幕上肿瘤鉴别诊断课件

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1、IMAGINGOFSUPRATENTORIALNEOPLASMSCHIS.ZEE,M.DPROFESSOROFRADIOLOGYANDNEUROSURGERYDIRECTOROFNEURORADIOLOGYTUMORIMAGINGPROTOCALSagT1WIAxialT1WIAxialT2WIAxialFLAIRPost-contrastT1WIinthreeplanesDiffusionweightedimaginganddiffusiontensorimagingMRprotonspectroscopyPerfu

2、sionimagingifneededMRProtonSpectroscopyCholineisthekeymetaboliteinbraintumor(aconstituentofthephospholipidcompositionofcellmembranes)InversecorrelationofcholevelwithADCvalueNAAlevelcorrelateswithneuronaltissueLactateisbelievedtobeduetoglycolyticactivityLipidsare

3、associatedwithcellularbreakdownandnecrosisCHEMICALSHIFTIMAGINGHamartomaRecurrentTumorvsRadiationchangesRecurrentTumorvsRadiationchangesPerfusionImagingRegionalCBViscalculatedfromsignalintensitylossengenderedbythepassageofcontrastPerfusionimagingprobablyreflectst

4、umorangiogenesisRegionalCBVcorrelateswithtumorvascularityandmitoticactivityPERFUSIONIMAGINGDiffusionTensorImagingPresurgicalplanningwithdiffusiontensorimagingusingtractographyInvolvementofwhitemattertractsbyinfiltratingtumorAnatomicallyintactwhitemattertractsmay

5、bepresentinabnormalappearingareasColorFAMap(TumorPatient)3DTractography(Tumorpatient)Exampleofalltractsthatintersectaselectedslice(slice14/28)INTRA-AXIALNEOPLASMSGlioblatomamultiforme胶母(WHOgadeVI)AnaplasticAstrocytoma(WHOgradeIII)InfiltratingAstrocytoma(WHOgrade

6、II)Well-definedAstrocytoma星行细胞瘤(WHOgradeI)Oligodendroglioma少突胶织细胞瘤Ependymoma室管膜瘤Ganglioglioma神经节细胞瘤DysembryoplasticneuroepithelialtumorPNET胚胎发育不良性神经上皮肿瘤Lymphoma淋巴瘤Metastasis转移瘤CEREBRALGLIOMASGBM(55%)Astrocytoma(20%)Ependymoma(6%)Oligodendroglioma(5%)Choroidplexu

7、spapilloma(3%)ASTROCYTOMAS(WHOgrade1)PilocyticastrocytomaPleomorphicxanthoastrocytomaGiantcellastrocytomaHypothalamic/opticGlioma视交叉胶质瘤GiantCellAstrocytoma巨细胞星形细胞瘤SUBEPENDYMALGIANTCELLASTROCYTOMAOccursalmostexclusivelyinpatientswithtuberoussclerosisintheirlatete

8、ensandearlytwenties10to15%ofpatientswithtuberoussclerosisdevelopSGCAArisefromsubependymalnoduleslocatedwallofthelateralventricleoverlyingtheheadofcaudatenucleusFLAIRP