MRI对海绵窦病变的诊断价值  

Value of MRI in diagnosis of cavernous sinus disease

作　　者：江林[1,2] 张体江[1] 李仕广[2] 杨伟[2] 刘衡[2] 柏拉拉 

机构地区：[1]遵义医学院附属医院影像科,贵州遵义563002 [2]遵义医学院第三附属医院影像科,贵州遵义563002

出　　处：《医学影像学杂志》2017年第2期204-208,共5页Journal of Medical Imaging

摘　　要：目的分析海绵窦(cavernous sinus,CS)病变的MRI表现及其临床价值。方法回顾性分析经临床或/和病理证实的海绵窦病变患者59例(男30例,女29例,年龄范围6~69岁,平均45.3岁)MRI资料。59例海绵窦病变患者均行MRI平扫及增强检查,分析病变形态、信号及累及范围。结果海绵窦原发肿瘤(脑膜瘤8例,三叉神经鞘瘤5例,多发性神经纤维瘤病1例,胶质瘤1例);海绵窦继发肿瘤(鼻咽癌18例,侵袭性垂体瘤8例,脊索瘤6例);非肿瘤性病变(颈内动脉瘤6例,颈内动脉海绵窦瘘3例,海绵状血管瘤2例,鼻咽部动静脉瘘累及海绵窦1例)。主要MRI征象:1)47例肿瘤性病变,一侧海绵窦受累29例,双侧海绵窦受累18例,其中13例包绕双侧颈内动脉,22例包绕一侧颈内动脉;2)非肿瘤性疾病12例,海绵窦内见异常血管流空信号,其中3例颈内动脉海绵窦瘘同侧眼上静脉扩张扭曲,6例动脉瘤表现为颈内动脉扩张呈类圆形流空信号,2例海绵状血管瘤呈稍长T1、长T2信号,增强扫描明显不均匀强化,延时扫描强化范围增大。结论 MRI能清楚显示海绵窦区病变及其累及范围,了解颈内动脉海绵窦段是否被包绕,对海绵窦病变的诊断及鉴别诊断具有重要意义,为临床治疗方案的选择提供理论依据。Objective To analyze MRI manifestation and clinical value of cavernous sinus （CS） diseases. Methods MRI findings of fiftynine patients （30 cases male, 29 cases female age range 6 -69 years old, mean 45.3 years old） with CS diseases proved by clinical and histopathologic findings were analyzed retrospectively. All patients were performed with MRI plain scan and contrast enhancement,to analyze shape and signal and involvement scope of cavernous sinus. Results The CS diseases were con- sisted of 15 cases primary tumors （meningioma 8 cases, trigeminal neuromas 5 cases, neurofibromatosis 1 case, glioma 1 case）, 32 cases secondary tumors （nasopharynigeal carcinoma 18 cases, invasive pituitary tumor 8 cases, chordoma 6 cases）, and 12 ca- ses non-neoplastic lesions （internal carotid artery （ICA） aneurysm 6 cases, carotid-cavernous fistula （CCF） 3 cases, cavernous hemangioma 2 cases, arteriovenous fistula of nasopharynigeal 1 case）. MRI manifestation included： 1 ） Abnormal signal were seen in all patient, CS was asymmetrical in shape and distortion, lesions side enlargement; 2）12 cases vascular lesions showed abnormal flow void-sign, enlargement of superior ophthalmic veins in 3 CCF, the flow void-sign was seen similar round in ICA-CS enlargement in 6 ICA aneurysm, cavernous hemangioma showed hypo-intensity on T1WI and hyper-intensity on T2WI in 2 cases, after enhanced inhomogeneous enhancement,delayed enhanced MRI was enlarged enhancement; 3） In 47 cases of tumorous le- sions, the involvement of CS were unilateral in 29 cases, bilateral in 18 cases, and bilateral ICA were totally encased by pathologi- cal tissue in 13 cases, unilateral in 22 cases. Conclusion The involvement of CS lesions can be displayed clearly by MRI, the involved side of scope and signal abnormal, can show whether ICA cavernous segment was encased, and MRI examination plays an important role in diagnosis and differential of CS diseases, and it is helpful for establishing accurate treatment project.

关 键 词：海绵窦 脑疾病 磁共振成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.41[医药卫生—诊断学]