颈动脉间隙内颈动脉体瘤和神经鞘瘤的影像学鉴别诊断  

Imaging differential diagnosis of carotid body tumor and schwannoma in carotid space

作　　者：郝大鹏[1,2] 满凤媛[2] 王振常[2] 徐文坚[1] 梁熙虹[2] 崔久法[1] 陈光利[2] 杨本涛[2] 

机构地区：[1]青岛大学医学院附属医院医学影像中心,山东青岛266003 [2]首都医科大学附属北京同仁医院医学影像中心,北京100730

出　　处：《中国医学影像技术》2010年第2期258-261,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨位于颈动脉间隙的颈动脉体瘤和神经鞘瘤的影像学特点。方法回顾性分析16例经手术病理证实的发生于颈动脉间隙的颈动脉体瘤和神经鞘瘤的CT、MRI和数字减影血管造影(DSA)表现。其中颈动脉体瘤8例,神经鞘瘤8例。6例颈动脉体瘤和5例神经鞘瘤患者接受CT平扫;所有患者均接受MR平扫和增强扫描;4例颈动脉体瘤和2例神经鞘瘤患者接受DSA检查。结果CT表现:①6例颈动脉体瘤为分叶状软组织肿块影,呈与周围肌肉组织等密度改变;2例累及颈静脉孔者可见颈静脉孔扩大,边缘不规则、虫蚀状骨质破坏。②5例神经鞘瘤为卵圆形或梭形软组织肿块影,呈与周围肌肉组织等或低混杂密度改变;2例累及颈静脉孔者可见颈静脉孔扩大,边缘光整,无骨质破坏。MRI表现:8例颈动脉体瘤呈分叶状,边界清楚,纵向生长,有特征性血管流空信号,分离并包绕颈内、外动脉,动脉管径正常,增强扫描明显强化。8例神经鞘瘤呈梭形或卵圆形,边界清楚,纵向生长,呈混杂信号,分离颈动、静脉,血管管径变窄,增强扫描呈不均匀强化。DSA表现:4例颈动脉体瘤呈明显肿瘤染色,2例神经鞘瘤呈轻度肿瘤染色。结论根据颈动脉间隙内颈动脉体瘤和神经鞘瘤的特征性影像学表现可对二者进行准确鉴别。Objective To observe imaging characteristics of carotid body tumor and schwannoma in carotid space. Methods CT, MRI and digital subtraction angiography （DSA） appearances of 16 patients with carotid body tumors and schwannomas in carotid space confirmed pathologically were retrospectively analyzed. There were 8 patients with carotid body tumors and 8 patients with schwannomas. Six patients with carotid body tumors and 5 patients with schwannomas underwent CT plain scan. All the patients underwent MR plain and contrast-enhanced scan. Four patients with carotid body tumors and 2 patients with schwannomas underwent DSA examination. Results CT.. Six carotid body tumors were lobulated soft tissue masses. The density of the tumors was similar to neck muscles. Two carotid body tumors involving jugular foramen expanded jugular foramen, and the margin was irregular and erosion-destructive. Five schwannomas were ovoid or fusiform soft tissue masses. The density of the tumors was mixed. Two schwannomas involved jugular foramen expanded jugular foramen, and the margin was smooth. MRI： Eight carotid body tumors were lobulated, well-defined, longitudinal growth masses with characteristic high-velocity flow voids. The tumor splayed and surrounded internal carotid artery and external carotid artery. The diameters of the arteries were normal. The tumors intensely enhanced on contrast-enhanced MRI. Eight schwannomas were ovoid or fusiform, well-defined, longitudinal growth masses with heterogeneous signal, splaying carotid artery and jugular vein. The diameters of the vessels were narrow. The tumors nonuniformly enhanced on contrast-enhanced MRL DSA： Four carotid body tumors showed intense tumor blush, while 2 schwannomas showed slight tumor blush. Conclusion According to the imaging characteristic of the tumors, carotid body tumor and sehwannoma in carotid space can be accurately differentiated.

关 键 词：头颈部肿瘤 磁共振成像 体层摄影术 X线计算机 血管造影术 数字减影 

分 类 号：R445[医药卫生—影像医学与核医学] R73[医药卫生—诊断学]