CT、MRI在海绵窦区病变诊断中的应用研究

发布时间：2018-09-04 14:28

【摘要】：目的：海绵窦（cavernous sinus，CS）结构小而复杂，病变种类繁多，均可压迫或侵犯邻近的颅神经和血管引起CS综合征,即包括眼肌麻痹、球结膜水肿、眼球突出、Horner综合征、三叉神经感觉缺失等。CS综合征不同病因，治疗方案也不同。通过影像学检查一方面对潜在致死性病变如海绵窦血栓性静脉炎（cavernous sinus thrombosis CST）的早发现早治疗早治愈起到重要作用，同时通过病变的影像学表现，可大致判断病变性质；另一方面观察病变与邻近结构的解剖关系，有助于选择最佳外科手术入路，从而减少手术并发症。本文回顾性分析经临床及病理确诊107例患者（130处病灶）的CS区病变影像表现，总结CS区疾病基本影像学表现，探讨CS各腔隙及MC腔解剖结构改变对病变起源、性质的诊断价值。方法：收集我院2011年5月~2012年12月107例CS区病变（130处病灶）患者，男50例，女57例，年龄20~79岁，平均49岁。原发性肿瘤11例（神经鞘瘤6例，脑膜瘤4例，节细胞胶质瘤1例），继发或侵犯性肿瘤60例（侵袭性垂体瘤45例，脊索瘤6例，胆脂瘤3例，成熟性囊性畸胎瘤1例，鼻咽癌1例，脑转移性腺样囊性癌1例，乳癌转移1例，肺癌转移1例，内翻性乳头状瘤癌变1例），血管性病变28例（血管瘤12例，动脉瘤8例，硬脑膜海绵瘘3例，创伤性颈内动脉海绵窦瘘5例），血栓性静脉炎8例。其中1例发育不良因例数太少，不在统计范围内。其中CT检查4例，CT血管造影（CTA）16例，MRI平扫检查98例，MRI增强检查88例, MRI平扫+增强82例，MRA检查2例。海绵窦炎症经临床治疗后证实，血管性病变经DSA证实，转移瘤中1例乳腺癌转移，1例肺癌转移，其余均经病理检查证实。结果：CS区肿瘤性病变占66.4%，其中继发性肿瘤占56.1%，，原发性肿瘤占10.3%;血管性病变占26.2%；炎性病变占7.5%。不同病变构成比有统计学差异（单变量的χ~2检验，χ~2=37.5，P0.05）；不同类别CS区病变性别、年龄组构成无统计学差异（χ~2分别为7.77、7.67，P0.05）；不同CS区病变侧别构成有统计学差异（Fisher精确检验，P=0.010.05）。影像学征象：①所有病变侧CS均增大伴异常密度/信号影，除了1例垂体微腺瘤外余病变侧外侧壁均膨隆。②ICA受累117处，占90%。③血管性病变MRI均见异常流空信号影。④98例MRI平扫检查中，等信号为主病灶占72.5%，长T1长T2为主占27.6%。CS区不同疾病信号总体构成有统计学差异（Fisher精确检验P=00.05）：除血管性病变组以长T1、T2为主（P＜0.05），其他三组患者均以等T1、T2信号为主（P＜0.05）。⑤107例MRI增强或CTA，轻中度、明显强化、无强化分别占50.5%，43.9%，5.6%。不同CS区病变强化方式具有统计学差异（Fisher精确检验P 0.01），并将四组疾病分别比较：继发性肿瘤以轻中度强化比例最大，其他三类疾病均为明显强化比例最大（P=00.05）。⑥M eckel腔受侵占46.2%，其中MC腔脑脊液信号消失占21.5%，部分残存占15.4%，MC腔扩张伴信号异常占9.2%，其中6例神经鞘瘤MC腔均扩大伴信号异常。不同CS区病变引起MC改变总体有统计学差异（Fisher精确检验，P＜0.05）；MC腔受侵以原发肿瘤组（90.9%）最高，血管性病变组（51.6%）和血栓性静脉炎组（50.0%）次之，继发性肿瘤组阳性率（37.5%）最低（P＝0.006＜0.05）。⑦C S腔受侵发生率：内、外侧腔最多，后上腔次之，前下腔最少；CS各腔病变构成：CS各腔病变以继发性肿瘤常见，血管性病变次之，原发性肿瘤、血栓性静脉炎少见；不同病变侵犯CS各腔隙构成：原发肿瘤易侵犯外侧腔，前下腔、后上腔次之，内侧腔少见；继发性肿瘤易侵犯后上腔及内侧腔，外侧腔次之，前下腔更次之，其中侵袭性垂体瘤侵犯内侧腔达100%；血管性病变，易侵犯外侧腔，内侧腔、前下腔次之，后上腔少见，其中动脉瘘累及全腔；血栓性静脉炎易侵犯外侧腔，前下腔次之，内侧腔及后上腔少见（χ~2=24.9，P 0.05）。结论：①CS区病变以继发性肿瘤多见。②CS区病变性别、年龄组构成均无统计学差异。③CS区病变发病侧别构成有统计学差异，以单侧发病为多。④CS增大、外侧壁膨隆、信号/密度改变、ICA包绕、狭窄或局部扩张提示CS病灶的存在。⑤异常流空信号可提示血管性病变。⑥CS区肿瘤性病变、血栓性静脉炎以等信号为主，血管性病变信号复杂。⑦继发性肿瘤以轻中度强化多见，血管性病变及血栓性静脉炎以明显强化为多见。⑧增强强化方式、CS各腔隙、MC腔结构改变，有助于判断病变的起源、性质。
[Abstract]:Objective: The structure of cavernous sinus (CS) is small and complex, and there are many kinds of lesions, which can compress or invade adjacent cranial nerves and blood vessels to cause CS syndrome, including ophthalmoplegia, bulbar conjunctival edema, exophthalmos, Horner syndrome, trigeminal nerve sensory loss and so on. On the one hand, it plays an important role in the early detection, early treatment and early cure of potentially fatal lesions such as cavernous sinus thrombophlebitis (CST), on the other hand, it can roughly judge the nature of the lesion by the imaging manifestations of the lesions; on the other hand, it is helpful to choose the best surgery by observing the anatomical relationship between the lesions and adjacent structures. The imaging manifestations of CS lesions in 107 patients (130 lesions) diagnosed clinically and pathologically were retrospectively analyzed. The basic imaging manifestations of CS lesions were summarized. The diagnostic value of anatomical changes of CS lacunae and MC cavity on the origin and nature of lesions was discussed.
Methods: 107 cases of CS lesions (130 lesions) from May 2011 to December 2012 in our hospital were collected, including 50 males and 57 females, aged from 20 to 79 years, with an average of 49 years. There were 11 cases of primary tumors (6 cases of neurilemmoma, 4 cases of meningioma, 1 case of ganglioma), 60 cases of secondary or invasive tumors (45 cases of invasive pituitary adenoma, 6 cases of chordoma, 3 cases of cholesteatoma, 3 cases of mature cyst). There were 1 case of teratoma, 1 case of nasopharyngeal carcinoma, 1 case of brain metastatic adenoid cystic carcinoma, 1 case of breast cancer, 1 case of lung cancer, 1 case of inverted papilloma carcinogenesis, 28 cases of vascular lesions (12 cases of hemangioma, 8 cases of aneurysm, 3 cases of dural cavernous fistula, 5 cases of traumatic internal carotid cavernous fistula), 8 cases of thrombophlebitis. There were 4 cases of CT examination, 16 cases of CT angiography (CTA), 98 cases of MRI plain scan, 88 cases of MRI enhancement, 82 cases of MRI plain scan and enhancement, and 2 cases of MRI examination.
Results: Tumorous lesions in CS area accounted for 66.4%, of which secondary tumors accounted for 56.1%, primary tumors accounted for 10.3%; vascular lesions accounted for 26.2%; inflammatory lesions accounted for 7.5%. Signs of imaging: 1. All lesions were enlarged with abnormal density / signal shadows, except one case of pituitary microadenoma. 2. ICA was involved in 117 lesions, accounting for 90%. (4) In 98 cases of plain MRI, the main lesions were iso-signal (72.5%) and long T1 and long T2 (27.6%). There were significant differences in the overall composition of different diseases in CS area (Fisher's exact test P = 00.05). Except for long T1 and T2 in vascular lesions (P < 0.05), the other three groups were mainly iso-signal T1 and T2 (P < 0.05). Mild to moderate, obvious enhancement, no enhancement accounted for 50.5%, 43.9%, 5.6% respectively. Different CS lesion enhancement methods were statistically different (Fisher exact test P 0.01), and the four groups of diseases were compared: secondary tumors with the largest proportion of mild to moderate enhancement, the other three types of diseases were the largest proportion of obvious enhancement (P = 00.05). _Meeckel cavity invasion accounted for 46.2%. Among them, 21.5% of MC lumen and cerebrospinal fluid signal disappeared, 15.4% of MC lumen remained, 9.2% of MC lumen dilated with signal abnormality, 6 cases of neurilemmoma were enlarged with signal abnormality. 1.6% and thrombophlebitis group (50.0%) followed by the secondary tumor group (37.5%) the lowest positive rate (P = 0.006 < 0.05). _CS lumen invasion rate: the most in the internal and lateral lumen, followed by the superior lumen, anterior and inferior lumen at least; CS lumen lesions: secondary tumors, vascular lesions followed by primary tumors, thrombophlebitis. Inflammation is rare; different lesions invade the lacuna of CS: the primary tumor is easy to invade the lateral cavity, anterior inferior cavity, posterior superior cavity, medial cavity is rare; secondary tumor is easy to invade the posterior superior cavity and medial cavity, lateral cavity is next, anterior inferior cavity is next, in which invasive pituitary tumor invades the medial cavity up to 100%; vascular lesions, easy to invade the lateral cavity, medial cavity. Anterior inferior cavity followed by posterior superior cavity, in which arterial fistula involved the whole cavity, thrombophlebitis was easy to invade the lateral cavity, anterior inferior cavity was next, medial cavity and posterior superior cavity were rare (_~2=24.9, P 0.05).
Conclusion: Secondary tumors were common in CS area. There was no significant difference in sex and age group in CS area. The lesions in CS area were more common in unilateral lesions. _Tumorous lesions in CS area, thrombophlebitis mainly iso-signal, and vascular lesions have complex signal. _Secondary tumors with mild to moderate enhancement, vascular lesions and thrombophlebitis with obvious enhancement are common. _Enhancement enhancement, CS lacunae, MC cavity structure changes, help to judge the lesions. The origin and nature of.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.1;R445.2

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