板障脑膜瘤--课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版文本样式,第二级,*,*,*,单击此处编辑母版标题样式,板障脑膜瘤-课件,1,临床资料,男性，54岁,发现左额颞部隆起4年余，呈渐进性增大，质硬，无滑动,临床资料男性，54岁,2,影像学检查,2012.4.20,颅脑CT平扫,影像学检查,3,其他检查,2012.4.19 同济医院CT示左侧额颞骨梭形病灶考虑为良性病变所致,其他检查,4,术中表现,病变颅骨内侧面与脑膜完全粘连，部分硬膜已骨化，与脑组织有轻微粘连,术中表现,5,板障脑膜瘤-课件,6,术后病理：脑膜瘤,术后病理：脑膜瘤,7,Primary intraosseous meningioma,Constitute,1 to 2%,of all meningiomas,Represents approximately,two thirds,of all extradural meningiomas,Elder,J.B.,et al.,Primary intraosseous meningioma.Neurosurg Focus,2007.23(4):p.E13.,Primary intraosseous m,8,Classification,Intraosseous meningiomas could be considered,Type II or III,primary extradural meningiomas based on whether extracalvarial extension,ClassificationIn,9,Hyperostotic is majority,Osteolytic is rarely,Hyperostotic is majority,Oste,10,Clinical Presentation,Sex：with the same frequency,Age：two peaks，the second decade and during the fifth through seventh decades,Usually slow growing and painless,Clinical Presentati,11,Radiographic appearance,Depends largely on their location and the effects of the tumor on the surrounding bone,Radiographic appearance,12,Radiographic appearance -osteoblastic,X-ray：hyperostosis,irregular foci of calcification,and atypical vascular markings,CT（with bone windows）：hyperdense(65 to 85Hu)，enhances densely,MRI:T1WI hypointense，T2WI hyperintense，homogeneous enhancement,Do not usually exhibit the,“dural tail”,Radiographic appearan,13,Radiographic appearance -osteolytic,X-ray：hypodense,CT：thinning,expansion,and interruption of the inner and outer cortical layers of the skull,enhance homogeneously,MRI：similar to osteoblastic,Radiographic appearance,14,Partial axial views of the preoperative CT scans showing hyperostosis of the left sphenoid bone protruding into the orbit,resulting in proptosis.,Partial axial views of the pre,15,Axial(upper)and coronal(lower)T1-weighted MR images after Gd contrast administration,showing a hypointense mass with moderate peripheral enhancement.Also noted is the mass effect on the orbit causing proptosis.,Axial(upper)and coronal(low,16,Differential Diagnosis,Differential Diagnos,17,Fibrous dysplasia,Anteroposterior skull radiograph(a)of a 24-year-old female demonstrates a sclerotic lesion in the right temporal bone.Axial CT image in bone window(b)reveals a ground-glass appearance in the right temporal bone.On axial SE T1-weighted MR image(c),a hypointense expansile lesion originating from the diploe is seen.,Yalcin,O.,et al.,CT and MRI findings in calvarial non-infectious lesions.Diagn Interv Radiol,2007.13(2):p.68-74.,Fibrous dysplasi,18,Usually stops growing after puberty,Homogenous ground-glass appearance,Expansion confined to the outer table,and no affect on the inner table,Usually stops growing after pu,19,Osteoma,Axial CT image(a)of a 45-year-old female demonstrates a welldefined,focal sclerosis originating from the outer table of the right frontal bone.Axial TSE T2-weighted(b)MR image shows a signal void lesion,OsteomaAxi,20,nonenhancing,nonenhancing,21,Osteosarcoma,Axial CT images(a)in bone and parenchymal(b)windows and coronal reformatted CT image(c)of a 28-yearold female demonstrate a lesion arising from the lateral wall of the orbita extending to the temporal bone,with destruction and a sunburst pattern.The lesion also contains a soft tissue component,OsteosarcomaAxia,22,Irregular contours,heterogeneous signal,and enhancement,Irregular contours,heterogene,23,Paget disease,Paget disease,24,In the osteolytic stage,there are lytic lesions that erode the outer table,In the osteosclerotic stage,differentiation between the inner and outer tables is lost and the diploe widens,In mixed stage,irregular areas of sclerosis demonstrate a cotton-wool appearance,Laboratory test,：,serum alkaline phosphatase is typically elevated,板障脑膜瘤-课件,25,Multiple myeloma,Lateral CT scanogram(a)of a 64-year-old female demonstrates a lesion near the vertex resembling a punch hole associated with a soft tissue component as well as many other lytic cranial lesions.Parenchymal(b)and bone(c)window axial CT images show punch hole lesions involving the inner and outer tables throughout the cranium with an associated soft tissue component,Multiple myelomaLa,26,Metastasis,A patient,who had undergone surgery for thyroid cancer 20 years earlier,presented with the complaint of a slowgrowing,painless swelling in the cranium.Axial CT(a),and TSE T2-weighted(b),and SE post-contrast T1-weighted MR images(c)depict a solitary metastatic mass lesion in the right parietal bone.The lesion destroys the inner and outer tables.It is expansile and has a soft tissuecomponent.It extends through the dura mater and subcutaneous tissue,and shows a dense homogenous enhancement pattern.,MetastasisA,27,板障脑膜瘤-课件,28,The end,！,Thank you,！,The end！,29,