硬膜浆细胞瘤的MR诊断

硬膜浆细胞瘤的MR诊断第1页/共27页Onlyseeasmallnumberofreportedliterature国内外文献仅见少数报道Andproposedthefollowingdiagnosticcriteria并提出如下诊断标准①nootherboneinvolvementinx-rayX线无其它骨受累②Mustbeconfirmedhistologically必须有组织学证实③Bonemarrowbiopsynegative骨髓穿刺阴性④NotProteinuria,hyperlipidemia无高蛋白血症和本周蛋白尿第2页/共27页74-year-oldfemalewithhistoryofheadache.74岁女性，头痛。Case第3页/共27页isointensesignalonTIrelatively在T1序列上呈相对的等信号第4页/共27页isointensesignalonT2relatively在T2序列上呈相对的等信号第5页/共27页增强T1WI横轴位Thelesiondemonstrateshomogeneouscontrastenhacement

第6页/共27页增强T1WI冠状位Thelesiondemonstrateshomogeneouscontrastenhacement

inCoronal第7页/共27页Thereisanextra-axial,duralbasedmasspredominantlyinthehighleftposteriorparietalregionwhichisrelativelyisointensesignalonTIandT2sequences.图示左侧后顶部的以脑膜为基底的脑外肿块，在T1和T2序列上呈相对的等信号。12第8页/共27页Thelesiondemonstrateshomogeneouscontrastenhacementonpostcontrastsequences,(yellowarrowinFigure3).Extensionalongtheinterhemisphericfissure(yellowarrowinFigure4),encasementofthesuperiorsagittalsinus(redarrowinFigure4)andextensionacrossmidlinetotheright(bluearrowinFigure4)isdemonstrated.病变显示明显的强化（图3、黄箭），病变沿大脑纵裂扩展（图4、黄箭），包埋上矢状窦（图4、红箭）和沿中线扩展至右侧（图4、蓝箭）34第9页/共27页Differentiationbetweenthesolitaryformandplasmacytomainassociationwithmultiplemyelomahasimportanttreatmentimplications.区别是孤立性浆细胞瘤还是多发性骨髓瘤相关的浆细胞瘤对于治疗有重要的意义。emphasis第10页/共27页Imagingcharacteristicsofduralplasmacytomasmaycloselyresemblethoseofmeningiomas.硬膜浆细胞瘤的影像特征与脑膜瘤非常相似。第11页/共27页Plasmacytomasoftheduralareuncommonplasmacelltumorsthatmayoccurasasolitaryneoplasmmorecommonly,inassociationwithmultiplemyeloma.孤立性的硬膜浆细胞瘤是不常见的，而多发性骨髓瘤相关的浆细胞瘤相对更常见些。Thelatterisusuallyaccompaniedbymultiplelyticlesionsoftheskull.后者通常伴有颅骨多发性囊性病变。第12页/共27页Indistinction,solitarycraniocerebralplasmacytomasarerelativelybenignandpotentiallycurable.区别是，孤立性的颅脑浆细胞瘤是相对良性并有潜在的可治愈性。Therefore,distinctionbetweenthetwohasimportantclinicalconsequences.因此，两者的鉴别有重要的临床意义。第13页/共27页Thedifferentialdiagnosisforduralplasmacytomaincludesmetastasis,lymphoma,duralsarcoma,plasmacellgranulomaandmeningioma.

硬膜浆细胞瘤的鉴别诊断包括转移瘤，淋巴瘤、硬脑膜肉瘤、浆细胞瘤肉芽肿和脑膜瘤。DifferentialDiagnosis第14页/共27页First,toexcludemyelomaandotherpartsoftheplasmacellsarcomainvolvingtheintracranial首先要排除骨髓瘤和其他部位的浆细胞肉瘤累及颅内Becausetheyarecompletelydifferenttreatmentandprognosis因为它们的治疗及预后完全不同Learnmoreaboutthehistorythroughwhichboneorotherpartsoftheprimarytumorcanbeidentified通过详细了解病史，后者有骨或其他部位的原发灶可鉴别第15页/共27页Andisthedifferencebetweenplasmacellgranuloma,whichisfullymatureplasmacells,andmixedmorelymphocytesandplasmacellsandotherinflammatorycells.与浆细胞肉芽肿的区别是，后者的浆细胞完全成熟，并混杂较多的淋巴细胞和浆细胞，并常有其它炎细胞浸润第16页/共27页Duralplasmacytomasareoftenconfusedwithmeningiomas(themostcommonextra-axialneoplasmfoundinadults)asthetwohavesimilarfeaturesandimagingcharacteristics.硬膜浆细胞瘤常常跟脑膜瘤（是成人最常见的脑外肿瘤）相混淆，因为两者具有类似的临床及影像特征。第17页/共27页Bothoccurmorecommonlyinwomenduringthefiftyyearoldwithapredilectionforsimilarsitesofinvolvementincludingthecerebralconvexities,sphenoidridge,falxandtentorium.两者都常见于50岁左右的女性，累及部位也类似，包括大脑凸面、蝶骨嵴、大脑镰和小脑幕。第18页/共27页OnMRbothmayappearnearlyisointensetobrainonT1Wimagesandiso-tohyperintenseonT2Wimageswithmarkedcontrastenhancement.在MRT1序列上两者都与脑实质信号相接近，在T2序列上表现为等到高信号，有明显的强化。

第19页/共27页Acharacteristic"duraltail"andintratumoralcalcificationsmaybeseeninbothlesions.特征性的脑膜尾征和软脑膜钙化也都可以见于两者。第20页/共27页Second,withtherichinlymphocytes-plasmacellsinthemeningiomadifferencebetweenthefirstimageoftheirorganizationhavemeningiomacomponentsweremixedlymphocytesandplasmacellsinfiltration,andthediseaselackthebasicimageofmeningioma,andasinglematurePlasmacells.

与富于淋巴细胞-浆细胞的脑膜瘤区别，后者其组织图像首先有脑膜瘤成分，淋巴细胞和浆细胞呈混合浸润，而本病缺乏脑膜瘤的基本图像，且为单一的较成熟的浆细胞。第21页/共27页Othermanifestationsofintracranialplasmacytomamayincludediffuseleptomeningealdiseaseandrarely,intracerebrallesionswithvasogenicedema.脑膜浆细胞瘤的表现包括弥漫性的脑膜病变和少见的颅内血管源性水肿。Thesepatientsmaypresentwithintracranialhypertensionand/orfocalneurologicalsignsfromtheduraloriginofthetumor.这些病变可以表现为颅高压和/或局部神经定位体征。

Clinicalmanifestations第22页/共27页Clinically,individualswithsolitaryduralplasmacytomascanbedistinguishedfromthosewithmultiplemyelomabytheabsenceofhypercalcemia,renalinsufficiency,anemia,lyticosseoueslesions,bonemarrowplasmacytosis,andelevatedserumorurinaryparaprotein.临床上，可以通过是否有高血钙、肾功能不全、贫血、多发性囊性骨病变、骨髓浆细胞增多以及血浆或尿液副蛋白增高等特征来鉴别究竟是孤立性浆细胞瘤，还是多发性骨髓瘤相关的浆细胞瘤。第23页/共27页Solitarymeningealplasmacytomagenerallycompleteresection,prognosisthanthebrainparenchymaandmultiplemyelomagood.脑膜孤立性浆细胞瘤一般可完整切除，预后较脑实质内者和多发性骨髓瘤好。Treatment第24页/共27页Followingsurgicaldecompressionand/orlocalradiotherapyforasolitarydural