MR在颈静脉球体瘤诊断及分型中的价值  

Value of MR Imaging in the Diagnosis and Classification of Glomus Jugulare Tumors

作　　者：李铮[1] 梁熙虹[1] 鲜军舫[1] LI Zheng;LIANG Xihong;XIAN Junfang(Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《中华耳科学杂志》2018年第5期593-597,共5页Chinese Journal of Otology

基　　金：北京市医院管理局临床医学发展专项经费资助("扬帆"计划眼耳鼻喉影像重点医学专业)(ZYLX201704);北京市高层次卫生人才学科带头人(2014-2-005)~~

摘　　要：目的探讨MR在颈静脉球体瘤诊断及临床分型中的应用价值。方法回顾性分析18例经病理证实的颈静脉球体瘤患者的临床及影像资料,全部患者行MR平扫及增强扫描,其中7例行弥散加权成像扫描。对患者的临床症状、术中出血量、病灶数量、累及范围、形态、边缘、平扫信号特点、强化表现、椒盐征、DWI信号强度、ADC值进行分析,并根据Fisch分型方法对肿瘤进行分型。比较Fisch C型与D型患者的MRI表现。结果 9例患者表现为搏动性耳鸣伴听力下降。经栓塞治疗后行肿瘤手术切除者术中出血量少于无栓塞治疗和栓塞不成功者(Z=-2.236,P<0.05)。18例患者中,17例为单侧单发病灶,1例合并颈部其他部位副神经节瘤。Fisch C1型2例,C2型7例,C3型4例,D1型4例,D2型1例。18病变均呈分叶状,15例病变均有清晰边缘,15例病变呈等T1长T2信号,17例病灶内可见血管流空影,其中10例可见典型的"椒盐征"。增强后18例病灶均明显强化。5例病变DWI信号低于脑实质,ADC值为1.30±0.15(×10-3mm2/s)。"椒盐征"在Fisch C型与D型之间的差异具有统计学意义(P<0.05)。结论颈静脉球体瘤患者的临床症状及MRI表现具有一定特征性。MR可准确评估病变累及范围,为临床分型提供可靠依据。Objective To report MRI findings in glomus jugulare tumors and assess the value of MRI in their diagnosis and classification.Methods The clinical and MRI findings in 18 patients with pathology confirmed glomus jugulare tumors were analyzed retrospectively.Conventional MRI sequences including nonenhanced and contrast-enhanced imaging were performed in all patients,and DW-MRI in 7 patients.The evaluation included clinical features,blood loss during surgery,and number,location,shape and margin of lesions,as well as signal enhancement characteristics,‘salt and pepper’signs,DWI and ADC values.The classification of glomus jugulare tumors was based on the Fisch system,and MRI features between Fisch types C and D were compared.Results Nine patients presented with pulsating tinnitus accompanied by hearing loss.Intraoperative blood loss of those undergoing tumor resection after embolization was less than without embolization or when resection was not successful(z=-2.236,P<0.05).Seventeen of the 18 patients presented with single lesion unilaterally.Lesions were classified as Fisch C1 in 2 patients,C2 in 7 patients,C3 in 4 patients,D1 in 4 patients and D2 in 1 patients,all lobular-shaped and with sharp margins in 15.The lesion showed isointensity T1WI signals and hyperintensity T2WI signals in 15 patients.Flow void was seen in 17 cases with 10 showing the classic‘salt and pepper’sign,which was more common in Fisch type D than in type C(P<0.05).With contrast administration,all lesions were enhanced.Five lesions appeared hypointense on DWI.ADC was at 1.30±0.15(×10-3 mm2/s).Conclusions Jugular bulb tumors have distinct clinical and MRI features.The latter provide reliable basis for tumor classification.

关 键 词：颈静脉球体瘤 磁共振 椒盐征 

分 类 号：R764[医药卫生—耳鼻咽喉科]