鼻腔鼻窦转移瘤的影像表现分析  

Imaging manifestation of metastatic tumors in nasal cavity and paranasal sinuses

作　　者：姜滨[1] 李建红[1] 燕飞[1] 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

出　　处：《中华放射学杂志》2015年第5期372-375,共4页Chinese Journal of Radiology

摘　　要：目的分析鼻腔鼻窦转移瘤的影像表现。方法回顾性分析经病理确诊为鼻腔鼻窦转移瘤患者10例，共12个肿块，原发肿瘤分别为肾透明细胞癌6例、肺腺癌2例、结肠腺癌和肝细胞癌各1例。所有患者均行CT及MRI平扫，其中9例行MRI增强扫描，5例行MRI动态增强扫描。对病灶的部位、骨质改变、形态、密度和信号特点以及强化特征进行观察。结果转移瘤位于蝶筛区3个、筛窦2个、上颌窦2个、鼻腔2个、额筛区2个、蝶窦1个。12个转移瘤均有骨质破坏，1例合并肿瘤骨形成。CT显示10个转移瘤呈等密度、1个呈等高混杂密度、1个呈等低混杂密度。MRI表现为T1WI与脑灰质相比呈等信号9个、等低混杂信号3个；T2WI呈等高混杂信号11个、均匀低信号1个。增强扫描肿瘤均呈明显不均匀强化，5例行动态增强扫描的时间-信号曲线呈流出型4例、平台型1例。结论鼻腔鼻窦转移瘤最常见的原发肿瘤是肾癌。典型影像表现是位于筛窦并累及周围多个窦腔的富血供软组织肿块伴明显骨质破坏。Objective To investigate the imaging manifestations of metastasis in the nasal cavity and paranasal sinuses. Methods Twelve lesions of 10 patients with pathologically proved metastasis were retrospectively reviewed, including 6 renal clear cell carcinoma, 2 pulmonary adenocarcinoma, 1 colorectal carcinoma and 1 hepatic carcinoma. All the patients underwent CT and MRI scan.Among them,9 patients had contrast enhanced MRI scan and 5 patients had dynamic contrast-enhenced MRI as well. The location, bone changes, shape,margin,density,signal intensity, and enhancement characteristics of the lesions were observed. Results The metastasis involved spheno-ethmoid area（n=3）, ethmoid sinus （n=2）, maxillary sinus （n=2）, nasal cavity（n=2）, fronto-ethmoid area（n=2） and sphenoid sinus （n=1）. All 12 metastatic lesions demonstrated bone destruction with tumor bone formation in 1 lesion. The CT displayed 10 metastases showed equal density, one mixed density was high, another form of low-density mixed. MR imaging showed equal signal in 9 lesions, while low-mixed signal in 3 lesions on T1WI compared with grey matter were found. On T2WI, 11 lesions showed high mixed signal and homogeneous low signal in 1 lesion. All 12 lesions demonstrated markedly heterogenous enhancement after intravenous administration of contrast media. Of 5 cases with dynamic contrast-enhanced MRI scanning, 4 lesions demonstrated wash-out time-signal intensity curve （TIC） pattern and 1 lesion demonstrated plateau pattern. Conclusions Renal carcinoma is the most common primary tumor for nasal cavity and paranasal sinuses metastasis. A typical imaging finding is located in the ethmoid sinuses, the soft tissue mass surrounded with rich blood supply multiple sinuses and significant bone destruction.

关 键 词：鼻腔 鼻窦 肿瘤转移 体层摄影术 X线计算机 磁共振成像 

分 类 号：R739.62[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44