Journal of the Korean Rad iologica l Society 1995 : 33(5) ’ 705- 711

MRI Findings of Intracranial Hemangioblastoma 1

Jong Deok Kim, M.D., Mee Young Cho, M.D. , Seung Kug Baik, M.D.2,

Sun Sub Choi. M .D .3, Chang Soo Kim, M.D.4, Chun Phil Chung , M.D.4

Purpose: Complete resection of the tumor nodule(mural nodule or solid portion of the tumor) is the essential goal of surgical treatment for heman­gioblastoma. The purpose of this study was to classify the morphologic types of intracranial hemangioblastoma on MRI and to compare the location and contour oftumor nodule on MRlwiththoseon angiography.

Materials and Methods : The MRI findings of 34 lesions(38 lesions if 4 spinal cord lesions were included) in 26 patients(17 males and 9 females , range of age,

18-67 years, mean, 39 years) with surgically and histopathologically proved intra­cranial hemangioblastomas were reviewed. Seventeen patients underwent CT scanning in a short interva l. Contrast-enahnced T1-weighted imaging pa - tterns of hemangioblastoma were classified according to Ho’ s morphologic types . The location and contour of tumor nodule were compared between MRI and angiography in 15 patients(24Iesions) .

Results: By location , cerebellar hemispherewas predominated(55%). followed by cerebellar vermis(26%). supratentorial region(5%). and medulla oblongata (3%). Spinal cord lesions(11%) were seen in 3 patients of 5von Hippel-lindau dis­eases . The frequency of morphologic types was as follows; Type 1 (purelycystic). 3%, Type 2(mural noduleL 50%, Type 3(cyst with wall enhancement). 3%, Type 4 (cystic nodule). 15%, Type 5(solid with internal cyst). 9%, and Type 6(solid). 20%. AII tumor nodules(33 lesions) enhanced intensely with intravenous contrast ma­terial on MRI. of which 24lesions(in 15 patients) revealed hypervascular masses fed by pial arteries on angiography. They were superficial and abutted pia mater partiallyor in large portion on both MRI and angiography.

Conclusion: Over 70% of intracranial hemangioblastomas had a surrounding cyst , and superficia l. pial -based location and number of the tumor nodules on MRI was correlated well with those on angiography. MRI is the examination of choice for preoperative evaluation of intracranial hemangioblastoma.

Index Words: Brain neoplasms, MR Angioma, central nervous system Cerebral blood vessels , angiography

INTRODUCTION

Hemangioblastomas are benign ne。이asms of endo-

, Department olDiagnostic Radiology , Col lege 01 Medicine, lnje Un iversi ty 2DepartmentofD iagnostic Radio logy, Wallace Memorial Hospital 3Department ofD i agnostic Radiology , College 01 Medicine, Dong-A University 4Department ofD iagnostic Rad iology, Maryknoll Hospital Received August18, 1 995 ; Accepted October1 9, 1995 Address reprint requests to : Jong Deok Kim , M. D. , Department 01 Diagnostic Radiology, College 01 Medicine , 1 미 e University Pusan Paik Hospital , 633- 165 Kegum-dong, Pusanj in-ku, Pusan, 614- 735 Korea

Te l. 82-51 -890-6549 Fax. 82- 51-896-1 085

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thelial origin and account for 1 -2.5 % of all intracran ial neoplasms. Although also found in the spinal cord(3 13 %) , medulla(2-3 %) , and cereb rum (1.5% ), heman gioblastomas most commonly occur in the cerebellum (83 -86 %) , where they comprise 7 -12 % of primary pos­terior fossa tumors. These tumors may occur spora­dically or as part of the von Hippel - Lindau disease (VHLD) , an inherited autosomal disorder characteri ­zed add itionally by retinal anigomas, renal cysts or carcinoma, pheochromocytoma, and pancreatic cysts or carcinoma. Cerebellar hemang ioblastomas are co­mmon in middle aged adults , with the mean age in

Journal of the Korean Radiological Society 1995 : 33(5) : 705- 711

most series between 30 and 40 years. Patients with VHLD develop cerebellar hemangioblastomas at a younger age(1 - 2). Approximately 70% of cerebellar hemangioblastomas are cystic , compared with only 20 % of cerebral or bulbar lesion. The diagnosis of cen­tral nervous system(CNS) hemangioblastomas as well as the surgical treatment requires the accurate radio­logic visualization of both cystic and solid components of the tumor, as complete resection of the tumor nodule is the essential goal of su rgery(1 • 5)

The puropose of this study was to classify the mo­rpholgic types of intracranial hemangioblastoma on MRI and to compare , whenever possible , the location and contour of tumor nodules on MRI with those on an­giography.

MATERIAlS and METHDOS

The MRI findings of 341esions in 26 patients(17 males and 9 females) with surgically proved intracranial he­mangioblastomas were reviewed. Two of the 26 pa­tients had a history of previous operation for heman-

Table 1. Location olCNS Hemangioblastomas

Location No. 01 Lesions

Cerebellar 31 (81 %)

Hemispheric 21

Vermian 10 Supratentorial 2( 5%)

Medulla oblongata 1 ( 3%)

Spinal cord 4(11 %)

Total 38 (1 00 %)

a b

gioblastoma. The patients ' ages ranged from 18 to 67 years(mean , 39 years) . AII patients were examined on a Toshiba 0.5T MRT-50A scanner. Imaging variables in all patients included T1 -weighted images (400 -500/15 -

20/2 , TR/TE/exitations) and T2-weighted images(2500 -3000 /30 , 80) in a combination of at least two orthogonal planes. In each patient, after an intravenous injection of 0.1 mmol/kg of gadopentate dimeglumine(Gd - DT­PA)(Magnevist, Shering , Germany) , axial , coronal and lor sagittal T1 - weighted images were obtained. Sev­

enteen patients underwent intravenous contrast - en­hanced CT scanning in a short interva l. Angiograms were available for comparison in 15 patients. Radio­logical patterns of the hemangioblastoma on the con­trast -enhanced T1 - weighted images were classified according to Ho’s morphologic types(7). The location and contour of tumor nodule (mural nodule or solid portion of the tumor) on contrast - enhanced T1 -weig­hted images were compared with those on angiog­raphy

Table 2. MRI Patterns 01 Intracranial Hemangioblastoma

Type NO.olLesions

Type 1 (pu re cyst)

Type 2 (mural nodul e)

1 (3 %)

17(50 %)

1 ( 3%)

5(15 %)

3( 9%)

7(20 %)

Type 3 (cyst with wall en hancement)

Type 4 (cystic nodul e)

Type5 (s이 id with internal cyst)

Type 6 (sol id)

Total 34(100 %)

Fig.1. Vermian hemangioblastoma, typical solid nodule with surrounding cyst(type 2) Gd-DTPA enhanced axial T1-weighted im­ages(a) reveal a small , densely enhancing “mural nodule" with an .?djacent nonen­hancing surrounding cyst. The lateral view

。1 vertebral angiogram(b) demonstrates the vascular tumor nodule in the vermis in a avascular region that corresponds to the surrounding cyst(arrows)

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Jong Deok Kim, et al: MRI Findin gs of Intracran ial Hemangioblastoma

RESULTS lesions in the vermis(26 %) , 1 lesion in the medulia

(3%) , 21esions in the supratentorial(5%) , and.4lesions

in the spinal cord(11 %). The hemangioblastomas were

m비tiple in 7 patients , and 5 of them had VHLD. Spinal

hemangioblastomas were found in 3 of these 5 VHLD and 2 of them had a documented familial history of

The location of 38 lesions of CNS hemangiobla­

stomas is presented in Table 1. Twenty - one lesions

were located in the cerebellar hemisphere(55%) , 10

a b c Fig. 2 . Cerebellar hemangioblastoma, purely solid(type 6)

Axial T2-weighted image(a) reveals multiple serpentine signal voids within and at th e periphery of the mass i nvolving left cerebellar

hemisphere. Gd-DTPA enhanced sagittal T1 -weighted image(b) shows a large , densely enhancing nodule abutting pia mater. The lat­

eral vi ew of vertebral angiogram(c) demonstrates a hypervascular tumor suppl i ed by both AICA and PICA

a b C

Fig . 3. Cerebellar hemangioblastoma, cysti c nodule(type 4) Gd-DTPA en hanced axial(a) and coronal(b) T1-weighted images reveal a larg e cystic nodule with an adjacent nonenhancing surround­

ing cyst. The A-P view of ver tebral ang iogram (c) demonstrates th e vascu lar tumor with central avascular region and a draining vein

m

Journal of the Korean Radiological Society 1995: 33(5) : 705-711

VHLD. The tumors ranged from 0.5 to 7.8 cm in diam­eter‘

The contrast - enhanced MRI findings of 34 intra­craniallesions in 26 patients are summarized in Table 2. The most common MRI pattern of hemangiobla­stoma was solid “ mural nodule" with an adjacent no­nenahncing surrounding cyst(type 2, 50 %)(Fig . 1) , f이­lowed by purely solid(type 6, 20 %)(Fig. 2) , a cystic mu­ral nodule(type 4, 15%)(Fig. 3) , a solid mass with in­ternal cyst(type 5, 9%), completely cystic(type 1, 3%) ,

and a cyst with wall enhancement(type 3, 3%)(Fig. 5). Overall 71 % of hemangioblastomas were predomin­antly cystic and the other 29 % were solid. AII 33 solid nidi were superficial and abutted pia mater. Serpentine signal voids within and/or at the periphery of the mass were observed in 24 lesions(70 %) (Fig. 2). Cystic po­rtion of the tumor was isointense or slightly hyperin­tense to CSF on all sequences. The tumor nodules were slightly hyperintense to gray matter on noncon­trast T1 -weighted images and long TR images and they enhanced intensely with Gd - DTPA.

Angiography showed one or more hypervascular nodules in 15 patients (24 tumor nodules) , correspond­ing to their number and location on the contrast en­hanced MRI(Fig. 4). In 17 of 24 nodules with type 2, 3, and 4 shown on MRI , angiography defined the cyst as an avascular mass(Fig. 1). The tumor nodules stained intensely, either with a homogenous or mottled app­earance , and were associated with one or more en­larged feeding(pial) arteries(superior cerebellar ar­tery , anterior inferior cerebellar artery , posterior in-

a b Fig. 4. Multiple hemangioblastomas

ferior cerebellar artery , middle cerebral artery , and oc­cipital artery of external carotid artery)(Fig. 1, 2, 3, 4). Six out of 24 hypervascular nodules had 2 or 3 feed ing arteries(Fig. 2) and early draining vein was seen in 10 lesions(Fig. 3)

DISCUSSION

Hemangioblastomas originate from the pia , grow slowly, and then subsequently develop either into a well-circumscribed large cystic tumor or a well -ci r­cumscribed solid tumor(1 , 4 -6). Morph이 ogically ， he­mangioblastomas are pink to yelllow , and abut the pial surface of the cerebellum , where the solid nidus(mural nodule or solid portion of the tumor) is found(1 -13) Dural involvement is present in up to 20% of posterior fossa hemangioblastomas(1 1). The “cyst" around the mural nodule is a collection of fluid arising by diffusion from the vascular component of the mural nodule and is not truly part of the neopJasm(1 -2, 11). The cyst wall , if present , is composed of compressed adjacent brain parenchyma or reactive neuroglial cells. The cysts may also occur within a mural nodule or solid tumor and in such case the cysts are part of the tumor representing dilated vascular spaces or necrosis within the neoplas­tic tissue ofthe hemangioblastoma(1 ,1 0-13)(Fig. 3).

Effective surgical treatment of CNS hemangiobla­stoma requires complete excision of the tumor nodule. A safe approach and resection are best accomplished when the exact location of the nodule and its relation­ship to the tumor cyst and adjacent structures are

c

Gd-DTPA enhanced axial T1-weighted images(a, b) illustrate multiple enhancing tumor nodules(type 2 and 6). The number and location 。fthese tumor nodules correspond to those 01 verteb ral angiogram(c)

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Jong Deok Kim, et al : MRI Findings of Intracranial Hemangioblastoma

a b

O~ f) Pure Cyst

R Mural Nodule Cyst with Wall

Enhancement

Cystic Nodule Solid with Cyst Solid

Fig. 6. Six morphologic types 01 hemangioblastoma on MRI and CT(cited Irom relerence 7)

known(3 , 5, 14 -15). MRI is superior to CT in delinea­ting the exact extent of the hemangioblastomas, for example contact with the arachnoid surface. Connec­tion of tumors to the surarachnoid space arises from thetumor’ s origin in the pial mesenchyma(8 -9).

Characteristic CT findings of a posterior fossa hem­angioblastoma include a cystic lesion with a small mu­ral nodule , that intensely enhances following intraven­ous contrast medium administration. Alternatively , the lesion may be solid and present as a densely enhanc­ing nodule without cyst formation(16 -18). The primary limitations of CT include decreased posterior fossa sensitivity , compared with MRI , due to artifacts from the base ofthe skull .

The MRI characteristics of hemangioblastoma are: (1) the cystic nature of the mass , (2) a peripheral , pial based mural nodule of solid tissue that enhances mark­edly with intravenous contrast , and (3) large vessels

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Fig. 5. Cerebellar hemangioblastoma(type 3)

Noncontrast(a) and Gd-DTPA enhanced(b) sagittal T1-weighted images reveal distinct enhancement 01 the wall 01 the cystic part 。1 a hemangioblastoma arising Irom the cerebellar tonsi l. Tumor cells were demon­strated histopatholgically in this wall (not shown). A a small solid hemangioblastoma posterior to this lesion and a mural nodule type in the cervical cord are also seen

within and/or at the periphery of the mass(serpentine signal voids) suggestive of dilated feeding or draining vessels that accompany these hypervascular tumor These are virtually pathognomonic for hemangiobla­stoma when found in conjunction with each other(7 , 10, 19 -23). The cysts are sharply marginated and smoo­thly bordered and isointense or slightly hyperintense to CSF on all sequences. The mural nodule or solid po­rtion of the tumor is only slightly hyperintense to gray matter on noncontrast T1 -weighted images and long TR images. Entirely solid hemangioblastomas occure in 30 -40 % of cases and are most common morpho­logic type if in the supratentorial compartment(7, 10, 15, 24 -25). The 20 % of solid tumors in our series is less in frequency than that reported in the literature. Seven cases of s 니 pratentorial intraventricular hemangiobla­stomas have been described in the literature and in­terestingly , all of these have been solid tumors(25) . Supratentirial hemangioblastomas are extremely rare. Using data from previous reports there are 82 cases of supratentorial hemanigoblastomas in the literature (25). In our study 2 of 38(5 %) CNS hemagnioblastomas occurred in the cerebrum and both cases(100 % ) were cystic , which was higher in frequency than that of pre­vious report(20 % )(4) although the number of subjects was smaller in this study. On MRI 60 -69 % of heman­gioblastomas have associated internal and/or periph­eral serpentine signal voids(7 , 10, 26) , which was simi­lar in frequency to ou r study(70 %)

Ho et al. described 6 radiologic types of hemangio­blastomas(including the frequency in each type) as vi­sualized on MRI and CT(7)(Fig. 6) : (1) purely cystic (type 1, 8%) , (2) solid “ mural nodule" with an adjacent nonenhancing surrounding cyst(type 2, 35%) , (3) a mu­ral nodule associated with an enhancing cyst wall (type 3, 6% ), (4) cystic nodule(type 4, 6 %) , (5) a solid mass

Journal of the Korean Radiologica l Society 1995 : 33(5) : 705- 711

with internal cysts(type 5, 12%), and (6) purely solid (type 6, 33%). Overall , roughly 55% of hemangiobla­stomas had surrounding cysts and the other 45% were predominantly solid and this radiographic distribution correlated well with the pathologic spectra of 60% cys­tic and 40% solid described by Rubinstein(1). Our study showed slightly higher incidence(71 %) of intra­cranial hemangioblastomas with a surrounding cyst (type 1 3% , type 2 50% , type 3 3%, type 415%). The most common MRI pattern was type 2(50%) as was in H。 ’ s report(35%). AII tumor nodules(type 2, 3, 4 , 5, 6) were superficial and abutted pia mater. The cyst wall usually does not enhance. However, if the cyst is lined by neoplasm , the wall will enhance(7 , 10, 26 -27). Only one case showed a cyst with wall enhancement in our study(Fig. 5) . Tumor cells were demonstrated histo­pathologically in this enhancing wall

As the differential diagnosis of hemangioblastoma on MRI , cystic astrocytomas and meningiomas are es­sential. The mural nodule abuts a pial surface in the cystic hemangioblastoma. In contrast , the mural nod­ule of cystic astrocytoma is found within the cerebellar parenchyma at a distance from a pial surface. 801 id hemangioblastoma can be differentiated from men­ingioma by the shape of the “ flow voids" around the tumor. The former appears as the spotty or serpentine shape and the latter as the smooth peritumoral rim(1 , 8). Guhl et al. (8) reported another way to differentiate between these tumors by the difference of the T2 relax­ation time ; the T2 values of angiomatous tumor were greater than those of meningioma. 8upratentorial he­mangioblastomas presenting as a cyst with mural nod­ule , ab니 tti ng on the falx but not adherent to it , provides the differential diagnosis with cystic astrocytoma and angioblastic meningioma. The nature of enhancement excludes the astrocytoma. Hemangioblastomas are round and have no flat base on the arachnoid , unlike an angioblastic meningioma. It has been accepted that dural attatchment dose not pre이 ude the diagnosis of hemangiobalstoma. Tentorial branches feeding a sup­ratentorial hemangioblastoma have been described(4, 16, 28). In our study there was no diffic비 ty in the diag­nosis of hemangioblastomas on MRI except a calcified supratentoriallesion.

Angiography provides detection and exact localiza­tion and the vascularization of the hemangioblastomas in the distribution ofth

nally, angiography is very useful in the demonstration of mutiple tumors and above all of the small tumors , which sometimes are not diagnosed by CT scanning and noncontrast MRI(7 , 10, 14, 26) . With noncontrast MRI the tumor nidus may blend with surrounding ed­ema and may not be visualized. Limitations of non­contrast MRI also preclude detection of small heman­gioblastomas that are not accompanied by mass effect, edema, or cyst(7 , 10, 19 -21 , 26). In our study the num­ber of hypervascular nodules or masses detected on angiography was identical to that of the enhancing nodules on MR I. AII tumor nodules of hemangiobla­stoma abutted pial surface on MRI and were fed by the pial arteries angiographically

In conclusion , over 70% of the intracranial heman­gioblastomas had surrounding cysts , and superficial pial-based location and number of the tumor nodules on contrast -enhanced MRI were correlated well with those on angiography. With above mentioned MRI fin­dings, intracranial hemaniolblastomas can be easily diagnosed by contrast - enhanced MRI in most cases and , angiography will be necessary to identify the vas­cular supply of the 1 esion before su rgery

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2. Neumann HPH, Eggert HR , Weigel K, et al. Hemangioblastomas 。f the central nervous system : a 1 O-year study with special refer­ence to von Hippel-Li ndau syndrome. J Neurosurg 1989 ;70

24-30 3. Anson JA, Glick RP , Crowell RM. Use of Gadolinium-enhanced

magnetic resonance imaging in the diagnosis and management of posterior fossa hemangioblastomas. Surg NeuroJ 1991 : 35 300-304

4. Russel D, Rubinstein L. PathoJogy of tumors of the centeraJ ner

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Surg NeuroJ 1978; 10 : 195-199 6. Rawe S, Gilder JV, Rothman S. Radiographic diagnostic evalu­

ation and surgical treatment of multiple cerebellar , brain stem , and spinal cord hemangioblastomas. Surg NeuroJ 1978: 9 337-492

7. Ho VB , Smirniotopulos JG , Murphy, Rushing EJ. Radiologic pathologic correlation: hemangioblastoma. AJNR 1992 : 13 1343-1352

8. Guhl L, Mironov A, Schroth G. Contribution of magnetic reson­ance imaging in the diagnosis of hemangioblastomas, J NeuroJ

1987 ; 235 : 95-98 9. Peters G. Klinishe NeuropathoJogie . Stuttgart: Thieme , 1970

414-415 10. Lee SR ‘ Sanches J, Mark AS, Oillon WO , Normal 0, Newton TH

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1989 ; 1 71 : 463-468 11. Silver M, Hennigar G. Cerebellar hemangioblastoma'a clini­

copathological review of forty cases. J Neurosurg 1952 ; 9 484-492

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12. Maiuri F. Cysts with mural tumor nodules in the cerebral hemi- 20. Elster AD‘ Arthur DW. Intracranial hemangioblastomas: CT and

sphere. Neurosurg 1988; 22: 703-706 MR findings. JComput AssistTomogr 1988 ; 12: 736-739

13. Jeffreys R. Pathological and hematological aspects of posterior 21 . Silbergeld J , Cohen WA, Maravilla KR , Dalley RW, Sumi M

fossa hemangioblastoma. J Neurol Neurosurgy Psychiatry 1975 Supratentorial and spinal cord hemangioblastomas : gadolinium

; 38 : 112-119 enhanced MR appearance with patholgic correlation. J Comput

14. Con stans JP , Meder F, Maiuri F, Donzelli R, Spaziante R, Divitiis AssistTomogr1989; 13: 1 048-1 051

E. Posterior fossa hemangioblastomas. Surg Neuro/1986; 25: 22 김선교， 이한진 ， 한성태 등 후두와 혈관아세포종의 방사선학적 소견

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15. Young S, Richardson AE. Solid hemangioblastomas of the pos- 23 박승칠 오민철 ， 정환흔， 설혜영 ， 이남준， 김정혁 혈관아세포종의 자기

terior fossa: radiological features and results of surgery. J 공명영상소견 대한방사선의학회 1994 ; 30 : 801-806

Neurol Neurosurgy Psychiatry 1987 ‘ 50 : 155-158 24. Okawara SH. Solid cerebellar hemangiobalstoma. J Neurosurg

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stomas. Radiology 1981 ; 138 : 65-73 27. Filling-Katz MR , Choyke PL, Patronas NJ, Gorin MB , et al

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。graphy of cerebellar hemangioblastomas. J Comput Assist Gd-DTPA enhanced MR imaging ofthe central nervous system. J

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대 한 방사선의학회지 1995; 33( 5) : 705-711

뇌 혈관아세포종의 자기공명영상소견1

1 인제대학교의과대학진단방사선과학교실

2침례병원 진단방사선과

3동아대 학교 의 과대학 진 단방사선 과학교실

4 머리놀병원 진단방사선과

김종덕 · 조미영 · 백승국2 . 최순섭3 • 김창수4 • 정춘필4

목 적 :혈관아세포종의 치료목적은 종앙결절(벽결절이나 종괴의 고형부분)을 완전히 제거하는 것이다. 뇌 혈관아세포종

의 조영증감후으1 T1강조영상 소견을 형태학적으로 분류하고， 종앙결절의 위치와 앙상을 혈관촬영 소견과 비교하고자 하였

다-대상 및 방법:수술로 확진된 뇌 혈관아세포종 34병소(26명의 환자， 남자 17명， 여자 9멸， 연렁분포 18-67서1， 평균연령 39

세 )의 조영증강후의 T1강조영상 소견을 Ho 등의 분류에 따라 형태학적으로 분류하였고， 혈관촬영을 시행한 15명의 환자(24

병소)에서 종앙결절의 위치와 앙상을 조영증강후 T1강조영상 소견과 비교하였다.

결 과.발샘부위별로는 소뇌반구가 가장 많았고( 55%) ， 다음으로 소뇌충수(26%) ， 전막상부(5%) ， 연수(3%)의 순이었으

며， 척수병변( 11% )은 5염으1 von Hippel - Li ndau 병 환자 중 3명에서 나타났다. 조영증강후의 T1강조영상 소견상의 형태학적

분류로는 제 1 형(순수한 낭종형)이 3%, 저12형(벽결절을 가진 낭종형 )이 50% , 저13형(조영증강되는 벽을 가진 낭종형)이

3%, 제4형 ( 낭성의 벽걸절을 가진 낭종형 )이 15% , 저15형(내부 낭종을 가진 고형형 )이 9% , 그리고 저16형 (고형성 )이 20% 01

었다. 종앙결절 모두가(33병소)가 조영제 주입 후에 강한 조영증감을 보였는데 이중 혈관촬영을 시행한 24병소는 뚜렷한 과

혈관성 종괴를 나타내었으며 언막동맥들로부터 공급받고 있었다. 또한 이들 24병소는 표재성으로써 일부 또는 대부분을 연

막에 기저를 두고 있는 앙상이 조영증감후의 T1강조영상과 혈관촬영상에서 일치하였다.

결 론뇌 혈관아세포종으170%01상이 낭종형이었으며， 조영증강후 T1강조영상과 혈관촬영상 종앙걸절의 위치와 앙상이

일치하였다.고로뇌 혈관아세포종의 술전 진단에는조영증강영상이 필수적 방법이라고할수있다.

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1996년도 의사전문의고시 문제 출제경향 안내

1. 전문의 시험 분야별 출제비율

τ Hr 비 율 비 고

호흡기 16%

섬맥관 6%

위장관 10%

간，담도，훼 10%

비뇨생식 13%

신경 15%

二L그， 二E쿄/걱「 10%

핵의학 10%

물리 10%

유방 1% (전체비율에서)

법규 1%

-τ。"'- 겨l 100%

2. 핵인학 분야 수련 및 출제

핵의학 분야의 수련은 현행대로 2개월 이상 의무적으로 시행해야 하며

전문의 시험에도핵의학을현행 비율대로계속출제 할것임.

3. 동위원소취급특수면허 취득을위한교육이나동면허취득으로상기 2

항의 수련 의무를 대신하지 못함.

4. 방사선관계 법규를총문제 수에서 1% 전，후출제 할것임 .

5. 상기 출제 비율은 당해년도 문제션택위원의 성향 또는 문제은행의 문

제성향등에 따라서 증감이 될수있음.

이

/ “ 지