CT和MRI诊断颈动脉及其周围间隙孤立性病变  

CT and MRI diagnosis of solitary lesions in carotid and pericarotid spaces

作　　者：李仰康[1] 周修国[1] 蔡爱群[1] 林建浜[1] 许桂晓[2] 

机构地区：[1]汕头大学医学院附属肿瘤医院放射科,广东汕头515041 [2]华南肿瘤学国家重点实验室中山大学肿瘤防治中心影像与微创介入科,广东广州510120

出　　处：《中国医学影像技术》2013年第4期519-523,共5页Chinese Journal of Medical Imaging Technology

基　　金：2012年度汕头市医疗重点科技计划项目(汕府科2012-113号)

摘　　要：目的探讨CT和MRI对颈动脉及其周围间隙孤立性病变的定位、定性诊断价值。方法收集65例经病理证实的颈动脉及其周围间隙孤立性病变患者,对38例行CT检查,其中29例行3DVR血管重建;对27例行MR检查,其中16例行三维对比增强MRA(3DCE-MRA)检查。分析病变的大小、形态、边界、密度、信号、内部结构、强化特征及其与颈动静脉的关系。结果神经鞘瘤、神经纤维瘤、颈动脉体瘤、颈内动脉瘤、淋巴结转移瘤、巨淋巴结增生症、腮裂囊肿及腮裂囊肿合并感染的CT或MRI表现具有一定特征性;血管瘤、淋巴瘤、淋巴结结核、结节病及支气管囊肿罕见,影像学表现缺乏特征性。神经鞘瘤和神经纤维瘤使颈动静脉向外或前外侧移位。淋巴结病变使颈动静脉向内或前内侧移位。颈动脉体瘤和颈内动脉瘤使颈动脉分叉角度增大,但颈内动脉瘤使受累血管呈瘤样增粗,CTA或MRA可直接定性诊断。结论CT和MRI分别结合3DVR血管成像和3DCE-MRA是定位诊断颈动脉及其周围间隙孤立性病变的有效手段,根据平扫和增强特征及其与颈动静脉的关系,可对大部分孤立性病变做出定性及鉴别诊断。Objective To assess the value of CT and MRI for localization and characterization of solitary lesions in carotid and pericarotid spaces. Methods Totally 65 patients with solitary lesions in carotid and pericarotid spaces proved patholog- icall5i were selected. CT was performed on 38 patients, and 3D volume rendering （VR） CTA was performed on 29 pa- tients. MR was performed on 27 patients, and 3I）-Tricks contrast enhancement MR angiography （CE MRA） was per- formed on 16 patients. The size, shape, margin, density, signal intensity, internal architecture, enhancement features of the lesions and the relationship between the great vessels and lesions were analyzed. Results Schwannoma, neurofibroma, carotid body tumor, inner carotid artery aneurysm, metastatic lymphadenopathy, Castleman disease, branchial cleft cyst and branchial cleft cyst with infection had characteristic signs or intensity on CT or MRI. Hemangioma, lymphoma, tuber- culosis, sarcoidosis and bronchogenic cyst were rare and lacked of imaging characteristics. Lateral or anterolateral displace- ment of the vessels was found in patients with schwannoma and neurofibroma. Medial or anteromedial displacement of the vessels was found in lymphadenopathy. Angle of common carotid bifurcation enlargement was found in carotid body tumor and inner carotid artery aneurysm, but tumor-like dilation of the involved vessel was found in inner carotid artery aneurysm on CTA or MRA. Conclusion CT and MRI in combination with 3D VR angiography and 3D CE-MRA respectively are ef- fective modalities of localizing solitary lesions in carotid and pericarotid spaces. According to the features of plain scan, en- hanced imaging and relationship between adjacent great vessels and lesions, most solitary lesions can be identified by CT and MRI.

关 键 词：颈动脉间隙病变 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445[医药卫生—影像医学与核医学] R814.42[医药卫生—诊断学]