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破裂的皮样囊肿伴化学性脑脊髓炎(Ruptured spinal dermoid with chemical meningitis)MRI病例图片影像诊断分析

时间:2010-11-05  来源:ACR Tuesday, June 23, 2009  作者:freemanpyw译 【复制分享】【讨论-纠错】【举报

tD7影像园XCTMR.com

 【讨论】:Differential diagnosis of a spinal dermoid includes lesions with high lipid content such as teratomas and lipomas.椎管内皮样囊肿的鉴别诊断包括那些含有高脂性的病变,如脂肪瘤和畸胎瘤。tD7影像园XCTMR.com

    Differential diagnosis of brain lesions that appear  hyperintense on T1W images on brain MRI are as follows:颅内出现T1高信号的病灶,其鉴别诊断包括以下:tD7影像园XCTMR.com

  1. Lesions with hemorrhagic components, such as infarct, encephalitis, intraparenchymal hematoma, cortical contusion, diffuse axonal injury, subarachnoid hemorrhage, subdural and epidural hematoma, intraventricular hemorrhage, vascular malformation and aneurysm, and hemorrhagic neoplasm. 病变有出血,如梗塞、脑炎、实质内血肿、皮质挫伤,弥漫性轴突损伤,蛛网膜下腔出血、硬膜下和硬膜外血肿,脑室内出血,血管畸形和动脉瘤以及出血性肿瘤。
  2. Protein-containing lesions, such as colloid cysts, craniopharyngiomas, Rathke's cleft cysts and atypical epidermoids. 含有蛋白成分的病变,如胶样囊肿、颅咽管瘤,Rathke's囊肿和不典型的表皮样囊肿。
  3. Lesions with fatty components, such as lipoma, dermoid and lipomatous meningioma. 病变含有脂肪成分,如脂肪瘤、皮样囊肿和脂肪瘤样脑膜瘤。
  4. Melanin-containing lesions, such as metastasis from melanoma and leptomeningeal melanosis. 含有黑色素成分的病变,如黑色素转移瘤和软脑膜黑变病。
  5. Lesions with calcification or ossification, such as endocrine-metabolic disorder, calcified neoplasm, infection, and dural osteoma. 伴有钙化和骨化的病变,如内分泌-代谢失调病变,钙化的肿瘤,感染,和硬脑膜骨瘤。
  6. Lesions with other mineral accumulation, such as acquired hepatocerebral degeneration and Wilson disease. 伴有其他矿物累积的病变,如获得性肝脑变性退变和Wilson病变
  7. Miscellaneous group, which includes ectopic neurohypophysis, chronic stages of multiple sclerosis and neurofibromatosis type I.其他,包括异位的神经垂体,多发性硬化的慢性阶段和神经纤维瘤病I型。

    A spinal dermoid is a rare, benign, slow-growing, dysontogenetic tumor arising from the inclusion of ectopic embryonic rests of the ectoderm and mesoderm within the spinal canal at the time of neural tube closure between the 3rd and the 5th week of fetal life. Several causes including spontaneous, iatrogenic or traumatic rupture have been reported to result in dissemination of lipid material from the dermoid tumours into the subarachnoid space or ventricles. Intra-spinal dermoids account for approximately 1-2% of intra-spinal tumors and tend to extend to the subarchnoid space, however there is no communication between the cyst and the subarchnoid space.  They occur predominantly in the lumbosacral region and rarely in the cervicothoracic region. They show a slight male predominance, and most reveal themselves during the second and third decades.tD7影像园XCTMR.com

    椎管内皮样囊肿是一种少见的、良性、缓慢生长的发育不良性肿瘤,起源于椎管内异位的外胚层和中胚层残余的包含体,发生在胎儿期第3到第5周期间的神经根闭合期。包括自发性、医源性、创伤性的多种原因的皮样囊肿破裂进而导致脂肪物质从皮样囊肿内散布到蛛网膜下腔和脑室内。椎体内的皮样囊肿占1-2%的椎管内肿瘤并且倾向于扩展至蛛网膜下腔,然而在囊肿和蛛网膜下腔之间并没有直接的交通。囊肿多见于腰骶部,几乎很少见于颈胸部。男性稍多见,常见于20-30岁。tD7影像园XCTMR.com

    Pathologically, spinal dermoids have a thick wall covered with stratified squamous epithelium containing dermal appendages such as hair, sebaceous glands and sweat glands and less commonly, teeth and nails. Dermoid tumours commonly have areas of calcification. Their rupture and spread is a rare event, which may be asymptomatic or may present acutely as chemical meningitis. The exact incidence of rupture of spinal dermoids is not known.  Cholesterol, which is the most irritating element of  the dermoid excites an inflammatory/ granulomatous meningeal reaction.tD7影像园XCTMR.com

    病理学上,椎体皮样囊肿有覆以复层鳞状上皮细胞的厚壁,其内包含有表皮附件如毛发、皮脂腺和汗腺,少见的情况下可能会有牙齿和指甲。皮样囊肿通常有钙化。囊肿的破裂和播撒是少见的,可以是无症状或表现为为畸形的化学性脑脊膜炎。囊肿破裂的发病率尚无精确的数字,胆固醇是最常见的引起炎性/肉芽肿性脑膜反应的成分。tD7影像园XCTMR.com

    Spinal dermoids appear as variegated, space-occupying lesions showing a heterogeneous signal on T2-weighted MRI due to the different components within the cyst. These have high protein-containing fluid and thereby appear brighter than CSF on T1-weighted images. The high lipid content also gives a characteristic hyperintense signal on T1-weighted spin-echo images.tD7影像园XCTMR.com

    脊椎皮样囊肿表现为成分不一的、占位性病变,由于其内的不同成分在T2序列上显示不均匀的信号影,由于含有高蛋白成分的液体,因此在T1序列上信号高于脑脊液强度,高脂性成分同时也使得T1序列上表现为特征性的高信号。tD7影像园XCTMR.com

    In conclusion, radiologists need to be aware that whenever a diagnosis of intra-spinal dermoid is suggested, it is essential to screen the entire neural axis to look for possible rupture and CSF spread. MRI is the imaging modality of choice.                           tD7影像园XCTMR.com

    无论何时,当一个椎管内皮样囊肿的诊断被考虑,对整个神经轴进行检查是非常重要的,以便于寻找可能存在的囊肿破裂和脑脊液播散。MRI是首选的检查方式tD7影像园XCTMR.com

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