institute of Neuropathology, University Hospital Zurich.;组织学亚型 纤维型星形细胞瘤(fibrillary astrocytoma) 肥胖细胞型星形细胞瘤(gemistocvtic astrocytoma) 原浆型星形细胞瘤(protoplasmic astrocytoma) 神经影像学 表现多样 CT 扫描肿瘤边界清/欠清、均匀低密度，增强不强化。早期可有钙化、囊变，高级别可见强化 MRI 肿瘤T1W 呈低信号，T2W 呈高信号。在低等级肿瘤强化不常见，但随着肿瘤恶化趋于强化;Diffuse astrocytoma WHO grade II, presenting as (A) hypodense frontal lesion on contrast-enhanced CT, as (B) hypointense focus on gadolinium-enhanced MRI and (C) as well-delineated hyperintense lesion on T2-weighted MRI.;T2-weighted MRI of a diffuse astrocytoma involving the fronto-temporal region with considerable mass effect. In the affected brain region, the cortex is enlarged but still recognizable.;Case 1;2. 间变型星形细胞瘤(anaplastic strocytoma);Age distribution of anaplastic astrocytoma, based on biopsies of 319 patients treated at the University Hospital, Zurich.;神经影像 边界不清 常常存在部分强化，一般无胶质母细胞瘤的典型显著环状强化 肿瘤快速生长和瘤周水肿可导致脑实质移位和颅内压增高 ;M/47，反复头痛2年，加重伴反复发作性意识不清2个月;3. 胶质母细胞瘤(glioblastoma);Age and sex distribution of glioblastoma, based on 715 cases from a population-based study, Canton of Zurich, Switzerland. ;GBM;神经影像 CT 检查典型表现为不规则形颅内病灶，增强后中央为低密度坏死区域，周边呈环状强化影 在MRI T1W 像上，肿瘤周边环状强化影并非肿瘤外缘，而是细胞增殖旺盛区和高密度血管区，浸润的胶质瘤细胞可在瘤周2cm 内外被强化。在T2W 上，环状强化区更宽，边界不清，并同血管性水肿相重叠 在PET 中，局部葡萄糖消耗量同肿瘤细胞构成和生存率密切相关 ;Glioblastoma. A T1-weighted MRI with marked gadolinium-enhancement, indicating neovascularization and vascular permeability. B T2-weighted MRI reveals extensive perifocal edema.;F/68，头痛头晕;4. 巨细胞胶质母细胞瘤(giant cell glioblastoma);A Giant cell glioblastoma consists of cells with variable size and shape. B An atypical mitotic figure in a giant cell. C A very large multinucleated giant cell. D Most but not all tumour cel