板障腦膜瘤-課件

板障腦膜瘤--課件1臨床資料男性，54歲發(fā)現(xiàn)左額顳部隆起4年余，呈漸進(jìn)性增大，質(zhì)硬，無(wú)滑動(dòng)臨床資料男性，54歲2影像學(xué)檢查2012.4.20顱腦CT平掃影像學(xué)檢查3其他檢查2012.4.19同濟(jì)醫(yī)院CT示左側(cè)額顳骨梭形病灶考慮為良性病變所致其他檢查4術(shù)中表現(xiàn)病變顱骨內(nèi)側(cè)面與腦膜完全粘連，部分硬膜已骨化，與腦組織有輕微粘連術(shù)中表現(xiàn)5板障腦膜瘤--課件6術(shù)后病理：腦膜瘤術(shù)后病理：腦膜瘤7PrimaryintraosseousmeningiomaConstitute1to2%ofallmeningiomasRepresentsapproximatelytwothirdsofallextraduralmeningiomasElder,J.B.,etal.,Primaryintraosseousmeningioma.NeurosurgFocus,2007.23(4):p.E13.Primaryintraosseousm8ClassificationIntraosseousmeningiomascouldbeconsideredTypeIIorIIIprimaryextraduralmeningiomasbasedonwhetherextracalvarialextensionClassificationIn9Hyperostoticismajority,OsteolyticisrarelyHyperostoticismajority,Oste10ClinicalPresentationSex：withthesamefrequency

Age：twopeaks，theseconddecadeandduringthefifththroughseventhdecadesUsuallyslowgrowingandpainlessClinicalPresentati11RadiographicappearanceDependslargelyontheirlocationandtheeffectsofthetumoronthesurroundingboneRadiographicappearance12Radiographicappearance

osteoblasticX-ray：hyperostosis,irregularfociofcalcification,andatypicalvascularmarkingsCT（withbonewindows）：hyperdense(65to85Hu)，enhancesdenselyMRI:T1WIhypointense，T2WIhyperintense，homogeneousenhancementDonotusuallyexhibitthe“duraltail”Radiographicappearan13Radiographicappearance

osteolyticX-ray：hypodenseCT：thinning,expansion,andinterruptionoftheinnerandoutercorticallayersoftheskull,enhancehomogeneouslyMRI：similartoosteoblasticRadiographicappearance

14PartialaxialviewsofthepreoperativeCTscansshowinghyperostosisoftheleftsphenoidboneprotrudingintotheorbit,resultinginproptosis.Partialaxialviewsofthepre15Axial(upper)andcoronal(lower)T1-weightedMRimagesafterGdcontrastadministration,showingahypointensemasswithmoderateperipheralenhancement.Alsonotedisthemasseffectontheorbitcausingproptosis.Axial(upper)andcoronal(low16DifferentialDiagnosisDifferentialDiagnos17Fibrousdysplasia

Anteroposteriorskullradiograph(a)ofa24-year-oldfemaledemonstratesascleroticlesionintherighttemporalbone.AxialCTimageinbonewindow(b)revealsaground-glassappearanceintherighttemporalbone.OnaxialSET1-weightedMRimage(c),ahypointenseexpansilelesionoriginatingfromthediploeisseen.Yalcin,O.,etal.,CTandMRIfindingsincalvarialnon-infectiouslesions.DiagnIntervRadiol,2007.13(2):p.68-74.Fibrousdysplasi18UsuallystopsgrowingafterpubertyHomogenousground-glassappearanceExpansionconfinedtotheoutertable,andnoaffectontheinnertableUsuallystopsgrowingafterpu19OsteomaAxialCTimage(a)ofa45-year-oldfemaledemonstratesawelldefinedfocalsclerosisoriginatingfromtheoutertableoftherightfrontalbone.AxialTSET2-weighted(b)MRimageshowsasignalvoidlesionOsteomaAxi20nonenhancingnonenhancing21OsteosarcomaAxialCTimages(a)inboneandparenchymal(b)windowsandcoronalreformattedCTimage(c)ofa28-yearoldfemaledemonstratealesionarisingfromthelateralwalloftheorbitaextendingtothetemporalbone,withdestructionandasunburstpattern.ThelesionalsocontainsasofttissuecomponentOsteosarcomaAxia22Irregularcontours,heterogeneoussignal,andenhancementIrregularcontours,heterogene23PagetdiseasePagetdisease24Intheosteolyticstage,therearelyticlesionsthaterodetheoutertableIntheosteoscleroticstage,differentiationbetweentheinnerandoutertablesislostandthediploewidensInmixedstage,irregularareasofsclerosisdemonstrateacotton-woolappearanceLaboratorytest：serumalkalinephosphataseistypicallyelevated板障腦膜瘤--課件25MultiplemyelomaLateralCTscanogram(a)ofa64-year-oldfemaledemonstratesalesionnearthevertexresemblingapunchholeassociatedwithasofttissuecomponentaswellasmanyotherlyticcraniallesions.Parenchymal(b)andbone(c)windowaxialCTimagesshowpunchholelesionsinvolvingtheinnerandoutertablesthroughoutthecraniumwithanassociatedsofttissuecomponentMultiplemyelomaLa26MetastasisApatient,whohadundergonesurgeryforthyroidcancer20yearsearlier,presentedwiththecomplaintofaslowgrowing,painlessswellinginthecranium.AxialCT(a),andTSET2-weighted(b),andSEpost-contrastT1-weightedMRimages(c)depictasolitarymetastaticmasslesionintherightparietalbone.Thelesiondestroystheinnerandoutertables.Itisexpansileandhasasofttissueco