來源:ACR Wednesday

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【臨床病史】

患者,42歲女性,有頭痛史,有頭痛史和人格改變,行CT掃描。42-year-old female with history of headache and personality change undergoes a CT brain scan.

【影像圖片】

MRI圖像

【影像表現】

Axial non contrast enhanced CT [Figure 1] shows a large lesion isointense to the brain in the frontal lobes crossing the midline.
Contrast enhanced axial image Figure 2] shows avid contrast enhancement of the lesion.

T2W axial image (Figure 3) shows a mixed signal large lesion with little surrounding edema.
Proton density axial image Figure 4) shows a lesion which is largely isointense to the surrounding brain parenchyma.
The lesion (Figure 5 and Figure 6) is low signal on TIW image with marked contrast enhancement.
Post contrast TIW sagittal image (Figure 7) shows the lesion to be extra axial with contrast enhancement

【影像診斷】

Olfactory Meningioma 嗅溝腦膜瘤

【診斷要點】

The olfactory groove meningioma accounts for about 10% of intracranial meningiomas.嗅溝腦膜瘤占所有腦膜瘤的10%;They may present with anosmia, personality change, psychological effects, epilepsy and other frontal lobe symptoms.可以表現為嗅覺喪失,性格改變,心理異常、癲癇,以及其他的額葉癥狀;They are slow growing tumors often reaching large size before detection.病變生長緩慢,常常在發現時已經很大。

【討論】

Meningiomas are the most common extraaxial tumor. The features which suggest an extraaxial etiology are tumor relationship to the dura, local bony hyperostosis, corticomedullary buckling, displacement of the cortex away form the bone, preservation of the grey/white matter junction and widening of the cisterns. Meningiomas are located in a supratentorial location in about 90% of cases, most commonly at the convexity of the hemispheres. Meningiomas are more common in females.

腦膜瘤是最常見的軸外腫瘤,提示軸外病變的特點是腫瘤與硬膜的相關性,局部的骨肥厚、皮質延髓受壓,皮質塌陷、灰白質界面存在,以及腦池的增寬。大約90%的腦膜瘤是位於幕上,最常見於大腦凸面。腦膜瘤更常見於女性。

On unenhanced CT, meningiomas are mostly hyperdense with intense homogenous uniform enhancement. They may be associated with hyperostosis of the adjacent bone. In most cases the surrounding edema is minimal, another feature which distinguishes it from an intraaxial lesion. The dural tail sign is a non-specific sign but one that suggests a meningioma. On MR, meningiomas are isointense to hypointense on TIW images with marked contrast enhancement. On T2W images they are isointense to slightly hyperintense in signal.

平掃CT,腦膜瘤常常呈高密度,伴有明顯的均勻強化。鄰近顱骨的肥厚,大多數病例中,周邊水腫是輕微的,這同時是鑒別腦內外腫瘤的另一個特征。腦膜尾徵是一種非特異性的徵像,但是也提示腦膜瘤的可能。在MR上,T1序列腦膜瘤是等到低訊號,伴有明顯的強化。在T2序列上呈等稍高訊號。

The multiplanar imaging capability of MR is useful in defining the exact anatomical location of the lesion.

MR的多維成像能力有利於精確的顯示病變的位置。

The olfactory groove meningioma accounts for about 10% of intracranial meningiomas. They arise in the midline between the crista galli and tuberculum sella. Olfactory groove meningiomas may be symmetrical around the midline or extend to one side or the other. 10 to 15% grow into the ethmoid sinuses. They may present with anosmia, personality change, psychological effects, epilepsy and other frontal lobe symptoms. When large they may involve the visual pathways causing visual field defects. They are slow growing tumors frequently reaching large size before detection.

嗅溝腦膜瘤占所有顱內腦膜瘤的10%。起源於鞍結節與雞冠間的中線。嗅溝腦膜瘤可以是對稱的環繞中線或向一側或另一側生長。10%-15%可以向篩竇內生長。臨床上可以出現嗅覺喪失、,性格改變,心理異常、癲癇,以及其他的額葉癥狀。當病變增大,他們可以累及視覺通路導致視野缺損,病變生長緩慢,在發現時常常已經很大。

【直購通道】

出自復旦大學出版社著名品牌

“現代系列”醫學專著

2000張配圖,歷時六年。

影像醫學界集大成之作

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