咽旁间隙神经鞘瘤与多形性腺瘤的鉴别诊断  

Differential diagnosis of neurilemmomas and pleomorphic adenomas in the parapharyngeal space

作　　者：苗焕民[1] 孙岳 于洋 杨琰昭 胡粟[1] MIAO Huanmin;SUN Yue;YU Yang;YANG Yanzhao;HU Su(Department of Radiology,The First Affiliated Hospital of Soochow University,Suzhou 215006,P.R.China;Department of Medical Imageology,The First Clinical Medical School,Medical College of Soochow University,Suzhou 215006,P.R.China)

机构地区：[1]苏州大学附属第一医院影像中心,江苏苏州215006 [2]苏州大学医学部第一临床医学院医学影像学系,江苏苏州215006

出　　处：《医学影像学杂志》2018年第11期1808-1811,共4页Journal of Medical Imaging

摘　　要：目的探讨咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现,旨在提高对两者的鉴别诊断能力。方法回顾性分析经手术病理证实的12例神经鞘瘤和8例多形性腺瘤的CT和/或MRI表现,分析内容包括病灶部位、最长径、形态与边界、密度或信号特点、强化方式、邻近解剖结构改变情况等。结果咽旁间隙神经鞘瘤及多形性腺瘤发生于左、右侧分别为6/6例和3/5例;两者均表现为类圆形肿块,境界多较清楚。CT表现为软组织密度肿块,可伴有囊变。MRI多表现为长T1长T2信号,伴有囊变者信号不均匀,增强后呈不均匀强化。神经鞘瘤多见于茎突后间隙(10/12,83. 3%),推压二腹肌后腹(10/12,83. 3%)、颈动脉鞘区血管(8/12,66. 7%)及茎突(4/12,33. 3%)向前和/或外侧移位,与腮腺深叶间境界均较清楚。多形性腺瘤多见于茎突前间隙(6/8,75%),推压二腹肌后腹(5/8,62. 5%)、颈动脉鞘区血管(5/8,62. 5%)及茎突(6/8,75%)向内和/或后侧移位。有2例(25%)与腮腺深叶分界不清。结论咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现各具特征性,临床工作中通过仔细分析其起源部位、与周围结构的关系等有助于鉴别诊断。Objective To investigate the imaging features of neurilemmomas and pleomorphic adenomas in the parapharyngeal space, and to improve the differential diagnosis ability. Methods The CT/MRI performance of neurilemmomas （n=12） and pleomorphic adenomas （n=8） confirmed by pathology were retrospectively analyzed, including location, size, shape, boundary, density or signal characteristics, enhancement pattern, and adjacent anatomical structure changes. Results The numbers of neurilemmomas located in the left/right side were 6/6 respectively, while those of pleomorphic adenomas were 3/5 respectively. Both of them showed as round mass with well-defined border, which demonstrated as tissue density mass with or without cystic degeneration. The mass showed hypo-intensity on T 1WI and hyper-intensity on T 2WI, with heterogenous enhancement on enhanced scans. 10 cases of neurilemmomas were occured in the posterior styloid space （83.3%）, with clear boundaries between the lesion and the deep lobe of the parotid gland. The posterior belly of digastric muscle （10/12, 83.3%）, vagina carotica （8/12, 66.7%） and styloid processes （4/12, 33.3%） were pushed forward and/or outward. 6 cases of pleomorphic adenomas were located in the anterior styloid space （75%）. The posterior belly of digastric muscle （5/8, 62.5%）, vagina carotica （5/8, 62.5%） and styloid processes （6/8, 75%） were pushed backward and/or inward. There were 2 cases （25%） of pleomorphic adenomas which displayed ill-defined margin with the deep lobes of parotid gland. Conclusion The imaging findings of neurilemmomas and pleomorphic adenomas in the parapharyngeal space have varied characteristics. This is helpful to differential diagnosis by carefully observation in clinical practice.

关 键 词：咽旁间隙 神经鞘瘤 多形性腺瘤 磁共振成像 体层摄影术 X线计算机 

分 类 号：R739.6[医药卫生—肿瘤] R445.2[医药卫生—临床医学]