神经科常见影像征象总结

神经科常见影像征象总结

脑膜尾症

【关于"脑膜尾征".

一、

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An early clinical description of meningioma was reported in 1614 (5). Unfortunately, at that time the diagnosis could be made only after death. In 1902, George E. Pfahler, MD, then a resident physician, was able to offer a radiologic diagnosis on a living patient. Pfahler described the "tumor shadow" of a meningioma on conventional radiographs (5). In 1989, Wilms et al (1) described dural tails that were associated with meningiomas on MR images. 1614年即有关于脑膜瘤的临表报道.

1902年,由George E. Pfahler, MD,提供了影象方面的诊断.患者当时在世.

1989年,由Wilms等人提出,MR上硬膜尾与脑膜瘤的相关性.

In 1990, Goldsher et al (2) published a report on 30 meningiomas, of which 60% had tails. The authors devised radiologic criteria to reliably establish the presence or absence of dural tails. Three criteria were adopted: (a) The tail should be identified on two successive sections through the tumor, (b) the tail should taper smoothly away from the tumor, and (c) the tail must have an enhancement greater than that of the tumor itself.

1990年,Goldsher等人提出脑膜尾的影象诊断标准,即:

1,至少连续出现于两个层面;

2,尾巴(自肿瘤出发向外)逐渐变细;

3,尾巴增强较肿瘤光亮.

No clear answer can be discerned from the literature as to why some tumors cause a dural tail and others do not. In the particular case of meningiomas, some investigators have noted tumor invasion, and others relate the tail to hypervascular reaction. These two

common explanations (namely, aggressive infiltration and inflammatory reaction) are also

noted for most of the nonmeningioma tumors.

脑膜尾出现的病理生理学解释:

1,肿瘤侵入性渗入;

2,肿瘤富血管并导致局部炎症反应.

To date, dural tails have been documented adjacent to chloroma, primary central nervous system lymphoma, sarcoidosis, vestibular schwannoma, metastatic tumor, syphilitic gumma, and an aggressive papillary middle ear tumor (7–10).

可以出现脑膜尾的其他肿瘤:

PCNSL、转移瘤、神经鞘瘤、梅毒性树胶肿、绿色瘤、肉瘤样病、“侵入性乳头状中耳瘤”. Whatever the explanation, the dural tail sign remains a helpful sign at least suggestive of

meningioma.

然而，脑膜尾仍然是脑膜瘤诊断的提示征象.

二、

Eur J Radiol. 2008 Feb 20.Pathologic significance of the "dural tail sign". CONCLUSION: In our study MRI findings failed to predict tumoural invasion of the dural tail in histologic samples and because of frequent presence of tumour nests in it, the dura matter should be resected as widely as possible.

MR研究不能通过出现硬膜尾而预测组织学样本中硬膜的肿瘤侵犯,鉴于肿瘤在硬膜物质中出现率较高，应尽可能广的切除硬膜。】

高密度大脑中动脉征：

“高密度大脑中动脉征”是大脑中动脉内血栓的直接征像，主要表现为大脑中动脉水平段密度增高，该征像可在缺血发作后立即出现，多见于累及皮层的大面积大脑中动脉分布区梗死，常常提示病人预后较差。由于扫描层面和大脑中动脉内血栓位置及大小的差异，并不是所有的急性脑缺血都能够可靠的出现高密度大脑中动脉征。高密度大脑中动脉征的诊断标准包括：1）。大脑中动脉密度增高，高于对侧大脑中动脉和基底动脉·2）没有使用造影剂。高密度大脑中动脉征说明动脉闭塞如果仍在脑缺血的治疗窗内则提示需要介入治疗