影像园论坛

 找回密码
 注册会员

扫一扫,访问微社区

QQ登录

只需一步,快速开始

邀请好友赚积分!大型设备上岗证专栏 新手任务奖励区每日一例
最新推荐影像专业书赚取论坛积分方法放射中级考试专题
查看: 4165|回复: 3

[MRI] 鼻部血管瘤(Nasal Hemangioma)MRI病例点评

  [复制链接]

签到天数: 23 天

[LV.4]偶尔看看III

升级 
 
52.4%
发表于 2012-4-23 12:07:48 | 显示全部楼层 |阅读模式
1. What are the imaging findings in this 1-year-old girl?
1.女,1岁。该患儿的影像学表现是什么?
2. What is your diagnosis?
2.你的诊断是什么?
3. What is the differential diagnosis?
3.鉴别诊断是什么?
4. Are there any malformative anomalies associated with this entity?
4.本病有哪些相关的畸形?

本帖子中包含更多资源

您需要 登录 才可以下载或查看,没有帐号?注册会员

x

签到天数: 23 天

[LV.4]偶尔看看III

升级 
 
52.4%
 楼主| 发表于 2012-4-23 12:08:11 | 显示全部楼层
Diagnosis: Nasal Hemangioma
诊断:鼻部血管瘤
1. The image shows a well-circumscribed lobular mass, with increased T2 signal and avid contrast enhancement noted in the subcutaneous fat of the nasal bridge. There are vascular flow voids within the mass seen best on T2-weighted image. No evidence of intracranial extension exists.
1.影像学检查于鼻梁皮下脂肪内可见一边界清楚的分叶状肿块,于T2WI呈高信号,增强扫描可见明显强化。肿块内的血管流空于T2WI显示最为清楚。未见肿块蔓延至颅内。
2. The patient has nasal hemangioma.
2.鼻部血管瘤。
3. In general, vascular malformations such as venous malformations, lymphatic malformations, and arteriovenous malformation (AVM) can be considered. Differential diagnosis would be affected by the location as well. In this case encephalocele, nasal dermoid, and nasal glioma could also be considered, but the previously defined imaging
features lead to a correct diagnosis.
3.一般情况下,应考虑与血管畸形相鉴别,如静脉畸形、淋巴管畸形、动静脉畸形(AVM)等。另外,鉴别诊断时,还需考虑病变的部位。本例还需与脑膨出、皮样囊肿、鼻神经胶质瘤等相鉴别。但本例的影像学表现提示本例为鼻部血管瘤。
4. Yes, the malformative anomalies include PHACES syndrome (posterior fossa malformations, hemangiomas, arterial abnormalities, coarctation of the aorta, and eye abnormalities); Dandy-Walker malformation; spine anomalies if located in the lumbar region; and Kasabach-Merritt syndrome.
4.与本病相关的畸形包括PHACES综合征(后颅窝畸形、血管瘤、动脉异常、主动脉缩窄、眼异常)(posterior fossa malformations, hemangiomas, arterial abnormalities, coarctation of the aorta, and eye abnormalities)、Dandy-Walker畸形、脊柱畸形(如血管瘤位于腰部)、Kasabach-Merritt综合征。

Reference 参考文献
Mulliken JB, Glowacki J: Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics, Plast Reconstr Surg 69(3):412–422, 1982.

Cross-Reference 相关参考文献
Blickman JG, Parker BR, Barnes PD: Pediatric radiology— the requisites, ed 3, Philadelphia, 2009, Mosby Elsevier, pp 314–316.

Comment 点评
Hemangiomas are the most common tumors in infancy and childhood and account for 7% of benign soft tissue tumors. Hemangiomas are tumors that express a localized increase in angiogenic growth factors. Mulliken and Glowacki first described the classification of vascular anomalies based on clinical, histologic, and cytologic features. Vascular anomalies are divided into two major groups: (1) vascular tumors (hemangiomas), and (2) vascular malformations including venous malformations, lymphatic malformations, AVMs, and arteriovenous fistulas. The correct classification is important because treatment options differ significantly between the two groups. Hemangiomas have cellular proliferation of endothelial cells, and they are true neoplasms. infantile Hemangiomas have subgroups consisting of infantile, congenital, noninvoluting, intramuscular, and kaposiform hemangioendothelioma types. The most common type is infantile hemangioma. Hemangiomas test positive for immunological markers such as glut1, FcrII, merosin, and Lewis Y antigen. A 3:1 female-to-male ratio exists. 血管瘤是小儿最常见的肿瘤,占良性软组织肿瘤的7%。血管瘤局部的血管生长因子增加。Mulliken和Glowacki最早根据临床、组织学和细胞学特征对血管异常进行了分类。血管异常可分为两大类型:(1) 血管性肿瘤(血管瘤); (2)血管畸形,包括静脉畸形、淋巴管畸形、动静脉畸形、动静脉瘘。对血管异常进行正确分类极为重要,因为两类血管异常的治疗方法大不相同。血管瘤内有上皮细胞增生,是真性肿瘤,又可进一步分为婴儿型血管瘤、先天性血管瘤、不消退型血管瘤、肌间血管瘤、卡波西样血管内皮细胞瘤,其中婴儿型血管瘤最为常见。血管瘤免疫标记物(如glut1、FcrII、分层蛋白、Lewis Y抗体等)试验阳性。男女发病比例约为1:3。

Hemangiomas usually appear in the first week of life and can be located in the head and neck (60%), the trunk (25%), and the extremities. The patient displays a typical history of rapid neonatal growth (3 to 9 months) and slow involution characterized by hypercellularity during the proliferating phase, as well as fibrosis and diminished cellularity during the involuting phase (18 months to 10 years). This typical clinical history is oftentimes diagnostic; however, certain cases would require imaging confirmation.
血管瘤常见于出生1周内的新生儿,可位于头颈部(60%)、躯干(25%)和四肢。肿瘤一般有典型的迅速生长期(3-9个月)和缓慢消退期。生长期,肿瘤细胞增多;消退期(18个月-10岁),肿瘤纤维化、细胞减少。这种典型的临床经过常很有诊断价值,但某些病理还需行影像学检查以确诊。

Imaging findings would obviously depend on the phase of the hemangioma. In the rapid-growth phase, ultrasound would reveal a variable echogenicity mass with increased flow on color-coded Doppler sonography. Involuting hemangiomas are heterogeneous masses with less intense color flow and fibrofatty changes. A magnetic resonance image (MRI) is advised with T1, T2, and postcontrast T1-weighted images. Fat suppression is of additional value in identifying this lesion. On MRI, typically a parenchymal, well-circumscribed mass with intermediate signal intensity on T1 and increased signal intensity on T2-weighted images is visualized. Avid contrast uptake is also noted, and the presence of flow voids within and around the soft tissue mass is an important feature.
血管瘤的影像学表现显然取决于其所处的时期。在快速生长期,超声可见回声不定的肿块,于彩色多普勒超声可见血流增加。消退期,血管瘤呈混杂回声肿块,其内血流减少,呈纤维脂肪变。行MRI检查时,推荐使用T1、T2平扫和T1增强扫描。压脂相对于血管瘤的诊断亦有一定的价值。血管瘤在MR常表现为边界清楚的实质性肿块,T1呈等信号,T2呈高信号。增强扫描,肿块明显强化。肿块内及其周边的流空亦是其重要的征象。

In the majority of cases, no treatment is required because of spontaneous involution. Indications for treatment in the remainder of the cases are primarily functional, such as obscuration of vision or breathing or persistent cutaneous ulceration, high cardiac output failure. Systemic or intralesional steroid agents can be used for treatment. Promising results with systemic propranolol admission has been reported.
大部分血管瘤病例可自行消退,故无需治疗。血管瘤的治疗指征主要是功能性的,如视野遮蔽、呼吸阻塞、持续性皮肤溃疡、高输出性心力衰竭等。可采用类固醇类药物进行全身性或局部治疗。有文献报道,心得安对血管瘤已取得了很好的疗效。
回复 支持 1 反对 0

使用道具 举报

签到天数: 130 天

[LV.7]常住居民III

升级 
 
57.4%
发表于 2013-1-7 19:35:46 | 显示全部楼层
谢谢分享!!
回复 支持 反对

使用道具 举报

签到天数: 329 天

[LV.8]以坛为家III

升级 
 
52.5%
发表于 2013-4-12 06:49:57 | 显示全部楼层
好资料,谢谢老师分享。
回复 支持 反对

使用道具 举报

您需要登录后才可以回帖 登录 | 注册会员

本版积分规则

免责声明|小黑屋|手机版|Archiver|排行榜|更新|XCTMR.COM ( 京ICP备13015137号-4

GMT+8, 2019-11-15 23:12 , Processed in 0.088758 second(s), 16 queries , Gzip On, Memcache On.

Powered by Discuz! X3.2

© 2001-2013 Comsenz Inc.

快速回复 返回顶部 返回列表