酷似鼻咽癌的鼻咽-颅底骨髓炎的影像学表现  

Radiological findings of nasopharyngeal-skull base osteomyelitis simulating nasopharyngeal carcinoma

作　　者：胡镭 王焱钧 张宗锐[1] 陈澜月 刘兆会[1] HU Lei;WANG Yanjun;ZHANG Zongrui;CHEN Lanyue;LIU Zhaohui(Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China;Department of Radiology,Zhongda Hospital,Southeast University,Nanjing,Jiangsu,210009,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 [2]东南大学附属中大医院放射科,江苏南京210009

出　　处：《中国耳鼻咽喉头颈外科》2023年第11期701-704,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的 探讨酷似鼻咽癌的鼻咽-颅底骨髓炎(nasopharyngeal-skull base osteomyelitis,NP-SBO)的临床及影像学表现。方法 回顾性分析3例经病理证实的NP-SBO的临床特征、CT和MRI表现的特点。结果 2例患者患有糖尿病,2例C反应蛋白升高,1例白细胞升高。所有患者均于鼻咽顶后方右侧壁形成软组织肿块,其中1例累及鼻咽左侧壁;鼻咽黏膜线不完整1例,黏膜线完整2例。弥散加权成像(diffusion weighted imaging,DWI)与脑实质相比病变均呈略低信号,表观扩散系数(apparent diffusion coefficient,ADC)均呈略高信号。3例邻近颅底骨质破坏,均累及岩尖及斜坡。2例双侧咽后、颈Ⅱ区淋巴结肿大,淋巴结信号均匀,内部无囊变或坏死区。结论 表现为鼻咽软组织增厚及颅底骨质破坏的NP-SBO与晚期鼻咽癌影像表现非常相似,但有糖尿病史的老年患者,伴有炎症标记物升高、DWI无明显扩散受限,尤其是当鼻咽黏膜线清晰完整时,提示NP-SBO的诊断。OBJECTIVE To discuss the clinical features and radiological findings of nasopharyngeal-skull base osteomyelitis(NP-SBO)simulating nasopharyngeal carcinoma.METHODS Clinical features,CT and MRI imaging findings of 3 cases with NP-SBO confirmed by histopathology were analyzed retrospectively.RESULTS There were 2 cases with diabetes,2 cases with high C-reactive protein level,and one case with elevated leukocyte level.A soft tissue mass was observed in the right lateral wall of nasopharynx in all patients,of which one case involved the left lateral wall of nasopharynx.A deep mucosal white line was present in 2 cases,with a focal loss of this line in one case.All lesions showed slightly lower signal intensity on diffusion-weighted images(DWI)and slightly higher apparent diffusion coefficient(ADC)values compared with the brain parenchyma.Bone destruction of the near skull base was found in all 3 cases,with the petrous apex and clivus involved.Enlarged bilateral retropharyngeal and level II lymph nodes were observed in 2 cases,with homogeneous signal intensity,without cystic degeneration or necrosis.CONCLUSION The imaging findings of NP-SBO with nasopharyngeal soft tissue thickening and skull base bone destruction are very similar to those of advanced nasopharyngeal carcinoma.However,nasopharyngeal mass in elderly patients with a history of diabetes,elevated inflammatory markers and without restricted diffusion,especially when deep mucosal white line is present,strongly suggests NP-SBO.

关 键 词：体层摄影术 X线计算机 磁共振成像 诊断 鼻咽癌 鼻咽-颅底骨髓炎 

分 类 号：R742.9[医药卫生—神经病学与精神病学]