医学影像学技术在颅内胆脂瘤诊治中的应用研究  

Application of medical imaging techniques in diagnosis and treatment of intracranial cholesteatoma

作　　者：陈鹏 CHEN Peng(Liaoyang Central Hospital,Liaoyang 111000,China)

机构地区：[1]辽阳市中心医院,111000

出　　处：《中国现代药物应用》2021年第14期35-38,共4页Chinese Journal of Modern Drug Application

摘　　要：目的探讨医学影像学技术在颅内胆脂瘤诊治中的应用效果。方法12例疑似颅内胆脂瘤患者作为研究对象,患者均因头晕、头痛间接发作、进行性加重入院,术前完成颅脑CT及磁共振成像(MRI)检查,术后与病理组织学诊断结果进行比较,观察其诊断情况及影像学特征。结果手术病理组织学诊断显示,10例患者确诊为巨大胆脂瘤样物:术中开放探查显示颅内有巨大胆脂瘤样物,体积约为2.0 cm×2.0 cm×3.0 cm~3.0 cm×4.0 cm×5.0 cm;根据位置分为2例小脑桥脑角胆脂瘤,2例鞍区胆脂瘤,2例脑实质内胆脂瘤,2例脑室胆脂瘤,2例颅骨胆脂瘤。10例患者胆脂瘤均为实性,与周围界限清楚,表面光滑,无明显供血动脉,其中2例伴有无菌性脑膜炎,3例伴有脑积水,2例累及外耳道后壁形成屡孔,部分累及窦脑膜角,其中1例面神经暴露并侵犯;10例颅内胆脂瘤周围骨质部分或全部吸收,骨质破坏明显。MRI和CT对颅脑胆脂瘤诊断灵敏度、特异度和准确率比较,差异无统计学意义(P>0.05)。MRI和CT联合诊断灵敏度、特异度、准确率高于MRI和CT单独诊断,但差异无统计学意义(P>0.05)。CT平扫显示患者病变多为占位性病变,肿块边缘清晰,可见或不可见包膜(薄膜,局部略厚),病灶内软组织密度较薄分隔,局部略厚;包膜及分隔可见少量弧形、条片状钙化影。颅脑MRI检查可见占位性病变,边界清楚,表面光滑,增强后未见强化;T1WI呈低信号为主,混杂稍高信号;T2WI呈高信号;弥散加权成像呈不均匀高信号;表观弥散系数不均匀等、稍高信号。结论CT和MRI对颅内胆脂瘤诊断准确性较高,必要时可联合诊断,进一步提升临床诊断准确性,可为手术治疗提供可靠的参考资料,临床应用价值较高。Objective To discuss the practical effect of medical imaging techniques in diagnosis and treatment of intracranial cholesteatoma.Methods There were 12 patients with suspected intracranial cholesteatoma as research subjects.All patients were admitted to the hospital due to indirect onset of dizziness and headache and progressive aggravation.Preoperative craniocerebral computed tomography(CT)and magnetic resonance imaging(MRI)examinations were completed.Postoperative diagnostic results were compared with histopathological results to observe the diagnosis and imaging features.Results The histopathological diagnosis showed that 10 patients were diagnosed with a giant cholesteatoma-like substance:open exploration during the operation showed that there was a giant cholesteatoma-like substance in the skull,with a volume of about 2.0 cm×2.0 cm×3.0 cm-3.0 cm×4.0 cm×5.0 cm;according to the location,there were 2 cases of cerebellopontine angle cholesteatoma,2 cases of sellar cholesteatoma,2 cases of intraparenchymal cholesteatoma,2 cases of ventricle cholesteatoma,and 2 cases of skull cholesteatoma.10 patients with cholesteatoma were all solid,with clear boundaries,smooth surface and no obvious blood supply arteries.Among them,2 patients had aseptic meningitis,3 patients had hydrocephalus,2 patients had multiple foramen involving the posterior wall of the external auditory canal,part of them involved the sinus meningeal angle,and 1 patient had facial nerve exposure and invasion;in 10 cases,the bone around cholesteatoma was partly or completely absorbed,and the destruction of bone was obvious.There was no statistically significant difference in sensitivity,specificity and accuracy between MRI and CT in the diagnosis of intracranial cholesteatoma(P>0.05).The sensitivity,specificity and accuracy of combined diagnosis of MRI and CT were significantly higher than that of MRI and CT alone,but the difference was not statistically significant(P>0.05).CT plain scan showed that the lesions of the patients were mostly space-occupy

关 键 词：医学影像学技术 颅内胆脂瘤 诊断 手术 CT 磁共振成像 

分 类 号：R739.41[医药卫生—肿瘤]