Pontoserebellar köşe tümörlerinde dinamik kontrastlı manyetik rezonans görüntüleme bulguları

Yıl 2007, Cilt: 17 Sayı: 4, 217 - 223, 01.07.2007

Ahmet Kemal Fırat Hakkı Muammer Karakaş Bayram Kahraman Yezdan Fırat Tayfun Altınok Ahmet Kızılay

Öz

Amaç: Pontoserebellar köşe tümörlerinin konvansiyonel manyetik rezonans görüntüleme MRG ileayırıcı tanısı her zaman mümkün olmayabilir. Buçalışmada, dinamik kontrastlı MRG’nin akustik nörinom, meninjiyom ve paragangliyom ayırıcı tanısındaki rolü araştırıldı.Hastalar ve Yöntemler: Tanıları akustik nörinom n=3 , paragangliyom n=5 ve meninjiyom n=4 olan 12 olguda konvansiyonel MRG ile eşzamanlı dinamikMRG uygulandı. Bu olgularda kontrast sonrası T1Asekanslar öncesinde dinamik MRG elde edildi. Görüntülerde 15 ayrı zaman noktasındaki rölatif vemaksimum rölatif tepe kontrastlanma Kmaks değerleri ve bu değerlere erişmek için geçen süre Zmaks hesaplandı. Lezyonların zaman-sinyal intensite eğripaternleri karşılaştırıldı.Bulgular: Literatürde tanımlanan dört temel zaman- sinyal intensite eğrisine göre, akustik nörinomların tip C, meninjiyomların tip A ve tip B, paragangliyomların ise tip A ile uyumlu patern gösterdiği görüldü.Sonuç: Dinamik MRG’nin pontoserebellar köşe tümörleri gibi, ekstra-aksiyal intrakraniyal patolojilerinayrıcı tanısında sınırlı da olsa katkısı olabileceği düşünüldü

Anahtar Kelimeler

Pontoserebellar köşe/patoloji, manyetik rezonans görüntüleme

Dynamic contrast-enhanced magnetic resonance imaging findings of mass lesions of the pontocerebellar angle

Öz

Objectives: The differential diagnosis of mass lesions of the pontocerebellar angle is not always possible by conventional magnetic resonance imaging MRI . İn this study, we investigated the role of dynamic contrast- enhanced MRI in the differential diagnosis of acoustic neurinoma, meningioma, and paraganglioma.Patients and Methods: Twelve patients 8 females, 4 males; mean age 47.5 years; range 8 to 71 years whose diagnoses were acoustic neurinoma n=3 , paraganglioma n=5 , and meningioma n=4 were evaluated by simultaneous conventional and dynamic contrast-enhanced MRI. Prior to postcontrast Tr weighted images, dynamic MRI was obtained. On these images, maximum contrast enhancement Cmax and time to peak enhancement Tmax were calculated at 15 different time points. Time-signal intensity curve patterns of the lesions were compared.Results: According to the four main time-signal inten­ sity curve patterns described in the literatüre, acoustic neurinomas, meningiomas, and paragangliomas exhibited type C, type A-B, and type A curve patterns, respectively.Conclusion: Our results suggest that dynamic con­ trast MRI may have an additional but limited role in the differential diagnosis of extra-axial intracranial tumors such as those of the pontocerebellar angle.

Anahtar Kelimeler

Cerebellopontine angle/pathology, magnetic resonance imaging

Kaynakça

• Padhani AR. Dynamic contrast-enhanced MRI in clin- ical oncology: current status and future directions. J Magn Reson Imaging 2002;16:407-22.
• Tokumaru A, O’uchi T, Eguchi T, Kawamoto S, Kokubo T, Suzuki M, et al. Prominent meningeal enhancement adjacent to meningioma on Gd-DTPA- enhanced MR images: histopathologic correlation. Radiology 1990;175:431-3.
• Mikhael MA, Ciric IS, Wolff AP. Differentiation of cere- bellopontine angle neuromas and meningiomas with MR imaging. J Comput Assist Tomogr 1985;9:852-6.
• Ishimori Y, Kimura H, Uematsu H, Matsuda T, Itoh H. Dynamic T1 estimation of brain tumors using double- echo dynamic MR imaging. J Magn Reson Imaging 2003;18:113-20.
• Zhu XP, Li KL, Kamaly-Asl ID, Checkley DR, Tessier JJ, Waterton JC, et al. Quantification of endothelial per- meability, leakage space, and blood volume in brain tumors using combined T1 and T2* contrast-enhanced dynamic MR imaging. J Magn Reson Imaging 2000; 11:575-85.
• Ikushima I, Korogi Y, Kuratsu J, Hirai T, Hamatake S, Takahashi M, et al. Dynamic MRI of meningiomas and schwannomas: is differential diagnosis possible? Neuroradiology 1997;39:633-8.
• Vogl TJ, Mack MG, Juergens M, Bergman C, Grevers G, Jacobsen TF, et al. Skull base tumors: gadodiamide injection-enhanced MR imaging-drop-out effect in the early enhancement pattern of paragangliomas versus different tumors. Radiology 1993;188:339-46.
• Tuncbilek N, Karakas HM, Okten OO. Dynamic mag- netic resonance imaging in determining histopatho- logical prognostic factors of invasive breast cancers. Eur J Radiol 2005;53:199-205.
• Greess H, Bentzien S, Gjuric M, Lell M, Lenz M, Bautz W. Diagnosis of glomus jugulare tumor recurrence with dynamic contrast medium flow in MRI. [Article in German] Rofo 2000;172:753-8.
• Buadu LD, Murakami J, Murayama S, Hashiguchi N, Sakai S, Masuda K, et al. Breast lesions: correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis. Radiology 1996;200:639-49.
• Tuncbilek N, Unlu E, Karakas HM, Cakir B, Ozyilmaz F. Evaluation of tumor angiogenesis with contrast- enhanced dynamic magnetic resonance mammogra- phy. Breast J 2003;9:403-8.
• Verstraete KL, De Deene Y, Roels H, Dierick A, Uyttendaele D, Kunnen M. Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging-parametric “first-pass” images depict tis- sue vascularization and perfusion. Radiology 1994; 192:835-43.
• Tuncbilek N, Karakas HM, Okten O. Diabetic fibrous mastopathy: dynamic contrast-enhanced magnetic res- onance imaging findings. Breast J 2004;10:359-62.
• Sanders WP, Chundi VV. Extra-axial tumors including pituitary and parasellar. In: Orrison WW, editor. Neuroimaging. Philadelphia: W. B. Saunders; 2000. p. 612-719.