咽旁间隙神经鞘瘤的CT诊断

本文报告11例咽旁间隙神经鞘瘤的CT 检查,均表现为侵占咽旁间隙的椭圆形肿块,边缘光滑清晰,增强后密度不均匀强化,颈动、静脉散开移位为其主要特点。一般可见颈内(和外)动脉向前外或前内推移,颈内静脉向外或后移位。高位肿瘤还常见茎突和茎突舌骨肌外移,较低位肿瘤则多致下颌骨和颌下腺移位。基於上述表现多可提出诊断和鉴别诊断。     

咽旁间隙神经鞘瘤与多形性腺瘤的鉴别诊断

目的探讨咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现,旨在提高对两者的鉴别诊断能力。方法回顾性分析经手术病理证实的12例神经鞘瘤和8例多形性腺瘤的CT和/或MRI表现,分析内容包括病灶部位、最长径、形态与边界、密度或信号特点、强化方式、邻近解剖结构改变情况等。结果咽旁间隙神经鞘瘤及多形性腺瘤发生于左、右侧分别为6/6例和3/5例;两者均表现为类圆形肿块,境界多较清楚。CT表现为软组织密度肿块,可伴有囊变。MRI多表现为长T1长T2信号,伴有囊变者信号不均匀,增强后呈不均匀强化。神经鞘瘤多见于茎突后间隙(10/12,83. 3%),推压二腹肌后腹(10/12,83. 3%)、颈动脉鞘区血管(8/12,66. 7%)及茎突(4/12,33. 3%)向前和/或外侧移位,与腮腺深叶间境界均较清楚。多形性腺瘤多见于茎突前间隙(6/8,75%),推压二腹肌后腹(5/8,62. 5%)、颈动脉鞘区血管(5/8,62. 5%)及茎突(6/8,75%)向内和/或后侧移位。有2例(25%)与腮腺深叶分界不清。结论咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现各具特征性,临床工作中通过仔细分析其起源部位、与周围结构的关系等有助于鉴别诊断。     

颈部神经源肿瘤的CT诊断

目的：探讨ＣＴ扫描对颈部神经源肿瘤的定位、定性诊断价值。材料与方法：复习经手术及病理证实的颈部神经源肿瘤的ＣＴ扫描３０例,包括神经鞘瘤１７例,神经纤维瘤６例,颈动脉体瘤３例,恶性神经源肿瘤４例。结果：肿瘤位于颈动脉间隙１５例,椎旁间隙９例,其他部位６例。颈动脉间隙肿物中,８例（５３．３％）使颈动、静脉向外侧移位,２例（１３．３％）使血管向前方移位,５例（３３．３％）使颈动、静脉分离（其中４例明确来     

咽旁间隙多形性腺瘤与神经鞘瘤的影像鉴别诊断

目的探讨咽旁间隙多形性腺瘤与神经鞘瘤的CT与MRI表现,旨在提高对两者的鉴别诊断水平。资料与方法回顾性分析经临床手术病理证实的13例咽旁间隙多形性腺瘤与8例神经鞘瘤患者的CT与MRI表现,重点观察病变所在位置、与周围组织的关系及占位效应。结果 21例咽旁间隙肿块均边界光滑,包膜完整,可见坏死囊变区,体积多较大(最长径多>4 cm),占位效应明显。其中13例多形性腺瘤均来源于腮腺深叶,突向咽旁间隙生长,同侧咽旁间隙受压变窄,向内移位,呈裂隙状位于肿块的内前方,茎突受压向内后方移位。8例神经鞘瘤,肿块与腮腺深叶分界清楚,可见脂肪间隙。结论生长在咽旁间隙的多形性腺瘤与神经鞘瘤的鉴别诊断较难,鉴别诊断需依靠肿块所在位置、与腮腺的关系及其周围结构如咽旁间隙脂肪和茎突的移位情况进行综合分析。     

应用超声鉴别颈部交感及迷走神经鞘瘤

目的：研究颈交感、迷走神经鞘瘤的彩超诊断。材料和方法：收集２２例经临床、手术及病理确诊为颈交感１６例和迷走６例神经鞘瘤,均行彩超检查。结果：其中７例仅以肿瘤本身的声像图特征为诊断依据者,其术前作出神经鞘瘤诊断的４例,神经鞘瘤可疑、占位病变或淋巴结肿大各１例。无一例能确定神经来源。另１５例以动脉、颈内静脉与肿瘤三者间的相关位置作为彩超诊断的根据：发现１１例交感神经来源者,颈总（颈内）动脉移位并紧贴于肿瘤的前方至外方,颈内静脉移位于动脉之外后方,靠近动脉或与动脉相距３０°－９０°。４例迷走神经来源者,颈总（颈内）动脉移位于肿瘤之前内至内后方,颈内静脉与动脉相反方向移位于肿瘤外侧,动静脉相距１２０°～１８０°。结论：单纯肿瘤声像图难以区分颈神经鞘瘤,利用颈内动、静脉声像图可助诊断,其中颈内动、静脉－起被推移而相互位置不变或动、静脉相距０～９０°内时提示交感神经鞘瘤,动、静脉相距１２０°～１８０°时提示迷走神经鞘瘤。     

侵及咽旁间隙的腮腺深叶肿瘤影像表现

目的：探讨侵及咽旁间隙(PPS)的腮腺深叶肿瘤的影像表现。方法回顾性分析23例累及 PPS 的腮腺深叶肿瘤的 CT和 MRI 表现，包括多形性腺瘤19例、基底细胞腺瘤2例、神经鞘瘤1例和恶性肌上皮瘤1例。结果17例肿块呈卵圆形，不规则形6例。23例肿块与腮腺之间均未见明显的脂肪间隙。9例可见脂肪帽征。8例见腮腺蒂征。4例可见茎突后移、4例见茎突被包绕。5例肿块位于二腹肌后腹的浅面。颈动脉鞘向内前方移位7例、向内后方移位11例。结论侵及 PPS 的腮腺深叶肿瘤具有一些影像学特征，有助于与 PPS 原发肿瘤鉴别。     

颈动脉间隙肿瘤的MRI诊断

目的：探讨颈动脉间隙肿瘤的MRI影象特征及其病理、解剖学基础和诊断价值。材料和方法：分析25例颈动脉间隙肿瘤的MRI征象，并与手术病理或血管造影比较。结果：多数肿瘤的病理改变或血管造影的特征能在MRI图像上反映，囊变和含丰富粘液的神经源性肿瘤T2加权像呈边界光滑的极高信号，化学感受器瘤瘤内的血管表现为扭曲条状和圆点状的极低信号，颈内动脉瘤信号分层，转移瘤边界毛糙或不清；不同来源的肿瘤与颈内、外动脉或颈总动脉和颈内静脉的位置关系有解剖上的相关性，有利于准确的定位和鉴别诊断；25例中术前诊断正确22例（88％）。结论：MRI对颈动脉间隙肿瘤的定位和定性具有重要的诊断价值，结合病史可减少误诊。     

咽旁间隙原发肿瘤的MRI特点分析

目的分析咽旁间隙原发肿瘤的MRI表现特点,提高对该区域病变鉴别诊断的认识。方法回顾性分析42例经手术病理证实的咽旁间隙肿瘤的MRI表现及临床资料。结果 42例中,良性肿瘤27例,包括15例神经源性肿瘤(11例神经鞘瘤,4例副神经节瘤),6例多形性腺瘤,3例纤维血管瘤,1例海绵状血管瘤,1例鳃裂囊肿,1例血管平滑肌脂肪瘤;恶性肿瘤15例,包括1例恶性神经鞘瘤,6例恶性间叶组织肿瘤(3例软骨肉瘤,1例肌纤维母细胞瘤,2例平滑肌肉瘤),3例腺样囊性癌,1例淋巴瘤,1例鳞状细胞癌,1例浸润性腺癌,1例肌上皮癌,1例粘液表皮样癌。咽旁间隙肿瘤分为神经源性、涎腺来源、间叶组织来源及其它组织来源;良性肿瘤边缘多光滑,与周围分界清楚;恶性肿瘤信号多不均匀,边界不规则,向周围浸润生长。多数肿瘤有其各自的MRI表现特点。结论咽旁间隙肿瘤病理种类多样,了解此间隙肿瘤的MRI特点,有助于提高诊断准确率。     

迷走神经副神经节瘤的MRI诊断(附6例报告及文献复习)

目的 分析迷走神经副神经节瘤的MRI表现。方法 对6例迷走神经副神经节瘤（良性4例，恶性2例）进行回顾性分析，重点分析其部位、信号、大血管移位和转移情况。结果 6例肿瘤中，4例位于上颈部，中、下颈部各1例；右颈部病变4例，左颈部2例；肿瘤类似纺锤形或不规则形；6例信号均欠均匀，其中4例出现“盐和胡椒征”，以“胡椒”表现最为显著；6例病变均有明显强化。对4例病变行MR血管造影，见颈动脉均向前、内移位，颈内静脉向后、外移位。2例恶性肿瘤中，1例破坏颈静脉孔区域骨质并颈部淋巴结和双肺内转移，1例出现颈部淋巴结的转移。结论 迷走神经副神经节瘤有其特定的部位和MRI信号，手术前可以进行定性诊断。     

颈部节细胞神经瘤一例

患者 女,31岁.因咽痛半个月入院.体检:咽左侧壁可见肿物突起,表面光滑.实验室检查无异常.CT平扫示左颈部椭圆形均一低密度肿块,大小约5.1 cm×2.4 cm×8.5 cm,CT值21～29 HU,边界光滑,占据左咽旁间隙、颈动脉间隙,向后达椎前间隙;增强后动脉期肿块未见明显强化,静脉期肿瘤内部可见片絮状强化,CT值28～76 HU(图1).病变下端起源于颈动脉鞘内侧,椎前肌前方.同侧颈内动、静脉受压外移.印象:神经源性肿瘤.平扫MRI示肿块于T1 WI呈较均一低信号,在T2 WI呈不均一高信号,其内可见絮状等信号(图2);增强后肿块呈明显不均一强化(图3).印象:副神经节瘤.     

颈部副神经节瘤的DSA诊断研究(附17例分析)

目的 探讨颈部副神经节瘤的ＤＳＡ诊断价值。方法 总结经病理证实的动脉体瘤（ＣＢＴ）１２例、颈静脉瘤（ＣＪＴ）５例,研究ＤＳＡ表现,并与其他颈部肿块性病变进行对照。结果 副神经节瘤主富血供型（ＣＢＴ１１例,ＧＪＴ３例）,ＤＳＡ能清楚显示肿瘤血管细节及肿瘤与相邻血管的整体关系。ＣＢＴ颈总动脉分驻开大呈握球状（１２例）、枕动脉近段向前上推移（１２例）、咽升动脉肿瘤中心供血（１０例）具有特征性,３例恶变者     

头颈部副神经节瘤影像学诊断

目的:探讨头颈部副神经节瘤的影像学特征。方法:回顾性分析19例头颈部副神经节瘤的CT、MRI和DSA表现,其中颈静脉球瘤3例,鼓室球瘤2例,颈动脉体瘤12例,迷走体瘤2例。结果:颈静脉球瘤的CT特征为颈静脉孔扩大和虫蚀骨质破坏,1例双侧因肿瘤为1cm首次平扫漏诊;鼓室球瘤均较小,发生于鼓岬区,临床特征为搏动性耳鸣和鼓膜充血;颈动脉体瘤位于颈总动脉分叉处,特征为颈内、外动脉分离和动脉镶嵌于肿瘤边缘或肿瘤内;迷走体瘤与颈动脉体瘤的区别在于颈内、外动脉受压后均向前移位。增强后肿瘤均见明显强化,MRA图像有助于确认肿瘤内的滋养血管,术前栓塞是治疗的有效方法,能减少约50%~70%肿瘤供血。结论:头颈部副神经节瘤具有特定的解剖学位置和影像学表现,对临床诊断和治疗有重要价值。     

X-ray computed tomographic aspects of neoplastic pathology of the parapharyngeal space

The parapharyngeal space is a fat-filled region situated deep in the head between the basicranium and the oral floor. It can be divided in two parts: the prestyloid and the poststyloid space. The mandibular nerve is contained in the prestyloid space, while the carotid artery, jugular vein, IX, X, XI, XII cranial nerves, cervical sympathetic chain and junctional lymph nodes are situated in the poststyloid compartment. The normal CT anatomy and CT findings in 22 patients with proven lesions of the parapharyngeal space are described. Three different groups of neoplastic processes can be distinguished: primary tumours, secondary tumours and enlarged lymph nodes. The nature of the lesions developing in the parapharyngeal space can be diagnosed by CT in many cases.     

Re-evaluation of optimal dose of contrast medium for vascular enhancement in CT of the head and neck

Adequate contrast enhancement of major neck vessels is more important than that of a tumour itself in CT of most head and neck tumours because of differentiation from neck node metastases. Our purpose was to re-evaluate the dosage of contrast medium for adequate vascular enhancement in CT of the head and neck. In a blind prospective fashion, 60 patients with a variety of head and neck lesions were randomised into three equal groups receiving 0.75, 1.0, or 1.25 ml/kg of meglumine ioglycate, 300 mg/ml. Contrast medium was administered by injector at 2 ml/s. The scan time and interscan delay were each 1 s, and total scan time 50–180 s. The scan was started immediately after administration of two-thirds of the contrast medium. The degree of vascular enhancement was assessed visually and quantitatively. We visually scored the degree of vascular enhancement as excellent (4 points), good (3), fair (2) or poor (1). For quantitative study, after measuring the CT numbers of the common or internal carotid artery (CA), internal jugular vein (IJV) and adjacent muscle at three levels, were calculated mean vessel/muscle contrast ratios. The degree of enhancement of the CA and IJV tended to increase with dose of the contrast media, but no examination was rated as showing poor enhancement in any group. The mean visual assessment scores for 0.75, 1.0, and 1.25 ml/kg were 2.7, 2.9 and 3.1, respectively; the mean ICA/muscle contrast ratios were 1.58, 1.55 and 1.63, and those of IJV/muscle 1.65, 1.59 and 1.59. There was no significant difference between visual and quantitative assessment in any group. The results suggest that 0.75 ml/kg of contrast medium appears sufficient for vascular opacification for head and neck lesions when the CT scan can be completed in about 120 s. Received: 21 November 1995 Accepted: 28 December 1995     

咽旁间隙肿瘤CT诊断

作者分析１８例经手术病理证实的咽旁间隙肿瘤的ＣＴ所见。将咽旁间隙分为茎突前间隙和茎突后间隙，根据解剖部位各异，其肿瘤的组织发生也不同，就该区域的解剖及病变所在表现，认为咽旁脂肪组织、血管、茎突的移位，变形和增强ＣＴ，对判定肿瘤的组织来源很有帮助。     

Common tumors of the parapharyngeal space: refined imaging diagnosis

Computed tomographic (CT) scans and magnetic resonance (MR) images in 103 patients with either a deep-lobe parotid tumor extending into the parapharyngeal space, a minor salivary gland tumor, a neuroma, or a paraganglioma were reviewed. The parotid or extraparotid nature of these masses was established by identifying a fat plane between the mass and the parotid gland. This was more reliably accomplished with MR imaging than with CT. Although dynamic CT allowed identification of the glomus tumors, MR imaging also permitted diagnosis of these lesions. The inherent CT and MR imaging characteristics of most of the neuromas and minor salivary gland tumors were indistinguishable. However, the neuromas tended to displace the internal carotid artery anteriorly, whereas the salivary lesions displaced this vessel posteriorly. This artery was better identified on MR images than on CT scans. Thus, these lesions, which are the four most common primary parapharyngeal space tumors, can be distinguished on MR images by evaluating not only their inherent signal characteristics but also the surrounding fat planes and any displacement of the internal carotid artery.     

Evaluation of topography and vascularization of cervical paragangliomas by magnetic resonance imaging and color duplex sonography

The management of cervical paragangliomas (PGs) depends on their specific type and their relation to adjacent vessels. The purpose of this study was to evaluate the potential of magnetic resonance imaging (MRI) and color duplex sonography (CDS) to classify PGs according to topography and vascularization. Sixteen patients harboring 22 PGs were studied retrospectively. With digital subtraction angiography as reference, the topographic relation of the tumors to the carotid arteries and the internal jugular vein and the patterns of vascularization were assessed. On MRI and CDS the typical feature of 15 carotid PGs was splaying of the carotid bifurcation, with the external carotid displaced anteriorly and the internal carotid artery and internal jugular vein located posteriorly. In five vagal PGs both modalities showed unidirectional anterior displacement of the external and internal carotid arteries. Two jugular PGs were found to extend within the lumen of the internal jugular vein. CDS completely depicted carotid body tumors but failed to delineate the high cervical portion of vagal and jugular PGs. MRI allowed us to assess the entire extent of all PGs. Nineteen lesions showed flow voids corresponding to abundant flow signal on CDS: three carotid body tumors appeared hypovascular on CDS and MRI. On CDS, intratumoral flow was directed cranially in carotid and inferiorly in vagal and jugular PGs. CDS and MRI are suitable for classification of cervical PGs as carotid, vagal or jugular PGs based on the topographic relation to the carotid arteries and internal jugular vein. Visualization of the intrinsic tumor vasculature proved an additional distinguishing criterion on CDS.     

介入放射学在颈静脉球瘤术前应用的价值

目的:评价介入放射学在颈静脉球瘤术前应用的价值.方法:本组9例颈静脉瘤患者均经手术病理证实,所有患者于术前行双侧颈内、外动脉和椎动脉造影检查,对其中7例患者行术前供血动脉栓塞及患侧颈内动脉球囊阻断试验以了解Willis'环功能.结果:9例颈静脉球瘤患者术前造影及7例供血动脉栓塞均获成功,肿瘤切除术中出血明显减少;6例通过颈内动脉球囊阻断试验,术中施行颈内动脉结扎术,术后随访均未出现神经系统症状或体征.结论:颈静脉球瘤术前供血动脉栓塞及颈内动脉球囊阻断试验是安全可靠的,可作为常规术前检查.     

Glomustumoren der Kopf-Hals-Region

Glomus tumors of the head and neck are rare tumors of adulthood which arise from paraganglia or glomus cells within the carotid glomus, vagus nerve, middle ear or jugular foramen. The diagnosis of these mostly benign lesions is predominantly done with CT and MRI. DSA can provide important additional information. Besides surgical resection, one therapy option is radiological intervention with tumor embolisation. Because of the typical radiological imaging and the “salt and pepper appearance” in MRI, glomus tumors can be differentiated from other lesions in the head and neck. This review gives a survey of the classification, diagnosis and therapy of paragangliomas with images to demonstrate characteristic features.