鼻腔鼻窦不同类型小圆细胞肿瘤CT及MRI表现  

CT and MRI findings of different types of small round cell tumor in the nasal cavity and sinuses

作　　者：钱波[1] 钟业鸣 倪婷 嵇洪波 崔杰 车子刚[1] QIAN Bo;ZHONG Yeming;NI Ting;JI Hongbo;CUI Jie;CHE Zigang(Department of Medical Imaging,Nanjing Tongren Hospital,School of Medicine,Southeast University,Nanjing 211102,China)

机构地区：[1]东南大学医学院附属南京同仁医院医学影像科,江苏南京211102

出　　处：《实用放射学杂志》2024年第4期539-542,共4页Journal of Practical Radiology

基　　金：南京市医学科技发展计划项目(QRX17207,YKK20212)。

摘　　要：目的探讨鼻腔鼻窦不同类型小圆细胞肿瘤(SRCT)的CT、MRI表现。方法回顾性分析35例经病理证实的SRCT患者的影像资料及临床资料,其中31例行CT检查,19例行MRI检查。结果肿瘤侵犯鼻腔20例,累及鼻窦19例,其中上颌窦11例,筛窦7例、蝶窦2例、额窦1例。CT表现:均表现为软组织影,淋巴瘤相对均质,骨质破坏程度轻,易累及鼻前庭皮肤,横纹肌肉瘤(胚胎型)发病年龄小,易发生骨质破坏及转移,黑色素瘤一般发生在鼻中隔、鼻腔内,易出血,小细胞神经内分泌癌密度不均匀,增强中度到明显强化,骨质吸收破坏多见。MRI表现:除黑色素瘤外,表现为等长T_(1)WI信号,T_(2)WI为高信号,扩散加权成像(DWI)及表观扩散系数(ADC)图表现为明显扩散受限。增强扫描淋巴瘤轻中度强化,横纹肌肉瘤为典型“葡萄征”,小细胞神经内分泌癌表现为“筛状”“地图样”明显强化。典型黑色素瘤表现为T_(1)WI高信号、T_(2)WI低信号,易出血,其MRI表现与是否含黑色素以及病灶内是否出血有关。结论鼻腔鼻窦SRCT恶性程度高,预后差,CT及MRI有很多类似表现,结合患者临床资料、骨质破坏情况、MRI增强及DWI序列能有效鉴别不同类型SRCT以及鼻腔鼻窦鳞癌、腺样囊性癌。Objective To investigate the CT and MRI findings of different types of small round cell tumor(SRCT)in the nasal cavity and sinuses.Methods A retrospective analysis was conducted on the imaging data and clinical data of 35 SRCT patients confirmed by pathology.Thirty-one SRCT patients underwent CT examination,and 19 SRCT patients underwent MRI examination.Results There were 20 cases of tumors that invaded the nasal cavity and 19 cases involved the sinuses,including 11 cases of the maxillary sinus,7 cases of the ethmoid sinus,2 cases of the sphenoid sinus,and 1 case of the frontal sinus.CT findings of SRCT were all soft tissue masses.Lymphoma was relatively homogeneous with mild bone destruction,and usually involved nasal vestibular skin.Rhabdomyosarcoma(embryonic type)happened at an early age and easily caused bone destruction and metastasis.Melanoma generally occurred in the nasal septum and nasal cavity,which was prone to bleeding.Small cell neuroendocrine carcinoma was heterogeneous,with moderate to significant enhancement,bone absorption and destruction were often noticed.The MRI manifestations of SRCT were equal or long signal on T_(1)WI,high signal on T_(2)WI,and significant diffusion limitation on diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)except for melanoma.On contrast-enhanced images,lymphoma showed mild to moderate enhancement,rhabdomyosarcoma showed typical“grape sign”,and small cell neuroendocrine carcinoma showed“sieve”and“map-like”obvious enhancement.Typical melanoma showed a high signal on T_(1)WI and a low signal on T_(2)WI and usually caused bleeding.The MRI findings were related to the presence of melanoma and hemorrhage within the lesion.Conclusion SRCT of the nasal cavity and sinuses have a high degree of malignancy and poor prognosis,CT and MRI have many similar manifestations.Combining clinical data,bone destruction,MRI enhancement,and DWI sequence can effectively distinguish different types of SRCT,as well as squamous cell carcinoma of the nasal cavity

关 键 词：鼻腔 鼻窦 小圆细胞肿瘤 计算机体层成像 磁共振成像 

分 类 号：R739.62[医药卫生—肿瘤] R814.42[医药卫生—临床医学] R445.2