颅底脊索瘤的CT和MRI影像分析  

Analysis of CT and MRI features in chordoma of skull base

作　　者：段莹星 廖伟华[1] 陈常勇[1] 陈登明[1] 彭娴婧[1] DUAN Ying-xing;LIAO Wei-hua;CHEN Chang-yong;CHEN Deng-ming;PENG Xian-jing(Department of Radiology Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院放射科

出　　处：《中国耳鼻咽喉颅底外科杂志》2019年第3期246-249,256,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的分析颅底脊索瘤的CT和MRI影像特点,探讨其影像诊断价值.方法回顾性分析2010年1月~2019年3月经手术病理证实颅底脊索瘤的62例患者的影像资料,所有患者术前均行CT和MRI检查,其中11例同时行CTA检查,观察病变部位、生长方式、密度或信号特点、强化方式.结果病变起源于斜坡46例,伴脑干和基底动脉受压后移15例,筛窦、蝶窦受累10例,单侧或双侧海绵窦受累8例,颅底受累5例,岩尖骨质受累6例;起源于斜坡外16例,其中伴突入鞍上池9例,累及邻近岩骨、枕骨破坏4例,脑干受压3例.CT表现肿块为不均匀等或稍高密度软组织影,其中骨质破坏区边缘硬化4例,病变内见钙化或残存骨49例.MRI信号不均匀,T1WI稍低或等信号,T2WI高信号,夹杂T1WI高信号和/或T2WI低信号.增强检查表现呈不均匀强化,其中轻、中度强化53例,强化显示“蜂房征”6例,边缘轻度环形强化3例.结论 CT和MRI可清楚显示颅底脊索瘤的部位形态特点、侵犯周围组织范围、强化方式,对明确疾病诊断、制定手术计划及术后随访评估具有较大价值.Objective To discuss the diagnostic values of computed tomography ( CT) and magnetic resonance imaging (MRI) via analyzing their features in chordoma of skull base. Methods CT and MRI data of 62 patients with chordoma of skull base confirmed by surgery and pathology from Jan. 2008 to Mar. 2019 were analyzed retrospectively. Of them, 11 cases were evaluated simultaneously with computed tomography angiography ( CTA). The tumor location, growth pattern, density or signal characteristics, enhanced features and relationship with the adjacent tissues were observed. Results Chordomas originated from clivus in 46 patients, including compressing and backward removing of brain stem and basilar artery in 15, invasion of sphenoid sinus and posterior ethmoid sinus in 10, invasion of unilateral or bilateral cavernous sinus in 8, invasion of skull base and nasopharynx in 5, and invasion of petrosal apex in 6. In addition, tumors originated from other untypical sites besides clivus in 16 cases, including entering the suprasellar cistern in 9, involving adjacent petrosal bone and occipital bone in 4, and compressing brain stem in 3. All the lesions were inhomogeneous isodensity or slightly high density on CT, including marginal sclerosis in the bone destruction area in 4 cases, and intralesional calcification or residual bone in 49. The tumors showed inhomogeneous signal intensity with iso-and hyposignal intensity on T1WI and high signal intensity on T2WI mixed with high T1WI signal or low T2WI signal. Enhanced MRI showed heterogeneous enhancement, including mild to moderate enhancement in 53,"honeycomb” sign in 6, and mild marginal ring-enhancement in 3 cases. Conclusion With clear display of location, morphology and size of tumor, as well as surrounding tissue invasion and its relationship with adjacent tissues, CT and MRI play important roles in the diagnosis, surgical plan and postoperative evaluation of chordoma of skull base.

关 键 词：颅底肿瘤 脊索瘤 体层摄影术 磁共振成像 

分 类 号：R739.41[医药卫生—肿瘤]