MRI评价鼻窦鼻腔和鼻咽部腺样囊性癌的区域侵犯和神经扩散的价值  

Value of MRI in assessing regional invasion and neural spread in sinonasal and nasopharyngeal adenoid cystic carcinoma

作　　者：刘向一[1] 陈兴发[1] 刘萌[1] 许强 LIU Xiangyi;CHEN Xingfa;LIU Meng;XU Qiang(Department of Radiology,Fujian Cancer Hospital,Clinical Oncology School of Fujian Medical University,Fuzhou 350014,Fujian,China)

机构地区：[1]福建医科大学肿瘤临床医学院,福建省肿瘤医院放射诊断科,福建福州3500141

出　　处：《中国现代医生》2023年第36期87-90,94,共5页China Modern Doctor

摘　　要：目的 探讨MRI评价原发于鼻窦鼻腔和鼻咽部的腺样囊性癌(adenoid cystic carcinoma,ACC)区域侵犯和神经扩散的价值。方法 回顾性分析经手术、病理证实的22例鼻窦鼻腔和鼻咽部ACC患者的MRI和临床资料。结果 22例患者中,MRI分别见肿瘤侵犯翼腭窝15例,咀嚼肌13例,颅底骨质13例,海绵窦9例,眶下裂9例,眼眶5例,颅内6例。只有3例患者在就诊时有颅神经症状,10例患者MRI可见颅神经增粗和强化,9例为三叉神经(V)的上颌支、下颌支(V2,V3),6例可见肌肉的失神经病变,接受手术的12例患者中有9例病理证实神经扩散,其中7例MRI可见颅神经改变,1例可见肿瘤累及翼腭窝、翼内肌至海绵窦、Meckel腔,另1例表现为肿瘤累及翼腭窝至蝶腭孔。治疗后随访11例患者中有4例复发,均伴有肺转移和治疗前神经扩散。结论 鼻窦鼻腔和鼻咽部ACC具有嗜神经性、局部广泛侵犯与易复发等特点,MRI有助于明确其侵袭范围和神经扩散情况,对临床诊疗具有一定的价值。Objective To explore the value of MRI in assessing regional invasion and neural spread of sinonasal and nasopharyngeal adenoid cystic carcinoma(ACC).Methods A retrospective collection of MRI and clinical data was analyzed in 22 patients with sinonasal and nasopharyngeal ACC confirmed by pathology.Results A total of 22 patients were included in the study.Invasion of the pterygopalatine fossa was observed in 15 cases,involvement of the masticatory muscles in 13 cases,skull base involvement in 13 cases,infiltration of the cavernous sinus in 9 cases,involvement of the infraorbital fissure in 9 cases,orbital involvement in 5 cases,and intracranial involvement in 6 cases.Only 3 patients presented with cranial nerve symptoms.MRI revealed thickening and enhancement of cranial nerves in 10 cases,with involvement of the maxillary and mandibular(V2,V3)branches of the trigeminal nerve(V)in 9 cases,and muscle denervation caused by nerve damage in 6 cases.Among the 12 patients who underwent surgery,9 cases were confirmed to have neural invasion by pathology,with MRI showing cranial nerve alterations in 7 cases of them,one case showed tumor involvement from the pterygopalatine fossa and medial pterygoid muscle to the cavernous sinus and Meckel cavity,while the other case showed tumor involvement from the pterygopalatine fossa to the sphenopalatine foramen.During the follow-up after treatment,4 of 11 patients experienced recurrence,all of which were accompanied by lung metastasis and pre-treatment neural invasion.Conclusion Sinonasal and nasopharyngeal ACC is characterized by a tendency for neural spread,extensive local invasion,and a high risk of recurrence.MRI is helpful in determining the extent of invasion and neural spread.

关 键 词：腺样囊性癌 鼻咽肿瘤 鼻窦肿瘤 神经扩散 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]