Tumor-simulierende Läsionen in der kranialen MRT

 

 Buy Article Permissions and Reprints

Zusammenfassung

Tumoren sind zwar statistisch die wahrscheinlichste Ursache einer intrakraniellen Raumforderung, doch kann sich eine Vielzahl nicht-neoplastischer Erkrankungen ebenfalls raumfordernd manifestieren. Häufigste nicht-neoplastische Raumforderungen sind Entzündungen und Missbildungen, die intraaxial vor allem Gliome, Lymphome und Metastasen, extraaxial Meningeome und Neurinome nachahmen. Voraussetzung einer guten radiologischen Differenzialdiagnose sind außer der Bereitschaft, die primäre Annahme zu hinterfragen, adäquate anamnestische und klinische Angaben. Ziel dieser Arbeit ist eine praxisorientierte Übersicht zur Differenzialdiagnose intrakranieller Raumforderungen mit Blick auf nicht-neoplastische Läsionen.

Abstract

Statistically tumors are the most likely cause of space-occupying intracranial lesions. However, many non-neoplastic diseases also manifest as mass lesions and may be indistinguishable from tumors. The most common of these are inflammatory and dysplastic lesions, which intraaxially imitate mostly glioma, lymphoma, and metastases and extraaxially meningeoma and neurinoma. Aside from a willingness on the part of the diagnostic radiologist to question the most obvious diagnosis, on clinical history and findings are prerequisites for a sound radiological differential diagnosis. The aim of this article is to provide a practical overview of the differential diagnosis of intracranial mass lesions with emphasis on non-neoplastic abnormalities.

Literatur

• 1 Barkovich A J, Kjos B O. Gray matter heterotopias: MR characteristics and correlation with developmental and neurologic manifestations.  Radiology. 1992;  182 493-499
  CrossrefPubMedGoogle Scholar
• 2 Bronen R A, Vives K P, Kim J H, Fulbright R K, Spencer S S, Spencer D D. Focal cortical dysplasia of Taylor, balloon cell subtype: MR differentiation from low-grade tumors.  Am J Neuroradiol. 1997;  18 1141-1151
  PubMedGoogle Scholar
• 3 Peretti-Viton P, Perez-Castillo A M, Raybaud C, Grisoli F, Bernard F, Pocet M, Salamon G. Magnetic resonance imaging in gangliogliomas and gangliocytomas of the nervous system.  J Neuroradiol. 1991;  18 189-199
  PubMedGoogle Scholar
• 4 Stanescu Cosson R, Varlet P, Beuvon F, Daumas-Duport C, Devaux B, Chassoux F, Fredy D, Meder J F. Dysembryoblastic neuroepithelial tumours: CT, MRI findings and imaging follow-up: a study of 53 cases.  J Neuroradiol. 2001;  28 230-240
  PubMedGoogle Scholar
• 5 Braffman B H, Bilaniuk L T, Naidich T P, Altman N R, Post M JD, Quencer R M, Zimmerman R A, Brody B A. MR imaging of tuberous sclerosis: pathogenesis of this phakomatosis, use of gadopentetate dimeglumine, and literature review.  Radiology. 1992;  183 227-238
  CrossrefPubMedGoogle Scholar
• 6 Mirowitz S A, Sartor K, Gado M. High-intensity basal ganglia lesions on T₁-weighted MR images in neurofibromatosis.  Am J Neuroradiol. 1989;  10 1159-1163
  PubMedGoogle Scholar
• 7 Sevick R J, Barkovich A J, Edwards M S, Koch T, Berg B, Lempert T. Evolution of white matter lesions in neurofibromatosis type 1: MR findings.  AJR Am J Roentgenol. 1992;  159 171-175
  PubMedGoogle Scholar
• 8 DiPaolo D P, Zimmerman R A, Rorke L B, Zackai E H, Bilaniuk L T, Yachnis A T. Neurofibromatosis type 1: pathologic substrate of high-signal-intensity foci in the brain.  Radiology. 1995;  195 721-724
  CrossrefPubMedGoogle Scholar
• 9 Wilms G, Marchal G, van Heck P, Plets C, Lammens M, Goffin J, Baert A L. Colloid cysts of the third ventricle: MR findings.  J Comput Assist Tomogr. 1990;  14 527-531
  PubMedGoogle Scholar
• 10 Fazekas  F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, ­Hartung H-P. Histopathologic analysis of foci of signal loss on gradient-echo T₂*-weighted MR images in patients with spontaneous intracerebral hemorrhage: Evidence of microangiopathy-related ­microbleeds.  Am J Neuroradiol. 1999;  20 637-642
  PubMedGoogle Scholar
• 11 Wilms G, Demaerel P, Bosmans H, Marchal G. MRI of non-ischemic vascular disease: aneurysms and vascular malformations.  Eur Radiol. 1999;  9 1055-1060
  CrossrefPubMedGoogle Scholar
• 12 Murphy J M, Gomez-Anson B, Gillard J H, Antoun N M, Cross J, Elliott J D, Lockwood M. Wegener granulomatosis: MR imaging findings in brain and meninges.  Radiology. 1999;  213 794-799
  PubMedGoogle Scholar
• 13 Dagher A P, Smirniotopoulos J. Tumefactive demyelinating lesions.  Neuroradiology. 1996;  38 560-565
  PubMedGoogle Scholar
• 14 Hartmann M, Heiland S, Sartor K. Funktionelle MR-Verfahren in der Diagnostik intraaxialer Hirntumoren: Perfusions- und Diffusions-Bildgebung.  Fortschr Röntgenstr. 2002;  174 955-964
  Article in Thieme ConnectPubMedGoogle Scholar
• 15 van der Knaap M S, Valk J. Magnetic resonance of myelin, myelination, and myelin disorders. 2nd edition. Springer Verlag Berlin-Heidelber-New York 1995
  Google Scholar
• 16 Hartmann M, Jansen O, Heiland S, Sommer C, Münkel K, Sartor K. Restricted diffusion within ring enhancement is not pathognomonic for brain abscess.  Am J Neuroradiol. 2001;  22 1738-1742
  PubMedGoogle Scholar
• 17 Grand S, Passaro G, Ziegler A, Esteve F, Boujet C, Hoffmann D, Rubin C, Segebarth C, Decorps M, Le Bas J F, Remy C. Necrotic tumor versus brain abscess: Importance of amino acids detected at 1H MR spectroscopy - initial results.  Radiology. 1999;  213 785-793
  PubMedGoogle Scholar
• 18 Gultekin S H, Rosenfeld M R, Voltz R, Eichen J, Posner J B, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunolocial findings and tumour association in 50 patients.  Brain. 2000;  123 1481-1494
  CrossrefPubMedGoogle Scholar
• 19 Moulignier A, Mikol J, Gonzalez-Canali G, Polivka M, Pialoux G, Welker Y, Alain S, Thiebaut J B, Dupont B. AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge.  Clin Infect Dis. 1996;  22 626-631
  PubMedGoogle Scholar
• 20 Ernst T E, Chang L, Witt M D, Aronow H A, Cornford M E, Walot I, Goldberg M A. Cerebral toxoplasmosis and lymphoma in AIDS: perfusion MR imaging experience in 13 patients.  Radiology. 1998;  208 663-669
  PubMedGoogle Scholar
• 21 Caldemeyer K S, Mathews V P, Edwards-Brown M K, Smith R R. Central nervous system cryptococcosis: Parenchymal calcification and large gelatinous pseudocysts.  Am J Neuroradiol. 1997;  18 107-109
  PubMedGoogle Scholar
• 22 DeLone D R, Goldstein R A, Petermann G, Salamat M S, Miles J M, Knechtle S J, Brown W D. Disseminated aspergillosis involving the brain: Distribution and imaging characteristics.  Am J Neuroradiol. 1999;  20 1597-1604
  PubMedGoogle Scholar
• 23 Chang K H, Han M H. MRI of CNS parasitic diseases.  JMRI. 1998;  8 297-307
  PubMedGoogle Scholar
• 24 Brismar J, Hugosson C, Larsson S G, Lundstedt C, Nyman R. Imaging of tuberculosis: III. Tuberculosis as a mimicker of brain tumour.  Acta Radiol. 1996;  37 496-505
  PubMedGoogle Scholar
• 25 Bauer J, Johnson R F, Levy J M, Pojman D V, Ruge J R. Tuberculoma presenting as an en plaque meningioma. Case report.  J Neurosurg. 1996;  85 685-688
  PubMedGoogle Scholar
• 26 Akar Z, Tanriover N, Tüzgen S, Canbaz B, Erman H, Öz B, Kuday C. Intracerebral Whipple disease: unusual location and bone desctruction.  J Neurosurg. 2002;  97 988-991
  CrossrefPubMedGoogle Scholar
• 27 Urbach H, Kristof R, Zentner J, Brechtelsbauer D, Solymosi L, Wolf H K. Sarcoidosis presenting as an intra- or extra-axial cranial mass: report of two cases.  Neuroradiology. 1997;  39 516-519
  CrossrefPubMedGoogle Scholar
• 28 Saatci I, Baskan O, Haliloglu M, Aydingoz U. Cerebellar and basal ganglion involvement in Langerhans cell histiocytosis.  Neuroradiology. 1999;  41 443-446
  CrossrefPubMedGoogle Scholar
• 29 Martinez R. Erdheim-Chester disease: MR of intracranial and extracranial brain stem lesions.  Am J Neuroradiol. 1995;  16 1787-1790
  PubMedGoogle Scholar
• 30 Kadota T, Mihara N, Tsuji N, Ishiguro S, Nakagawa H, Kuroda C. MR of xanthogranuloma of the choroid plexus.  Am J Neuroradiol. 1996;  17 1595-1597
  PubMedGoogle Scholar
• 31 Bramwit M, Kalina P, Rustia-Villa M. Inflammatory pseudotumor of the choroid plexus.  Am J Neuroradiol. 1997;  18 1307-1309
  PubMedGoogle Scholar
• 32 Nelson S J, Vigneron D B, Dillon W P. Serial evaluation of patients with brain tumors using volume MRI and 3D 1H MRSI.  NMR Biomed. 1999;  12 (3) 123-138
  CrossrefPubMedGoogle Scholar
• 33 Barkovich A J, Newton T H. MR of aqueductal stenosis: evidence of a broad spectrum of tectal distortion.  Am J Neuroradiol. 1989;  10 471-476
  PubMedGoogle Scholar
• 34 Kim G, Mehta M, Kucharczyk W, Blaser S. Spontaneous regression of a tectal mass in neurofibromatosis 1.  Am J Neuroradiol. 1998;  19 1137-1139
  PubMedGoogle Scholar
• 35 Engel U, Gottschalk S, Niehaus L, Lehmann R, May C, Vogel S, Jänisch W. Cystic lesions of the pineal region - MRI and pathology.  Neuroradiology. 2000;  42 399-402
  CrossrefPubMedGoogle Scholar
• 36 Lee R R, Becher M W, Benson M L, Rigamonti D. Brain capillary telangiectasia: MR imaging appearance and clinicohistopathologic findings.  Radiology. 1997;  205 797-805
  CrossrefPubMedGoogle Scholar
• 37 Rolen P B, Sze G. Small, patent cerebral aneurysms: atypical appearances at 1,5-T MR imaging.  Radiology. 1998;  208 129-136
  PubMedGoogle Scholar
• 38 Piastra M, Chiaretti A, Tortorolo L. Ruptured intracranial mycotic aneurysm presenting as cerebral hemorrhage in an infant: case report and review of the literature.  Child's Nerv Syst. 2000;  16 190-193
  PubMedGoogle Scholar
• 39 Tannouri F, Divano L, Cauchteur V, Hacourt A, Pirotte B, Salmon I, Balériaux D. Cavernous haemangioma in the cavernous sinus: case report and review of the literature.  Neuroradiology. 2001;  43 317-320
  Google Scholar
• 40 Krainik A, Cyna-Gorse F, Bouccara D, Cazals-Hatem D, Vilgrain V, Denys A, Rey A, Sterkers O, Menu Y. MRI of unusual lesions in the internal auditory canal.  Neuroradiology. 2001;  43 52-57
  PubMedGoogle Scholar
• 41 Cellerini M, Gabbrielli S, Maddali Bongi S, Cammelli D. MRI of cerebral rheumatoid pachymeningitis: report of two cases with follow-up.  Neuroradiology. 2001;  43 147-150
  CrossrefPubMedGoogle Scholar
• 42 Goyal M, Malik A, Mishra N K, Gaikwad S B. Idiopathic hypertrophic pachymeningitis: spectrum of the disease.  Neuroradiology. 1997;  39 619-623
  CrossrefPubMedGoogle Scholar
• 43 Lexa F J, Grossman R I. MR of sarcoidosis in the head and spine: spec­trum of manifestations and radiographic response to steroid therapy.  Am J Neuroradiol. 1994;  15 973-982
  PubMedGoogle Scholar
• 44 Schramm P, Hähnel S. Das Tolosa-Hunt-Syndrom - eine neuroradiologische Ausschlussdiagnose?.  Fortschr Röntgenstr. 2001;  173 962-964
  PubMedGoogle Scholar
• 45 Connor S EJ, Penney C C. MRI in the differential diagnosis of a sellar mass.  Clin Radiol. 2003;  58 20-31
  CrossrefPubMedGoogle Scholar
• 46 Gazioglu N, Tüzgen S, Öz B, Koçer N, Kafadar A, Akar Z, Kuday C. Idiopathic granulomatous hypophysitis: are there reliable, constant radiological and clinical diagnostic criterias?.  Neuroradiology. 2000;  42 890-894
  CrossrefPubMedGoogle Scholar
• 47 Teng M MH, Huang C-I, Chang T. The pituitary mass after transsphenoidal hypophysectomy.  Am J Neuroradiol. 1988;  9 23-26
  PubMedGoogle Scholar
• 48 Tsuruda J S, Chew W M, Moseley M E, Norman D. Diffusion-weighted MR imaging of the brain: value of differentiation between extraaxial cysts and epidermoid tumors.  AJR Am J Roentgenol. 1990;  155 1059-1065
  PubMedGoogle Scholar
• 49 Wilms G, Casselman J, Demaerel P, Plets C, De Haene I, Baert A L. CT and MRI of ruptured intracranial dermoids.  Neuroradiology. 1991;  33 149-151
  CrossrefPubMedGoogle Scholar
• 50 Bejjani G K, Wright D C, Schessel D, Sekhar L N. Endodermal cysts of the posterior fossa. Report of tree cases and review of the literature.  Neurosurgery. 1998;  89 326-335
  PubMedGoogle Scholar
• 51 Bartenstein P, Grünwald F, Kuwert T, Tatsch K, Sabri O, Benkert O, Fahlbusch R, Gründer G, Herholz K, Weiller C. Clinical applications of single photon emission tomography in neuromedicine.  Nuklearmedizin. 2000;  39 180-195
  PubMedGoogle Scholar
• 52 Favre J,Taha J M, Burchiel K J. An analysis of the respective risks of hematoma formation in 361 consecutive morphological and functional stereotactic procedures.  Neurosurgery. 2002;  50 48-57
  PubMedGoogle Scholar
• 53 Smith M M, Thompson J E, Castillo M, Mukherji S K, Miller C H, Quattrocchi K B. MRI of recurrent highgrade astrocytomas after intralesional immunotherapy.  Am J Neuroradiol. 1996;  17 1065-1071
  PubMedGoogle Scholar

Prof. Dr. Klaus Sartor

Abteilung Neuroradiologie, Neurologische Klinik, Universitätsklinikum Heidelberg

Im Neuenheimer Feld 400

69120 Heidelberg

Phone: ++49/6221-567566

Fax: ++49/6221-564673

Email: klaus_sartor@med.uni-heidelberg.de