硬膜浆细胞瘤的MR诊断.4.2.ppt
MR diagnosis of Dural Plasmacytomas 硬脑膜浆细胞瘤MR诊断,Dural plasmacytomas are uncommon extramedullary plasma cell tumors that should be considered in patients with a dural mass and history of plasma cell dyscrasia.硬脑膜浆细胞瘤是一种不常见的髓外浆细胞肿瘤，当病人有浆细胞性恶液质病史，出现硬膜肿块时需要考虑到本病的可能。,Overview,Only see a small number of reported literature国内外文献仅见少数报道And proposed the following diagnostic criteria并提出如下诊断标准no other bone involvement in x-rayX线无其它骨受累Must be confirmed histologically必须有组织学证实 Bone marrow biopsy negative骨髓穿刺阴性 Not Proteinuria,hyperlipidemia无高蛋白血症和本周蛋白尿,74-year-old female with history of headache.74岁女性，头痛。,Case,isointense signal on TI relatively在T1序列上呈相对的等信号,isointense signal on T2 relatively在T2序列上呈相对的等信号,增强T1WI横轴位The lesion demonstrates homogeneous contrast enhacement,增强T1WI冠状位The lesion demonstrates homogeneous contrast enhacement in Coronal,There is an extra-axial,dural based mass predominantly in the high left posterior parietal region which is relatively isointense signal on TI and T2 sequences.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。,1,2,The lesion demonstrates homogeneous contrast enhacement on post contrast sequences,(yellow arrow in Figure 3).Extension along the interhemispheric fissure(yellow arrow in Figure 4),encasement of the superior sagittal sinus(red arrow inFigure 4)and extension across midline to the right(blue arrow in Figure 4)is demonstrated.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）,3,4,Differentiation between the solitary form and plasmacytoma in association with multiple myeloma has important treatment implications.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,Imaging characteristics of dural plasmacytomas may closely resemble those of meningiomas.硬膜浆细胞瘤的影像特征与脑膜瘤非常相似。,Plasmacytomas of the dural are uncommon plasma cell tumors that may occur as a solitary neoplasm more commonly,in association with multiple myeloma.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。The latter is usually accompanied by multiple lytic lesions of the skull.后者通常伴有颅骨多发性囊性病变。,In distinction,solitary craniocerebral plasmacytomas are relatively benign and potentially curable.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,distinction between the two has important clinical consequences.因此，两者的鉴别有重要的临床意义。,The differential diagnosis for dural plasmacytoma includes metastasis,lymphoma,dural sarcoma,plasma cell granuloma and meningioma.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。,Differential Diagnosis,First,to exclude myeloma and other parts of the plasma cell sarcoma involving the intracranial首先要排除骨髓瘤和其他部位的浆细胞肉瘤累及颅内Because they are completely different treatment and prognosis因为它们的治疗及预后完全不同Learn more about the history through which bone or other parts of the primary tumor can be identified通过详细了解病史，后者有骨或其他部位的原发灶可鉴别,And is the difference between plasma cell granuloma,which is fully mature plasma cells,and mixed more lymphocytes and plasma cells and other inflammatory cells.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,Dural plasmacytomas are often confused with meningiomas(the most common extra-axial neoplasm found in adults)as the two have similar features and imaging characteristics.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。,Both occur more commonly in women during the fifty year old with a predilection for similar sites of involvement including the cerebral convexities,sphenoid ridge,falx and tentorium.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。,On MR both may appear nearly isointense to brain on T1W images and iso-to hyperintense on T2W images with marked contrast enhancement.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。,A characteristic dural tail and intratumoral calcifications may be seen in both lesions.特征性的脑膜尾征和软脑膜钙化也都可以见于两者。,Second,with the rich in lymphocytes-plasma cells in the meningioma difference between the first image of their organization have meningioma components were mixed lymphocytes and plasma cells infiltration,and the disease lack the basic image of meningioma,and a single mature Plasma cells.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。,Other manifestations of intracranial plasmacytoma may include diffuse leptomeningeal disease and rarely,intracerebral lesions with vasogenic edema.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。These patients may present with intracranial hypertension and/or focal neurological signs from the dural origin of the tumor.这些病变可以表现为颅高压和/或局部神经定位体征。,Clinical manifestations,Clinically,individuals with solitary dural plasmacytomas can be distinguished from those with multiple myeloma by the absence of hypercalcemia,renal insufficiency,anemia,lytic osseoues lesions,bone marrow plasmacytosis,and elevated serum or urinary paraprotein.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。,Solitary meningeal plasmacytoma generally complete resection,prognosis than the brain parenchyma and multiple myeloma good.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,Following surgical decompression and/or local radiotherapy for a solitary dural plasmacytoma,the prognosis is good.通过外科减压术和/或局部的放疗，孤立性浆细胞瘤预后可以相对良好.This is in contrast to patients with plasmacytoma and multiple myeloma who typically have a much poor prognosis.而多发性骨髓瘤的预后通常更糟糕。,Thank you！,
