【双语病例】松果体囊肿一例MR影像表现

History

A 36-year-old woman undergoing brain MRI. History withheld.

36岁女性,行颅脑MR扫描。病史暂保留。

1.Where is the abnormality?

Calvarium 颅顶

Base of tongue 舌根

Pineal region 松果体区

Suprasellar cistern 鞍上池

T2 and Flair images

2.Lesion in the pineal region follows cerebrospinal fluid signal.

松果体区病灶与脑脊液呈等信号。

True

False

Pre- and postcontrast images

3.There is enhancement associated with the pineal mass.

增强扫描,松果体区肿块可见强化。

True

False

4.What is the diagnosis?

Pineal cyst 松果体区囊肿

Teratoma 畸胎瘤

Metastasis 转移瘤

Pineocytoma 松果体瘤

选择题答案:

  1. Pineal region

  2. FalseThere is not complete suppression of signal on the FLAIR sequence suggesting proteinaceous fluid in the cyst.

    FLAIR序列上病灶信号没有完全被抑制,提示囊液内含有蛋白成分。

  3. TrueThere is faint rim enhancement.

    病灶周边轻微环形强化。

  4. Pineal cyst

Findings and Diagnosis

Findings

  • There is a T2 hyperintense and T1 hypointense cystic mass in the pineal region. Internal contents do not suppress on FLAIR.松果体区可见长T1长T2信号囊性肿块,其内容物于FLAIR序列不完全抑制。
  • There is slight rim enhancement. No internal enhancement.增强扫描病灶周边轻度环形强化,内部无强化。
Differential Diagnosis

  • Pineal cyst 松果体囊肿
  • Pineocytoma 松果体瘤
  • Metastasis 转移瘤
  • Germ cell tumor 生殖细胞瘤
DiagnosisPineal cyst

松果体囊肿

Discussion

Imaging Findings

  • T1: Typically iso- to hypointense compared to brain parenchyma. Often can be T1 hyperintense. Homogenous in signal.T1:与脑实质相比,典型表现为等至低信号。也常可见T1WI高信号。内部信号较均匀。
  • T2: Typically T2 hyperintense.T2WI呈高信号。
  • FLAIR: Often does not fully attenuate.FLAIR:病灶信号减低,但不完全抑制。
  • T1 contrast: Approximately 60% of lesions enhance; however, the enhancement is usually thin, measures less than 2 mm, and is confined to the rim (complete or incomplete).T1WI增强扫描:约60%的病灶可见周边环形强化(呈完整或不完整的环形),一般为不超过2mm的薄壁强化。
Differential Diagnosis

  • Pineocytoma (other pineal parenchymal tumors): Avid enhancement is usually seen, solid or peripheral.松果体瘤(其他松果体实质肿瘤):常为肿瘤实质或周边明显强化。
  • Metastasis: Usually solid enhancement.转移瘤:通常表现为实性部分强化。
  • Germ cell tumor: Usually solid enhancement and larger with more mass effect.生殖细胞瘤:通常为实质部分强化,一般体积较大,且伴有占位效应。
Treatment
  • In the vast majority of cases, no treatment is needed.绝大部分无需特殊治疗。
  • Consider follow-up if lesion measures 10-14 mm, as sometimes pineocytomas can be almost all cystic.由于部分松果体瘤可完全囊变,所以如果病灶大小达到10-14mm,则需要随访观察。

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