头颈部恶性肿瘤沿三叉神经分支扩散的CT、MRI表现  

CT and MRI features of perineural tumor spreading along the trigeminal nerve in malignant head and neck tumors

作　　者：魏懿[1] 肖家和[1] 周翔平[1] 

机构地区：[1]四川大学华西医院放射科,成都610041

出　　处：《中华放射学杂志》2005年第7期768-771,共4页Chinese Journal of Radiology

摘　　要：目的探讨头颈部恶性肿瘤沿三叉神经转移的CT和MRI征象,提高头颈部恶性肿瘤诊断的准确性,帮助临床提高肿瘤的治疗效果。方法回顾分析9例经临床及影像学诊断、有沿三叉神经分支扩散现象的头颈部恶性肿瘤的CT和MRI资料。结果9例中,硬腭腺样囊性癌3例,鼻咽癌2例,上颌窦腺样囊性癌、上颌窦鳞状上皮细胞癌、颊部腺样囊性癌及腮腺腺样囊性癌各1例。9例中,腺样囊性癌共有6例,占67%。在3例硬腭腺样囊性癌和1例上颌窦鳞状上皮细胞癌中可见远离原发灶的腭大孔和翼腭窝扩大,其内密度增高,其中1例还可见同侧卵圆孔扩大,三叉神经节有强化的软组织影。1例上颌窦腺样囊性癌中可见眶下孔破坏,同侧翼腭窝扩大。1例颊部腺样囊性癌可见同侧翼腭窝扩大,圆孔扩大,其内可见强化软组织侵入三叉神经节。1例腮腺腺样囊性癌可见耳颞神经处有软组织影,并破坏同侧卵圆孔侵入颅内。2例鼻咽癌中可见肿瘤侵入咀嚼肌间隙并侵犯同侧三叉神经下颌支。结论头颈部恶性肿瘤可以沿三叉神经扩散,CT和MRI可以对其准确判断,熟悉三叉神经及其周围的头颈部解剖结构对诊断极为重要。Objective To study the imaging features regarding perineural spread of tumor along the trigeminal nerve in malignant head and neck tumors, investigate its usefulness in improving diagnostic accuracy and palnning for clinical treatment. Methods Images in 9 patients with clinical or radiological findings suggestive of perineural spread along trigeminal nerve were retrospectively studied. Results Among the 9 patients, 6 were adenoid cystic carcinoma of the hard palate (n=3), maxillary sinus (n=1), parotid gland (n=1) and buccal space (n=1), respectively. Two were nasopharyngeal carcinoma and 1 was squamous carcinoma of the maxillary sinus. Enlargement and fat effacement of greater palatine foramen and pterygopalatine fossa distant from primary diseases were seen in all the 3 patients with adenoid cystic carcinoma of the hard palate and 1 with squamous carcinoma of maxillary sinus, furthermore, enlargement of foramen ovale and invasion of meckal cave was seen in 1 case. Erosion of infraorbital foramen and enlargement of the pterygopalatine fossa was seen in 1 patient with adenoid cystic carcinoma of maxillary sinus. Enlargement of pterygopalsatine fossa and foramen rotundum and invasion of the Meckal cave were seen in 1 patient with adenoid cystic carcinoma of buccal space. Perineural spread along auriculotemporal nerve and intracranial invasion through foramen ovale were seen in 1 patient with adenoid cystic carcinoma of parotid gland. Enhancement of mandibular nerve was seen in 2 patients with nasopharyngeal carcinoma. Conclusion Perineural tumor spread along trigeminal nerve can be seen in malignant head and neck tumors, and knowledge of the anatomy of trigeminal nerve and its surrounding structures is important for correct diagnosis.

关 键 词：头颈部恶性肿瘤 神经分支 MRI表现 CT 鳞状上皮细胞癌 腺样囊性癌 三叉神经下颌支 三叉神经节 恶性肿瘤诊断 MRI征象 影像学诊断 咀嚼肌间隙 上颌窦 翼腭窝 软组织 神经转移 治疗效果 回顾分析 扩散现象 密度增高 耳颞神经 

分 类 号：R739.91[医药卫生—肿瘤] R322.8[医药卫生—临床医学]