摘要
目的：研究鞍上生殖细胞瘤的CT、MRI影像特征，分析主要误诊原因。方法：回顾性分析14例影像误诊，而经手术证实的鞍上生殖细胞瘤病例，总结其CT、MRI影像学表现及误诊原因。结果：本组14例鞍上生殖细胞瘤好发于儿童和青少年（平均年龄15.5岁），女性（n=8）稍多于男性。临床症状以多饮多尿（n=8）、闭经（n=3）等下丘脑-垂体轴受损症状及视力下降（n=7）为主。血清或脑脊液β-HCG（n=4）可升高。其影像表现以实性为主（n=10），部分可见囊变（n=4），钙化少见（n=2）。CT平扫呈稍高密度，MRI扫描T1、T2均为等或稍高信号。增强扫描呈明显均匀强化（n=7）。本组鞍上生殖细胞瘤误诊原因包括：①因检查不全未明确诊断（n=6）；②因年龄或钙化误诊为颅咽管瘤（n=6）；③因“雪人征”误诊为垂体瘤（n=3）；④因年龄及其他原因误诊为胶质瘤（n=3）。结论：鞍上生殖细胞瘤易误诊为颅咽管瘤、垂体瘤、胶质瘤等，需要在完善影像学检查的基础上，结合患者年龄、临床表现、实验室检查及影像表现综合诊断。
Abstract
Objective: To study imaging features of suprasellar germinoma, and analyse the reasons of diagnostic error. Methods: The imaging findings of 14 misdiagnosed and pathologically confirmed suprasellar germinoma cases were retrospectively reviewed. The most common causes of diagnostic error were analysed. Results: Teenagers(mean age 15.5y) and female patients(n=8) were more common in these suprasellar germinoma patients, clinical features including visual loss(n=7) and hypothalamic-pituitary dysfunction symptoms, such as polydipsia, polyuria(n=8) and amenorrhea(n=3). Sometimes serum or cerebrospinal fluid β-HCG elevation could be recognized(n=4). The tumors were mainly solid(n=10), cystic change(n=4) could be seen in some cases. Calcification(n=2) was rare. They showed slightly high density on CT scan, iso-high signal on MRI scan. The lesions were usually obviously and homogenously enhanced(n=7). The common causes of misdiagnosis include: ①unconfirmed diagnosis because of incomplete imaging examination(n=6), ②craniopharyngioma due to calcification or age(n=6), ③pituitary adenoma because of "snowman sign"(n=3), ④glioma because of age or other reasons(n=3). Conclusion: Suprasellar germinoma tends to be misdiagnosed as craniopharyngioma, pituitary adenoma, or glioma. Correct diagnosis of suprasellar germinoma should base on complete imaging examination and in the meanwhile, patient's age, clinical symptoms, laboratory examination should be taken into consideration.
关键词
脑肿瘤 /
生殖细胞瘤 /
体层摄影术 /
螺旋计算机 /
磁共振成像 /
误诊
Key words
Brain neoplasms /
Germinoma /
Tomography /
spiral computed /
Magnetic resonance imaging /
Diagnostic errors
程婉滢;高培毅.
鞍上生殖细胞瘤的影像诊断及误诊分析[J]. 中国临床医学影像杂志. 2011, 22(9): 609-611
CHENG Wan-ying;GAO Pei-yi.
Imaging diagnosis of suprasellar germinoma and diagnostic errors analysis[J]. Journal of China Clinic Medical Imaging. 2011, 22(9): 609-611
中图分类号：
Ｒ739.41
R730.262
R814.42
Ｒ445.2
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