耳鼻咽喉部腺样囊性癌影像分析  

Imaging Analysis of Adenoid Cystic Carcinoma of ENT

作　　者：钱雯[1] 唐作华[1] 包兵[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院放射科

出　　处：《中国医学计算机成像杂志》2013年第4期317-320,共4页Chinese Computed Medical Imaging

摘　　要：目的:通过分析耳鼻咽喉部腺样囊性癌(ACC)的影像表现,提高对本病的认识和诊断。方法:回顾性分析耳鼻咽喉部经手术和病理证实的ACC病例的临床和影像资料,共38例(鼻腔鼻窦或鼻底腭部22例、外耳道11例、鼻咽3例和喉部2例),均行CT检查,19例行MRI检查。结果:①部位和形态:鼻腔、鼻窦和鼻底腭部ACC中20例呈分叶或浸润状,2例边缘光滑,5例见肿瘤侵犯三叉神经分支,2例沿鼻腔和腭部结构浸润状生长;耳部ACC多数发生于外耳道外侧段,沿耳道壁浸润性生长;鼻咽部ACC呈分叶状,2例肿瘤沿三叉神经分支侵入颅内;喉部ACC范围广泛,累及喉及颈段气管,基底广且表面不规则。②密度和信号:CT平扫中等或稍低密度,增强扫描呈轻或中度强化;MRI T1WI等或稍低信号,T2WI等或高信号,中等或明显强化;27例(71%)肿瘤内见囊性区,其中16例(42%)呈特异性筛囊样改变,以鼻腔鼻窦和鼻咽部病例为多。③骨质:破坏13例(鼻腔鼻窦10例、鼻咽2例、喉部1例);破坏伴受压11例(鼻腔鼻窦10例、耳部1例);骨质受压1例(鼻窦);较多外耳道ACC骨质无异常。结论:耳鼻咽喉部ACC的影像表现具有恶性肿瘤的共同特点:边缘不规则、不清楚、浸润状生长、肿瘤内囊性或坏死区、伴骨质破坏等。其较特异性的表现为筛囊状、沿神经侵犯和沿结构浸润生长,筛囊状表现可能以鼻咽和鼻窦ACC较多见,耳部ACC骨质破坏相对少见。Purpose： The imaging manifestations of the adenoid cystic carcinoma （ACC） in ENT region were analyzed to improve the recognition and diagnosis of the disease. Methods： Thirty-eight cases of surgically and pathologically approved ACC were respectively analyzed （22 located in sino-nasal or palatonasal region, 11 in external auditory canal, 3 in nasopharynx and 2 in throat）. All patients underwent CT and 19 had MRI examination. Results： （1） Location and shape： 20 sino-nasal or palatonasal ACCs had lobular or infiltrating shape, whereas 2 with smooth margin, the branch of trigeminal nerve was invaded in 5 tumors and the palatonasal structure was infiltrated in 2; Most ear ACCs were originated from the lateral segment of external auditory canal with infiltrating margin~ Nasopharyngeal ACCs had lobular margin and 2 of them invaded the cranium with the trigeminal nerve; Throat ACCs involved throat and trachea with widespread basis and irregular surface. （2） Density and signal： Middle or slightly low density on plain scan, mild or moderate enhancement on enhanced CT. Middle or slightly low signal on MRI T1WI sequence, middle or high signal on T2WI sequence, moderate to marked enhancement on enhanced TIWI~ 27 cases （71%） had cystoid region in the tumor and 16 of them （42%） with a specific sign of cribriform-cystoid change, which were more likely showed in sino-nasal and nasopharyngeal ACCs. （3） Bony changes： Destruction in 13 cases （10 sino-nasal ACC, 2 nasopharyngeal ACC, 1 throat ACC）, destruction and compression in 11 cases （10 sino-nasal ACC, 1 ear ACC）, compression in 1 case （sino-nasal ACC）. Most ACCs of the external auditory canal had no bony abnormality. Conclusion： ACCs in ENT common manifestations of malignant tumor： irregular and infiltrating margin, cystoid or necrosis in the tumor, bony destruction, etc. The specific features are cribriform-cystoid sign, invading the nerve and infiltrating anatomic structure. Cribriform-cystoid sign may be more likely

关 键 词：腺样囊性癌 体层摄影术 X-线计算机 磁共振成像 

分 类 号：R739.6[医药卫生—肿瘤]