颅底下面自然通道影像解剖与鼻咽癌侵犯的MRI研究

发布时间：2018-06-05 00:30

本文选题：鼻咽癌 + 磁共振成像　；参考：《暨南大学》2011年硕士论文

【摘要】：目的探讨正常中颅窝底下面自然通道在MRI上的影像解剖学特点和鼻咽癌侵犯颅底自然通道的影像特征。方法 1、本研究通过对60例颅底检查正常者行MRI扫描,获得颅底下面自然孔卵圆孔、圆孔、棘孔、破裂孔、翼腭窝及翼管的横断面T1WI、T2WI图像及冠状面T2WI图像,观察相关自然孔形态并测量其相关径值,相关自然孔测量值性别及侧别间比较采用t检验,统计学分析采用SPSS13.0软件,P值小于0.05认为相关测量值间差别有统计学意义。 2、连续收集154例在本院行放疗前MRI检查且获得活检病理证实的鼻咽癌病例,两名医师分析其中有相关自然孔侵犯的影像资料,并对结果意见达成一致,探讨鼻咽癌对这些常见自然通道侵犯特征。结果 1、卵圆孔在横断面上形态变异较大,多呈卵圆形,内容物在T1WI呈等信号、T2WI呈略高信号,卵圆孔最大径和最小径平均值分别为：6.5±0.8mm、3.8±0.7mm。圆孔在横断面呈管型或孔型,冠状面上多为类圆形,内容物在T1WI呈等信号、T2WI呈略高信号,其平均内径、长度分别为：2.5±0.5mm、4.9±1.6mm。棘孔较小,50%棘孔在MRI横断面上能够较好显示,横断面上多呈圆形,冠状面呈略弯曲管道,测量棘孔最大值分别约3.2mm,最小值约1.7mm,中央内容物在T1WI、T2WI呈低信号或无信号。翼管多呈较直细管状结构,横断面呈圆形,64%翼管能够很好显示,内容物在T1WI呈等信号、T2WI呈略高信号,翼管长度最大值约为17.8mm、最小值约为10.1mm,前口最大值约为4.2mm、最小值约为1.0mm,后口最大值约为2.6mm、最小值约为1.0mm。翼腭窝在不同层面大小及形态有一定变化,经翼板融合部、翼突基底部、翼管及圆孔四个层面测量其最大前后径分别约：2.9±1.0mm、2.4±0.5mm、3.8±0.9mm、3.4±1.0mm,内容物在T1WI及T2WI上呈高信号。破裂孔是由蝶骨、枕骨斜坡及颞骨岩尖围成骨性孔道,内容物在T1WI、T2WI上呈低信号,三边边长分别约：8.1±1.7mm、13.8±3.0mm、12.1±2.3mm。统计分析表明,卵圆孔、圆孔、翼腭窝及破裂孔在左右侧别及性别无统计学差异(P值均大于0.05)。 2、154例鼻咽癌患者中MRI发现有颅底自然通道破坏的病例有75例(48.7%),卵圆孔24例、圆孔15例、翼腭窝55例、翼管66例、破裂孔47例、棘孔2例,其中单一自然通道受累11例,两个以上自然通道同时受累64例。鼻咽癌侵犯颅底自然孔形式主要表现为骨质破坏、沿自然孔蔓延、沿神经侵犯及肿瘤直接侵犯等形式。 3、MRI检查发现颅底脑膜侵犯的病例有26例,在MRI上主要表现硬膜增厚,增强明显强化,其中经卵圆孔、破裂孔、圆孔途径脑膜侵犯病例分别为：22例、16例、9例,以卵圆孔居多。结论 1、MRI多参数、多层面成像能较为清楚、直观显示中颅窝底下面部分自然通道的正常形态特征,尤其是卵圆孔、圆孔、翼腭窝及破裂孔结构,获得了相关统计学资料,有助于颅底病变影像诊断。 2、鼻咽癌容易以不同方式侵犯颅底下面自然通道,如卵圆孔、圆孔、翼管、棘孔、破裂孔及翼腭窝等这些重要结构,并进入颅内。MRI能够较好显示鼻咽癌颅底自然孔的侵犯,对鼻咽癌分期及诊断有重要帮助。
[Abstract]:objective
Objective to investigate the imaging features of natural passages below the middle cranial fossa on MRI and the imaging features of nasopharyngeal carcinoma invading the natural passages of the skull base.
Method
1, in this study, 60 cases of normal cranial base examination were performed MRI scan to obtain the natural orifice of oval hole, circular hole, spinous hole, fracture hole, T1WI, T2WI image and coronal T2WI image of the pterygopalatine fossa and pterygus, and to observe the related natural pore shape and measure the relative diameter of the skull base, and the relative natural pore measurements were compared with t. Statistical analysis using SPSS13.0 software, P value less than 0.05 considered that the difference between the relevant measurement values were statistically significant.
2, 154 cases of nasopharyngeal carcinoma were collected before the MRI examination and confirmed by biopsy pathology in our hospital. Two doctors analyzed the images of the related natural hole invasion, and agreed on the results, and explored the characteristics of the nasopharyngeal carcinoma to these common natural channels.
Result
1, the morphological variation of the oval hole on the cross section is larger, mostly oval, content in T1WI, T2WI slightly high signal, the average value of the maximum diameter and the minimum diameter of the oval hole is 6.5 + 0.8mm, 3.8 + 0.7mm. round holes are tube type or pass in the cross section, the coronal surface is mostly round, the content is in T1WI, and the T2WI is slightly high signal. The average inner diameter is 2.5 + 0.5mm, 4.9 + 1.6mm. spinous pore smaller, 50% spinous holes can be shown better on the MRI cross section, the cross section is more circular, the coronal face is slightly curved pipe, the maximum value of the spinous hole is about 3.2mm, the minimum value is about 1.7mm, the central content is T1WI, T2WI shows low signal or no signal. The wing tube is more straight tube. The cross section is round, and the 64% wing tube can be displayed well, the content is in T1WI, T2WI is slightly high signal, the maximum value of the length of the wing tube is about 17.8mm, the minimum value is about 10.1mm, the maximum value of the front mouth is about 4.2mm, the minimum value is about 1.0mm, the maximum value of the back mouth is about 2.6mm, the minimum value is about the size and shape of the 1.0mm. wing and palate fossa at different levels and forms. The maximum front and back diameters of the wing plate fusion section, the base of the pterygwing, the wing tube and the round hole are measured in four aspects: 2.9 + 1.0mm, 2.4 + 0.5mm, 3.8 + 0.9mm, 3.4 + 1.0mm, and the contents are high signal on T1WI and T2WI. The fracture hole is composed of the sphenoid bone, the occipital slope and the temporomandibular apex, and the contents are low in T1WI and T2WI. The number and three side edge length were about 8.1 + 1.7mm, 13.8 + 3.0mm, and 12.1 + 2.3mm. statistical analysis showed that the oval hole, round hole, pterygopalatine fossa and ruptured hole had no statistical difference between the left and right side and the sex (the P value was greater than 0.05).
In 2154 cases of nasopharyngeal carcinoma, there were 75 cases (48.7%), 24 cases of oval foramen, 15 cases of round hole, 55 cases of pterygopalatine fossa, 66 cases of pterygopalatine fossa, 66 cases of pterygopalatine, 47 cases of ruptured holes and 2 cases of spinous holes, of which the single natural channel was 11 cases, and more than two natural passages were involved in 2154 cases. The main form of the nasopharyngeal carcinoma invasion of the skull base was bone mainly manifested by the bone. Mass destruction, spreading along natural pores, along nerve invasion and direct invasion of tumors.
3, 26 cases of skull base meningeal invasion were found by MRI examination. The main manifestations of MRI were the thickening of the dura and enhanced enhancement. The cases of meningoencephalitis through the foramen ovale, the perforated hole and the circular hole approach meningoencephalitis were 22 cases, 16 cases and 9 cases, with the most of the oval foramen.
conclusion
1, MRI multi parameters, multi-layer imaging can be more clear, intuitively display the normal morphological characteristics of some natural channels below the bottom of the middle cranial fossa, especially the oval hole, round hole, pterygopalatine fossa and rupture pore structure, which can help to diagnose the image of skull base lesions.
2, nasopharyngeal carcinoma can easily invading the natural passages below the base of the skull, such as foramen ovale, round hole, pterygoid, spinous hole, ruptured hole and pteropalatine fossa and so on, and entering the intracranial.MRI can better display the invasion of the natural hole of the skull base of nasopharyngeal carcinoma, which is of great help to the staging and diagnosis of nasopharyngeal carcinoma.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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