颞骨恶性肿瘤影像诊断与鉴别诊断  

Imaging diagnosis and differential diagnosis of temporal bone malignancy

作　　者：余裕珍 洪桂洵[2] 饶良俊[2] 杨智云[2] YU Yuzhen;HONG Guixun;RAO Liangjun;YANG Zhiyun(MR Room,Shaoguan First People's Hos pital,Shaoguan,Guangdong Province 512000,China;Department of Radiology,the First Afiliated Hospital,Sun Yat sen University,Gruangzhou 510080,China)

机构地区：[1]韶关市第一人民医院MR室,广东韶关512000 [2]中山大学附属第一医院放射科,广东广州510080

出　　处：《实用放射学杂志》2020年第8期1200-1203,共4页Journal of Practical Radiology

基　　金：广东省科技计划项目(2017B020229004).

摘　　要：目的提高对颞骨恶性肿瘤影像征象的认识,减少误诊、漏诊.方法回顾性分析30例颞骨恶性肿瘤的CT、MRI表现,包括外耳道-中耳癌21例,胚胎型横纹肌肉瘤(RMS)7例,乳头状内淋巴囊低级别腺癌、骨肉瘤各1例,均经手术病理证实.男21例,女9例,男女比例为2.3︰1.年龄3~80岁,外耳道-中耳癌患者95.24%>40岁(14例有中耳乳突炎病史),RMS患者均<8岁.结果颞骨恶性肿瘤均表现为不同程度的骨质破坏,边界不清,虫蚀样改变15例,骨皮质均破坏、中断.80.95%外耳道-中耳癌骨质破坏以外耳道、中耳为中心,而RMS均以岩骨为中心,内淋巴囊低级别腺癌以内淋巴囊凹为中心.骨肉瘤可见特征性的肿瘤骨.颞骨恶性肿瘤形态不规则,密度、信号多不均匀,强化明显、不均匀,均有周围软组织肿块,多有颞骨内及周围结构侵犯.淋巴结肿大6例.结论颞骨恶性肿瘤具有共同的恶性征象,不同病理类型的肿瘤好发年龄、骨质破坏的中心位置及影像表现有不同特点.Objective To improve the roognition of temporal bone malignancy and reduce misdiagnosisMethods CT and MRI findings of 30 temporal bone malignancy confirmed by surgery and pathology were analyzed retrospectively.21 patients with external auditory canal and middle ear carcinoma,7 cases of embryonal thabdomyosarcoma(RMS),and each 1 case of papillary low grade endolymphatic adenocarcinoma and ostcosarcoma were included in this study.There were 21 males and 9 females witha ratio of 2.3:1.The patients were aged from 3 to 80 years old,of which 95.24%were over 40 years old in the external auditory canal and middle ear carcinoma(14 cases had a history ol otitis media and mastoiditis),and less than 8 years old for RMS.Results All temporal bone malignancies showed different degree of bone destruction with unclear boundary,of which worm-like bone destruction was seen in 15 cases,all osseous shells were disrupted.The bone destruction of the extemal auditory canal and middle ear carcinoma was centerod on the extemal auditory canal and middle ear in 80.95%of the cases,while the RMS was centered on the petrous bone and the papillary low-grade endolymphatic adenocarcinoma was centered on the endolymphatic sac concave.Osteosarcoma was characterized by tumor bone.All the temporal bone malignancies with irregular morphology showed heterogencous attenuation or signal intensity,obvious and heterogeneous enhancement。acompanied by surrounding soft tissue mass and invasion of the temporal bone and surrounding structures.L.ytmph node enlargement was found in 6 cases.Conclusion There are common malignant appearances of temporal bone malignancy.Different pathological types of tumors have different features such as age,central location of bone destruction and imaging manifestations.

关 键 词：颞骨恶性肿瘤 计算机体层成像 磁共振成像 

分 类 号：R739.91[医药卫生—肿瘤] R814.42[医药卫生—临床医学]