1、 临床资料男性，54岁发现左额颞部隆起4年余，呈渐进性增大，质硬，无滑动 影像学检查2012.4.20 颅脑CT平扫 其他检查2012.4.19 同济医院CT示左侧额颞骨梭形病灶考虑为良性病变所致 术中表现病变颅骨内侧面与脑膜完全粘连，部分硬膜已骨化，与脑组织有轻微粘连术后病理：脑膜瘤 Primary intraosseous meningiomaConstitute 1 to 2% of all meningiomasRepresents approximately two thirds of all extradural meningiomasElder, J.B., et al., Pr
2、imary intraosseous meningioma. Neurosurg Focus, 2007. 23(4): p. E13. ClassificationIntraosseous meningiomas could be considered Type II or III primary extradural meningiomas based on whether extracalvarial extensionHyperostotic is majority, Osteolytic is rarely Clinical PresentationSex：with the same
3、 frequency Age： two peaks，the second decade and during the fifth through seventh decadesUsually slow growing and painless Radiographic appearanceDepends largely on their location and the effects of the tumor on the surrounding bone Radiographic appearance -osteoblasticX-ray：hyperostosis, irregular f
4、oci of calcification, and atypical vascular markingsCT（with bone windows）：hyperdense (65 to 85Hu)，enhances denselyMRI:T1WI hypointense，T2WI hyperintense，homogeneous enhancementDo not usually exhibit the “dural tail”Radiographic appearance -osteolyticX-ray：hypodenseCT：thinning, expansion, and interru
5、ption of the inner and outer cortical layers of the skull, enhance homogeneouslyMRI：similar to osteoblasticPartial axial views of the preoperative CT scans showing hyperostosis of the left sphenoid bone protruding into the orbit, resulting in proptosis.Axial (upper) and coronal (lower) T1-weighted M
6、R images after Gd contrast administration, showing a hypointense mass with moderate peripheral enhancement. Also noted is the mass effect on the orbit causing proptosis. Differential Diagnosis Fibrous dysplasiaAnteroposterior skull radiograph (a) of a 24-year-old female demonstrates a sclerotic lesi
7、on in the right temporal bone. Axial CT image in bone window (b) reveals a ground-glass appearance in the right temporal bone. On axial SE T1-weighted MR image (c), a hypointense expansile lesion originating from the diploe is seen.Yalcin, O., et al., CT and MRI findings in calvarial non-infectious
8、lesions. Diagn Interv Radiol, 2007. 13(2): p. 68-74.Usually stops growing after pubertyHomogenous ground-glass appearanceExpansion confined to the outer table,and no affect on the inner table OsteomaAxial CT image (a) of a 45-year-old female demonstrates a welldefinedfocal sclerosis originating from
9、 the outer table of the right frontal bone. Axial TSE T2-weighted (b) MR image shows a signal void lesionnonenhancing OsteosarcomaAxial CT images (a) in bone and parenchymal (b) windows and coronal reformatted CT image (c) of a 28-yearold female demonstrate a lesion arising from the lateral wall of
10、the orbita extending to the temporal bone, with destruction and a sunburst pattern. The lesion also contains a soft tissue componentIrregular contours, heterogeneous signal, and enhancement Paget diseaseIn the osteolytic stage, there are lytic lesions that erode the outer tableIn the osteosclerotic
11、stage,differentiation between the inner and outer tables is lost and the diploe widensIn mixed stage, irregular areas of sclerosis demonstrate a cotton-wool appearanceLaboratory test：serum alkaline phosphatase is typically elevated Multiple myelomaLateral CT scanogram (a) of a 64-year-old female dem
12、onstrates a lesion near the vertex resembling a punch hole associated with a soft tissue component as well as many other lytic cranial lesions. Parenchymal (b) and bone (c) window axial CT images show punch hole lesions involving the inner and outer tables throughout the cranium with an associated s
13、oft tissue component MetastasisA patient, who had undergone surgery for thyroid cancer 20 years earlier, presented with the complaint of a slowgrowing,painless swelling in the cranium. Axial CT (a), and TSE T2-weighted (b), and SE post-contrast T1-weighted MR images (c) depict a solitary metastatic mass lesion in the right parietal bone. The lesion destroys the inner and outer tables. It is expansile and has a soft tissuecomponent. It extends through the dura mater and subcutaneous tissue, and shows a dense homogenous enhancement pattern. The end！ Thank you！
