Rathke囊肿的MRI诊断与鉴别诊断(1)
【摘要】 目的：分析Rathke囊肿的MRI表现，提高Rathke囊肿的MRI诊断和鉴别诊断水平。方法：搜集经临床随访和手术病理诊断的12例Rathke囊肿患者的临床和MRI资料，所有病例均行MRI平扫，其中11例同时进行MRI增强扫描，分析囊肿的具体位置、大小、形态、边缘和MRI表现。结果：12例Rathke囊肿最大径均小于10 mm，位于鞍内10例，位于鞍上2例。囊肿边缘光滑锐利，11例形态规则，1例呈分叶状。MRI平扫上T1WI和T2WI呈多种不同信号组合，其中6例T1WI呈低信号和T2WI呈高信号，11例增强扫描后呈环形强化1例，未见强化10例。12例均未见囊内结节或囊底沉淀物征象。结论：鞍内Rathke囊肿的MRI表现较具有诊断特征，鞍上型Rathke囊肿较少见且常需要与鞍区其他囊性病变鉴别。
【关键词】 Rathke囊肿； MRI； 诊断； 鉴别诊断
【Abstract】 Objective：To analyze the MRI findings of Rathke’s cleft cyst and to improve the level of MRI diagnosis and differential diagnosis in rathke’s cleft.Method：The clinical and MRI data of 12 patients with Rathke’s cleft cyst proved by clinical follow-up and surgical pathology were collected.All patients received MRI plain scanning and 11 patients received contrast-enhanced scanning at the same time.The location，size，shape，margin and MRI findings of Rathke’s cleft cyst were analyzed.Result：The maximal diameter of the 12 rathke’s cleft cysts was less than 10 mm.There were 10 cysts in the intrasella and 2 cysts in the suprasellar.The margins of all cysts were clear.11 cysts were regular in shape and 1 cyst was lobular.There were diverse signals on T1WI and T2WI.The low signal on T1WI and high signal on T2WI were seen in 6 Rathke’s cleft cysts.After enhancement scan in 11 patients，only 1 cyst was enhanced peripherally and the other 10 cysts were not enhanced.The intracystic nodule and bottom sediment did not appear in all Rathke’s cleft cysts.Conclusion：The MRI appearance of intrasellar Rathke’s cleft cysts is more characteristic in diagnosis.However，the suprasellar Rathke’s cleft cyst is seldom seen，it often needs differential diagnosis from the other cystic lesions in the sellar region.
, http://www.100md.com
【Key words】 Rathke’s cleft cyst； MRI； Diagnosis； Differential diagnosis
First-author’s address：Yantian District People’s Hospital of Shenzhen City，Shenzhen 518081，China
doi：10.3969/j.issn.1674-4985.2015.32.024
Rathke囊肿是一种发生于鞍区的良性上皮性囊肿，又称垂体囊肿、上皮样囊肿和垂体胶样囊肿等，在临床和影像学表现上有时与鞍区蛛网膜囊肿、垂体瘤卒中、囊性颅咽管瘤和空蝶鞍等其他囊性病变相似而出现误诊，常需要进行鉴别诊断[1-5]。目前国内不同文献报道中Rathke囊肿MRI表现的病例样本大小不一，其MRI信号也表现多样。本文搜集12例Rathke囊肿的临床和MRI资料加以分析，结合文献复习以提高Rathke囊肿的MRI诊断与鉴别诊断水平，现报道如下。
, 百拇医药
1 资料与方法
1.1 一般资料 搜集经临床随访和手术病理诊断的12例Rathke囊肿患者的临床和MRI资料，其中男5例，女7例，年龄9～80岁，平均(37.9±6.1)岁。患者就诊时临床症状包括闭经1例，性腺功能低下1例，头痛2例(其中1例伴有颅骨多发骨纤维异常增殖症)，另外2例和6例分别因头部外伤和颈部不适而偶然发现。4例手术(1例经颅病灶切除，3例经蝶病灶切除)，术中发现2例囊内容物为淡黄色黏稠物，2例囊内容物为白色黏液物，送检组织病理显示囊壁为纤维组织和纤毛柱状上皮细胞构成。
1.2 方法
1.2.1 检查方法 所有患者均行头部MRI平扫检查，采用Siemens 1.5T 和Philips Achieva 1.5T超导型MR机和相控阵头部线圈，常规行自旋回波序列冠状面和矢状面T1WI成像、快速自旋回波序列冠状面T2WI成像，部分加做快速自旋回波序列矢状面T2WI成像和脂肪抑制自旋回波序列矢状面T1WI成像。扫描参数：T1WI(TR/TE 340～500 ms/15～20 ms)，T2WI(TR/TE 3000～3500 ms/100～120 ms)，扫描视野16 cm×16 cm，矩阵256×256，层厚3～5 mm，层间隔0.3～0.5 mm，激励次数2～3次，其中11例增强扫描按0.1 mmol/kg体重剂量经肘前静脉或肘静脉快速注射钆喷酸葡胺(Gd-DTPA)对比剂后获得横断面、矢状面和冠状面自旋回波序列T1WI成像。, http://www.100md.com(林天武 高振华)
【关键词】 Rathke囊肿； MRI； 诊断； 鉴别诊断
【Abstract】 Objective：To analyze the MRI findings of Rathke’s cleft cyst and to improve the level of MRI diagnosis and differential diagnosis in rathke’s cleft.Method：The clinical and MRI data of 12 patients with Rathke’s cleft cyst proved by clinical follow-up and surgical pathology were collected.All patients received MRI plain scanning and 11 patients received contrast-enhanced scanning at the same time.The location，size，shape，margin and MRI findings of Rathke’s cleft cyst were analyzed.Result：The maximal diameter of the 12 rathke’s cleft cysts was less than 10 mm.There were 10 cysts in the intrasella and 2 cysts in the suprasellar.The margins of all cysts were clear.11 cysts were regular in shape and 1 cyst was lobular.There were diverse signals on T1WI and T2WI.The low signal on T1WI and high signal on T2WI were seen in 6 Rathke’s cleft cysts.After enhancement scan in 11 patients，only 1 cyst was enhanced peripherally and the other 10 cysts were not enhanced.The intracystic nodule and bottom sediment did not appear in all Rathke’s cleft cysts.Conclusion：The MRI appearance of intrasellar Rathke’s cleft cysts is more characteristic in diagnosis.However，the suprasellar Rathke’s cleft cyst is seldom seen，it often needs differential diagnosis from the other cystic lesions in the sellar region.
, http://www.100md.com
【Key words】 Rathke’s cleft cyst； MRI； Diagnosis； Differential diagnosis
First-author’s address：Yantian District People’s Hospital of Shenzhen City，Shenzhen 518081，China
doi：10.3969/j.issn.1674-4985.2015.32.024
Rathke囊肿是一种发生于鞍区的良性上皮性囊肿，又称垂体囊肿、上皮样囊肿和垂体胶样囊肿等，在临床和影像学表现上有时与鞍区蛛网膜囊肿、垂体瘤卒中、囊性颅咽管瘤和空蝶鞍等其他囊性病变相似而出现误诊，常需要进行鉴别诊断[1-5]。目前国内不同文献报道中Rathke囊肿MRI表现的病例样本大小不一，其MRI信号也表现多样。本文搜集12例Rathke囊肿的临床和MRI资料加以分析，结合文献复习以提高Rathke囊肿的MRI诊断与鉴别诊断水平，现报道如下。
, 百拇医药
1 资料与方法
1.1 一般资料 搜集经临床随访和手术病理诊断的12例Rathke囊肿患者的临床和MRI资料，其中男5例，女7例，年龄9～80岁，平均(37.9±6.1)岁。患者就诊时临床症状包括闭经1例，性腺功能低下1例，头痛2例(其中1例伴有颅骨多发骨纤维异常增殖症)，另外2例和6例分别因头部外伤和颈部不适而偶然发现。4例手术(1例经颅病灶切除，3例经蝶病灶切除)，术中发现2例囊内容物为淡黄色黏稠物，2例囊内容物为白色黏液物，送检组织病理显示囊壁为纤维组织和纤毛柱状上皮细胞构成。
1.2 方法
1.2.1 检查方法 所有患者均行头部MRI平扫检查，采用Siemens 1.5T 和Philips Achieva 1.5T超导型MR机和相控阵头部线圈，常规行自旋回波序列冠状面和矢状面T1WI成像、快速自旋回波序列冠状面T2WI成像，部分加做快速自旋回波序列矢状面T2WI成像和脂肪抑制自旋回波序列矢状面T1WI成像。扫描参数：T1WI(TR/TE 340～500 ms/15～20 ms)，T2WI(TR/TE 3000～3500 ms/100～120 ms)，扫描视野16 cm×16 cm，矩阵256×256，层厚3～5 mm，层间隔0.3～0.5 mm，激励次数2～3次，其中11例增强扫描按0.1 mmol/kg体重剂量经肘前静脉或肘静脉快速注射钆喷酸葡胺(Gd-DTPA)对比剂后获得横断面、矢状面和冠状面自旋回波序列T1WI成像。, http://www.100md.com(林天武 高振华)