颌面部病变侵犯中颅窝底的CT表现  

Central Basicranial Erosion due to Maxillofacial Lesions: CT Findings

作　　者：石慧敏[1] 王平仲[1] 余强[1] 罗济程[1] 

机构地区：[1]上海第二医科大学附属第九人民医院放射科,200011

出　　处：《临床放射学杂志》2002年第3期188-191,共4页Journal of Clinical Radiology

摘　　要：目的　评价颌面部病变侵犯中颅窝底的CT表现。资料与方法　搜集经CT横断和冠状面检查显示有中颅窝底破坏的颌面部病变 5 0例 ,所有病变均经手术或活检病理证实。结果　CT显示中颅窝底破坏方式可分为 4型 :Ⅰ型 :颅底骨质吸收 ,又分为Ⅰa(颅底骨外板吸收 ,内板未受侵 ,18例 )和Ⅰb(颅底骨内板受侵 ,13例 ) ;Ⅱ型 :颅底的孔、管扩大 (6例 ) ;Ⅲ型 :颅底骨质硬化 (2例 ) ;Ⅳ型 :Ⅰ和Ⅱ型 (11例 )并存。 5 0例中 ,CT显示颅底破坏的常见结构为翼突 (36例 )、蝶骨大翼 (31例 )、蝶骨体 /窦 (2 6例 )、翼管 (2 3例 )、卵圆孔 (2 6例 )及圆孔 (2 3例 )。 5 0例中 ,除 5例为病变直接侵犯中颅窝底外 ,其余 4 5例均是自颌面深部间隙侵犯中颅窝底 ,这些间隙分别是 :颞下间隙 (31例 )、翼腭窝 (34例 )和咽旁间隙 (11例 )。CT上显示有颅内结构 (海绵窦、大脑颞叶 /脑膜和垂体 )受侵者 2 5例 ,其中表现为Ⅰa型 3例 ,Ⅰb型 12例 ,Ⅱ型 4例 ,Ⅲ型 1例和Ⅳ型 5例。结论　骨吸收是颌面部病变侵犯中颅窝底的主要CT表现。颌面深部间隙是颌面部病变破坏中颅窝底的主要途径。颌面部病变的颅内侵犯与颅底内板吸收和中颅窝底孔。Objective To evaluate CT manifestations of central basicranial erosion due to a variety of maxillofacial lesions.Materials and Methods Axial and coronal CT findings in 50 patients with central basicranial erosion due to pathologically proved maxillofacial lesions were retrospectively analyzed.Results On CT scan, basicranial erosion could be divided into 4 types. Pattern Ⅰ: basicranial bone absorption. This pattern could be subdivided into Ia (absorbed outer table and normal inner table, n=18) and Ib (absorbed inner table, n=13). Pattern Ⅱ: enlarged foramen or canal (n=6). Pattern Ⅲ: basicranial bone sclerosis (n=2). Pattern Ⅳ: Ⅰ plus Ⅲ (n=11). The common involved basicranial structures included pterygoid process (n=36), sphenoid greater wing (n=31), sphenoid body/sinus (n=26), pterygoid canal (n=23), foramen ovale (n=26) and foramen rotundum (n=23). Of 50 lesions, direct invasion to the basicranial base was seen in 5 and invasion from deep maxillofacial spaces in 45. The deep spaces included infratemporal fossa (n=31), pterygopalatine fossa (n=34) and parapharyngeal space (n=11). On CT, involvement of the intracranial structures was found in 25 patients, of which Ⅰa pattern was seen in 3, Ⅰb pattern in 12, Ⅱ pattern in 4, Ⅲ pattern in 1 and Ⅳ pattern in 5.Conclusion The main CT sign or central basicranial invasion due to maxillofacial lesions is the bone absorption. The major invading pathway is the deep maxillofacial spaces. The intracranial involvement in maxillofacial lesions is in close relation with basicranial bone absorption and the involvement of middle basicranial foramina and canals.

关 键 词：头颈部肿块 颌面部病变 中颅窝底侵犯 CT 诊断 

分 类 号：R816.1[医药卫生—放射医学]