表现为搏动性耳鸣的颞骨占位性病变的影像学诊断  

Imaging diagnosis of masses in temporal bone associated with pulsatile tinnitus

作　　者：戴媛媛[1] 沙炎[1] 张放[1] 黄文虎[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院放射科,上海200031

出　　处：《中华医学杂志》2013年第33期2617-2621,共5页National Medical Journal of China

摘　　要：目的提高以搏动性耳鸣为主要症状的颞骨占位性病变的影像诊断水平。方法回顾性分析复旦大学附属眼耳鼻喉科医院自2006--2011年32例有搏动性耳鸣症状并经病理证实的颞骨占位性病变的CT和MRI表现，总结其影像表现特点。结果根据病变否累及颈静脉孔区可分成两组。（1）累及颈静脉孔区组包括：颈静脉球瘤5例，强化显著，2例典型者MRI表现为“盐和胡椒”征象；中耳癌5例，均见鼓室鼓窦区、外耳道深部软组织肿块及咽鼓管骨性段骨质破坏；内淋巴囊肿瘤3例，均见不规则针状骨结构，T1WI肿块周边后缘呈高信号；转移瘤1例，颞枕骨大范围骨质破坏，累及颈静脉孔区，T1WI呈等信号，T2WI呈等高信号，增强后轻中度强化。（2）未累及颈静脉孔区组包括：鼓室球瘤15例，鼓室及听小骨等均未见骨质破坏，7例仅局限于鼓岬，7例充满鼓室鼓窦且有5例涉及外耳道深部，1例向颞骨乳突蔓延，12例行MRI增强扫描均强化显著；中耳胆固醇肉芽肿2例，表现为鼓室鼓窦区软组织灶，T1WI和T2WI均呈高信号；面神经血管瘤1例，表现为面神经膝状窝的扩大和软组织肿块，累及面神经鼓室段，伴听小骨移位和骨质吸收，增强MRI表现为显著强化。结论表现为搏动性耳鸣的颞骨占位性病变中，副神经节瘤（包括鼓室球瘤、颈静脉球瘤）较多见且其影像学表现有特征性，易作出诊断；其他占位性病变虽少见，但根据临床和影像学表现特点也能作出正确诊断。Objective To improve the imaging diagnosis accuracy on masses of temporal bone associated with pulsatile tinnitus. Methods The CT and MRI features of masses in temporal bone associated with pulsatile tinnitus in 32 cases, confirmed by pathology, were retrospectively analyzed. Results They were grouped into two according to the jugular bulb involved or not. In the group involving the jugular bulb, there were 5 cases with glomus jugular, 2 cases of them presented the feature of ＂saltpepper＂. There were 5 cases with middle ear carcinoma, which presented the masses in the tympanic cavity and antrum, extended to the external auditory canal and eroded the eustachian tube and jugular bulb. There were 3 cases with endolymphatie sac tumors, which presented multiple bony spicules on CT images and high signal on T1 -weighted images. There was 1 case with metastatic tumor, which extensively eroded temporal and occipital bone, involved the jugular bulb, presented intermediate signal on Tl-weighted images and intermediate or high signal on T2-weighted images, moderately enhanced following contrast administration. In the group not involving the jugular bulb, there were 15 cases with tympanic glomus, without ossicles and tympanic erosion, 7 cases of them limited to the promontory, 7 cases of them filled the tympanic cavity and antrum and 5 cases extended deep into the external auditory canals, 1 case extended to the mastoid, 12 cases intensely enhanced with gadolinium. There were 2 cases with cholesterol granulomus of the middle ear, which presented the masses in the tympanic cavity and antrum and high Tt -weighted and T2-weighted signal. There was 1 case with facial nerve hemangioma, which presented the enlargement and mass of the geniculate fossa involving the tympanic segment of facial nerve with the erosion and displacement of ossicles. On MR images, the mass was intensely enhanced after contrast administration. Conclusion Among the masses of temporal bone associated with pulsatile tinnitus, the paragangliomas are the mo

关 键 词：搏动性耳鸣 颞骨占位 体层摄影术 X线计算机 磁共振成像 

分 类 号：R764[医药卫生—耳鼻咽喉科]