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Semiologia ImagiolóGica Dos Tumores PrimáRios Do Snc Antigo

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Semiologia ImagiolóGica Dos Tumores PrimáRios Do Snc Antigo

  1. 1. <ul><li>Edema </li></ul><ul><ul><ul><li>Brilha no primeiro eco </li></ul></ul></ul><ul><li>Lesões quísticas </li></ul><ul><ul><ul><li>Sinal idêntico ao do LCR </li></ul></ul></ul><ul><li>Lesões hipointensas em T2 </li></ul><ul><ul><ul><li>Linfoma, meduloblastoma e meningioma </li></ul></ul></ul>
  2. 2. Semiologia Imagiológica dos Tumores Primários do SNC Tiago Baptista Serviço de Neurorradiologia CHLC 21 de Junho de 2008
  3. 3. Importância da NR <ul><li>Localização </li></ul><ul><li>Dimensões </li></ul><ul><li>Efeito de massa </li></ul><ul><li>Diagnóstico diferencial </li></ul><ul><li>Complicações associadas </li></ul><ul><li>Pós-operatório </li></ul><ul><li>Follow-up </li></ul><ul><li>Terapêutica </li></ul>
  4. 4. Fisiopatologia <ul><li>A evolução natural dos tumores cerebrais é o aumento progressivo do seu volume </li></ul><ul><ul><ul><li>Estabilidade prolongada </li></ul></ul></ul><ul><ul><ul><li>Comportamento agressivo (hemorragia e formação quística) </li></ul></ul></ul><ul><li>Relação com tecidos peritumorais </li></ul><ul><ul><ul><li>Tumores expansivos </li></ul></ul></ul><ul><ul><ul><li>Tumores infiltrativos </li></ul></ul></ul>
  5. 5. Fisiopatologia <ul><li>Metastização </li></ul><ul><ul><ul><li>É rara </li></ul></ul></ul><ul><ul><ul><li>Os meduloblastomas e germinomas podem metastizar pelos espaços de LCR </li></ul></ul></ul>
  6. 6. Índice <ul><li>Classificações </li></ul><ul><li>Semiologia </li></ul>
  7. 7. Topográfica <ul><li>Tumores supra-tentoriais </li></ul><ul><li>Tumores infra-tentoriais </li></ul>
  8. 8. Histopatológica <ul><li>Tumores neuroepiteliais </li></ul><ul><ul><ul><li>Astrocitoma pilocítico [garu I] </li></ul></ul></ul><ul><ul><ul><li>Astrocitoma difuso [grau II] </li></ul></ul></ul><ul><ul><ul><li>Astrocitoma anaplásico [grau III] </li></ul></ul></ul><ul><ul><ul><li>Glioblastoma multiforme [grau IV] </li></ul></ul></ul><ul><ul><ul><li>Oligodendroglioma </li></ul></ul></ul><ul><ul><ul><li>Ependymoma </li></ul></ul></ul><ul><li>Tumores das meninges </li></ul><ul><ul><ul><li>Meningioma </li></ul></ul></ul><ul><ul><ul><li>Hemangioblastoma </li></ul></ul></ul><ul><li>Tumores de células germinativas </li></ul><ul><li>Tumores da região selar </li></ul><ul><ul><ul><li>Tumores pituitários </li></ul></ul></ul><ul><ul><ul><li>Craniofaringioma </li></ul></ul></ul>
  9. 9. CBTRUS (2005) statistical report: Primary Brain Tumors in the United States, 1998–2002
  10. 11. CBTRUS (2005) statistical report: Primary Brain Tumors in the United States, 1998–2002
  11. 12. CBTRUS (2005) statistical report: Primary Brain Tumors in the United States, 1998–2002
  12. 13. Técnicas disponíveis <ul><li>TAC </li></ul><ul><li>RM </li></ul><ul><li>AngioTAC e AngioRM </li></ul><ul><li>Espectroscopia </li></ul><ul><li>DWI </li></ul><ul><li>Perfusão </li></ul><ul><li>RM funcional </li></ul><ul><li>ASD diagnóstica e terapêutica </li></ul>
  13. 14. TAC <ul><li>A absorção diferencial do Raio X permite observar as diferentes densidades intra-cranianas e o contraste entre os tecidos </li></ul><ul><li>É o método de escolha para metástases do crânio </li></ul>
  14. 15. RM
  15. 16. Fisiopatologia <ul><li>A evolução natural dos tumores cerebrais é o aumento progressivo do seu volume </li></ul><ul><ul><ul><li>Estabilidade prolongada </li></ul></ul></ul><ul><ul><ul><li>Comportamento agressivo (hemorragia e formação quística) </li></ul></ul></ul><ul><li>Relação com tecidos peritumorais </li></ul><ul><ul><ul><li>Tumores expansivos </li></ul></ul></ul><ul><ul><ul><li>Tumores infiltrativos </li></ul></ul></ul>
  16. 17. Fisiopatologia <ul><li>Metastização </li></ul><ul><ul><ul><li>É rara </li></ul></ul></ul><ul><ul><ul><li>Os meduloblastomas e germinomas podem metastizar pelos espaços de LCR </li></ul></ul></ul>
  17. 18. Fisiologia Barreira Anatómica Enzimas Facilitadoras Barreira Eléctrica Ausência de vesículas de pinocitose BHE
  18. 19. Fisiopatologia Tumor Disrupção da BHE Realce com contraste Aumento da permeabilidade capilar Edema Cerebral Vasogénico TAC RM Hipodensidade perilesional Hipo em T1 Hiper em T2
  19. 20. GRAU I GRAU IV Edema Proliferação vascular Celularidade Necrose
  20. 22. Tumores neuroepiteliais Astrocitoma pilocítico [grau I] Astrocitoma difuso [grau II] Astrocitoma anaplásico [grau III] Glioblastoma multiforme [grau IV] Oligodendroglioma Ependimoma Tumores das meninges Meningioma Hemangioblastoma Tumores de células germinativas Tumores da região selar Tumores pituitários Craniofaringioma
  21. 23. Astrocitoma de baixo grau CLÍNICA 30-40 anos Cefaleias HISTOPATOLOGIA Crescimento lento Malignização potencial Baixa celularidade Ausência de proliferação vascular ou necrose
  22. 24. Astrocitoma de baixo grau
  23. 25. Astrocitoma de baixo grau <ul><li>Decisão terapêutica </li></ul>Critérios imagiológicos Captação de contraste Efeito de massa Ausente Presente Vigilância Cirurgia + RT ou Cirurgia + RT + QT < 40 anos Epilepsia
  24. 27. Tumores neuroepiteliais Astrocitoma pilocítico [grau I] Astrocitoma difuso [grau II] Astrocitoma anaplásico [grau III] Glioblastoma multiforme [grau IV] Oligodendroglioma Ependimoma Tumores das meninges Meningioma Hemangioblastoma Tumores de células germinativas Tumores da região selar Tumores pituitários Craniofaringioma
  25. 28. Astrocitoma anaplásico CLÍNICA 35-55 anos 90% supra-tentoriais Crises convulsivas, deficits neurológicos, hipertensão intra-craniana HISTOPATOLOGIA Aumento da hipercelularidade Pleomorfismo e anaplasia Proliferação vascular Necrose ausente
  26. 29. Astrocitoma anaplásico
  27. 31. Tumores neuroepiteliais Astrocitoma pilocítico [grau I] Astrocitoma difuso [grau II] Astrocitoma anaplásico [grau III] Glioblastoma multiforme [grau IV] Oligodendroglioma Ependimoma Tumores das meninges Meningioma Hemangioblastoma Tumores de células germinativas Tumores da região selar Tumores pituitários Craniofaringioma
  28. 32. Glioblastoma multiforme CLÍNICA 35-55 anos 90% supra-tentoriais Crises convulsivas, deficits neurológicos, hipertensão intra-craniana HISTOPATOLOGIA
  29. 33. Glioblastoma multiforme
  30. 34. Astrocitomas graus III e IV <ul><li>Disseminação </li></ul><ul><ul><ul><li>Pince de crabe </li></ul></ul></ul><ul><ul><ul><li>Asa de borboleta </li></ul></ul></ul><ul><ul><ul><li>Multicentricidade </li></ul></ul></ul><ul><ul><ul><li>Gliomatosis cerebri </li></ul></ul></ul>
  31. 35. Gliomatosis cerebri
  32. 37. Tumores neuroepiteliais Astrocitoma pilocítico [grau I] Astrocitoma difuso [grau II] Astrocitoma anaplásico [grau III] Glioblastoma multiforme [grau IV] Oligodendroglioma Ependimoma Tumores das meninges Meningioma Hemangioblastoma Tumores de células germinativas Tumores da região selar Tumores pituitários Craniofaringioma
  33. 38. Oligodendroglioma CLÍNICA Lobo frontal, parietal, occipital Raramente na fossa posterior HISTOPATOLOGIA
  34. 39. Oligodendrogliomas
  35. 41. Tumores neuroepiteliais Astrocitoma pilocítico [grau I] Astrocitoma difuso [grau II] Astrocitoma anaplásico [grau III] Glioblastoma multiforme [grau IV] Oligodendroglioma Ependimoma Tumores das meninges Meningioma Hemangioblastoma Tumores de células germinativas Tumores da região selar Tumores pituitários Craniofaringioma
  36. 42. Ependimoma CLÍNICA HISTOPATOLOGIA
  37. 43. Ependimoma

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