鼻咽纤维血管瘤CT、MRI和DSA影像学分析  

CT、MR and DSA Imaging Analysis of Nasopharyngeal Angiofibroma

作　　者：闫钟钰[1] 王玉辉[2] 梁熙虹[1] 王振常[3] 鲜军舫[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730 [2]北京市昌平区中西医结合医院放射科 [3]首都医科大学附属北京友谊医院

出　　处：《临床放射学杂志》2014年第7期982-987,共6页Journal of Clinical Radiology

摘　　要：目的回顾性分析鼻咽纤维血管瘤术前CT、MRI、DSA影像学表现，总结其形态学和血供特点。方法94例鼻咽纤维血管瘤患者，根据有无既往治疗史分为原发组和术后继发组，分析影像征象，包括肿瘤发生部位、形态、轮廓边缘、CT密度、骨质侵蚀破坏、MRI T1WI信号强度、T2WI信号强度、T2WI信号均匀度、流空信号、增强后表现、DSA血供类型。结果94例中发生于鼻咽后鼻孔区89例，鼻腔上颌窦5例。发生于鼻咽部89例（94．6％），鼻腔鼻窦5例（5．4％）；圆形或椭圆形42例（44．7％），不规则形52例（55．3％）；边缘光滑20例（21．2％），分叶状74例（78．8％）。70例CT检查中，密度均匀63例（90．0％），密度不均匀7例（10％），CT值在40～60HU之间；局限性骨质侵蚀50例（71．4％），广泛性颅底骨质侵蚀16例（22．9％），无明确颅底骨质侵蚀4例（5．7％）；74例MRI检查病例中，与脑灰质相比，T1WI等信号69例（93．2％），稍低信号5例（6．8％），信号均匀；T2WI高信号66例（89．1％），等信号8例（10．9％）；T2WI信号均匀8例（10．9％），不均匀66例（89．1％），其中2例内部可以见到片状囊变信号区；MRI流空信号61例（82．4％），流空信号不明显13例（17．6％），MRI增强后明显不均匀强化49例（66．2％），均匀强化25例（33．8％）；行DSA检查72例中，供血类型为单纯同侧颈外动脉分支供血39例（54．2％），颈外合并同侧或对侧颈内动脉分支供血33例（45．8％）。结论鼻咽纤维血管瘤影像学表现有特征性，以发生于鼻咽部、分叶状轮廓、CT密度均匀、局限性骨质侵蚀、MRI T1WI等信号、T2WI高信号且不均匀、流空信号、明显不均匀强化等征象为主，肿瘤大小、形态、供血类型3种征象，原发组和手术后复发组无特征。Objective To retrospectively analyze the preoperative CT, MR and DSA findings of nasopharyngeal angiofi- broma in order to summarize its morphology and blood supply features. Methods Ninety-four patients with pathologically- proved nasopharyngeal angiofibroma were enrolled in this study. Based on the presence or absence of previous treatment, the patients were divided into the primary group （ n = 61 ） and the postoperative secondary group （ n = 33 ）. The imaging signs, including the location, shape, margin, CT density, bone destruction, MRI signal intensity （hypo, iso- or hyper-intensity） on T1 WI and T2WI, the signal homogeneity on T2WI, signal void, degree of contrast enhancement, blood supply types on DSA, etc. were analyzed. Results Of the 94 cases, the tumor was originated from nasopharyngeal area in 89 （94.6%） and from nasal cavity in 5 （5.4%）. The tumor was round or oval in shape in42 cases （44.7%）, and was irregular in shape in 52 cases （55.3%）. The tumor＇ s margin was smooth in 20 cases, and was lobulated in 74 cases （78.8%）. CT scanning was carried out in 70 cases. On CT scans the tumor＇ s density was homogenous in 63 cases （90, 0% ） and heterogeneous in 7 cases （ 10% ）. CT values varied from 40 to 60 HU. Localized bone destruction was seen in 50 cases （71.4%）, diffuse bone erosion at basicranial region was detected in 16 cases （22.9%）, and in 4 cases （5.7%） no definite bone erosion at basicranial region was found. MRI scanning was performed in 74 cases. On T1WI the tumor exhibited iso-intensity signal in 69 cases （93.2%） as compared with the signal of cerebral grey matter, and homogenous slightly low-intensity signal in 5 cases （ 6.8% ）. On T2WI the tumor assumed high-intensity signal in 66 cases （89.1%） and iso-intensity signal in 8 cases （10.9%）. On T2WI homogenous signal was seen in 8 cases （10.9%） and heterogeneous signal in 66 cases （89.1% ）, among them cystic degeneration within the tumor was demonstrated in two. MRI

关 键 词：纤维血管瘤 鼻咽部 磁共振成像 体层摄影术 X线计算机 

分 类 号：R739.63[医药卫生—肿瘤]