腹膜后恶性副神经节瘤1例

恶性副神经节瘤亦称非嗜铬性副神经节瘤、化学感受器瘤。临床少见,可发生在人体的各个部位,发生于腹膜后者约为30．4％。我科近5年来仅收治1例,现就其诊治体会并结合文献复习,报告如下。     

腹膜后副神经节瘤1例

病人,女,51岁.3个月前在当地医院体检时B超发现腹膜后占位(直径约12 cm).患者无腰腹疼痛、心慌、头晕等不适,未给予进一步检查及治疗,2个月前再次行MRI及CT检查示:右肾上腺区富血供占位性病变,约12 cm×5 cm×5 cm.     

终丝副神经节瘤1例

患者女性,45岁。双下肢乏力伴疼痛,间歇性跛行1年余,加重2月。专科检查:腰部活动受限,双侧股四头肌、胫前肌、踇趾背伸、第5趾跖屈肌肌力Ⅲ级,膝反射、踝反射减退,双下肢直腿抬高试验(+)。MRI检查:T 12~L 3椎体水平椎管内可见长条状肿块影,边界较清晰,T 1WI呈等信号,邻近椎体后缘见扇贝样压迹(图1),T 2WI呈稍高信号,病变上部可见粗大血管流空信号(图2),病变下缘可见弧形含铁血黄素沉积导致的低信号,即“帽征”(图3)。增强扫描:病灶呈明显均匀强化,边界清楚,病变上缘可见迂曲强化的血管影(图4,5)。     

腹膜后副神经节瘤1例

1病例报告患者男,58岁。在体检时发现右侧腹膜后有一肿瘤,门诊以腹膜后肿瘤收治入院。查体：体温36.6℃,心率78/min,血压104/72mmHg;神志清,精神好,皮肤巩膜无黄染,浅表淋巴结未见肿大;右腹部可触及质地中等硬度、表面光滑、活动度较差的肿块。实验室检查：WBC计数1.3×109/L,N 0.84,L 0.16;尿10项（-）;肾素、醛固酮及血管紧张素水平正常。心电图正常;辅助检查：CT平扫可见右侧肾上腺与肾之间有一结节灶,大小为2.8cm×2.8cm,其内密度不均匀、边缘光滑,     

腰椎椎管内副神经节瘤一例

病例资料患者,男,50岁。3个月前无明显诱因出现腰痛不适,无肢体抽搐。3个月来症状逐渐加重,下肢行走尚好,自感排尿有影响。查体：神经系统检查未见异常。实验室检查未见异常。     

腹膜后恶性副神经节瘤1例

<正> 男,62岁。于1月前无明显诱因出现左上腹部隐痛,呈持续性,逐渐加重,无腰、背部放射痛。无腹胀、腹泻,恶心、呕吐,发热、畏寒。精神、食欲、睡眠欠佳。大便细、软、带血。自发病以来体重减轻约5 kg。10 d前于当地医院行B超检查示"腹部包块",来我院就诊。腹部平坦,未见胃肠形及蠕动波,左上腹部触及巨大包块,上自肋缘下,下至脐水平,约13.0 cm×12.0 cm×10.0 cm大小,质硬,轻压痛,活动度差。CT示:腹膜后左肾下极前方见一约     

B超诊断腹膜后副神经节瘤2例

1　病例简介病例 1　患者 ,男 ,2 3岁 ,Ｂ超发现腹膜后包块 10天。血压波动在 14 9.3ｋＰａ～ 2 0 14 .7ｋＰａ ,血生化检查正常。Ｂ超检查显示右腹膜后见 8.1ｃｍ× 5 .7ｃｍ× 2 .8ｃｍ等回声包块 ,内可见数个直径为 0 .5ｃｍ无回声区 ,包膜完整清楚。包块位于胰头后下方 ,下腔静脉前方 ,腹主动脉右前方。ＣＴ平扫示胰头部后下方 ,腹主动脉右前有一软组织肿块 ,部分囊性变 ,境界清楚 ,增强扫描示该肿块实性区中等增强 ,囊变区不增强。诊断 :神经节母细胞瘤。病理诊断 :副节瘤。病例 2 :患者 ,男 ,5 4岁。持续性右上腹隐痛 5 0余天 ,无放…     

原发性副神经节瘤CT诊断

目的：探讨CT对原发性副神经节瘤的诊断价值。方法：回顾性分析42例经手术病理证实的原发性副神经节瘤患者影像资料,其中29例行平扫加单期增强扫描,13例行平扫加双期增强扫描。结果：全部病例均为单发。32例位于肾上腺,其中右侧20例,左侧12例;10例位于肾上腺外。CT平扫特点为肿块密度不均,常伴有坏死与囊变,增强后病灶实性部分显著强化,延迟扫描肿瘤呈进行性强化。结论：CT检查能很好显示原发性副神经节瘤的部位、形态、大小,是对定位和定性诊断有效的影像学检查方法。     

腹膜后非功能性副神经节瘤1例

患者女,26岁。2周前出现全腹部腹痛不适,与饮食无关。体格检查：腹部无膨隆,左上腹隐约可触及一包块5cm×5cm,质偏硬,表面光滑,边界尚清。B超示左腹腔低回声包块。Cr平扫示十二指肠下方腹主动脉左旁见一大小约5．2cm×5．4cm5个层面可见的软组织密度肿块影,边界尚清、内见更低坏死密度区,周围肠管、血管受压（图1）,增强扫描示肿块边缘实质部分强化非常明显并持续强化,     

髂动脉闭塞介入治疗的临床观察

目的探讨髂动脉闭塞性病变介入治疗的技术要点。方法本组41例髂动脉闭塞的患者通过行闭塞段开通、经导管局部溶栓、血管腔内成形术（PTA）和内支架置入等多种介入方法综合治疗来观察效果。结果 41例患者介入治疗成功率达100%,治愈36例,好转5例,共9例血管闭塞者进行了溶栓治疗。术后随访2～24个月,平均18个月,除2例分别在术后11个月和8个月发生支架内再闭塞行二次介入治疗外,其余患者症状均无加重或复发。结论血管腔内介入治疗可作为治疗髂动脉闭塞可选择的手术替代方案,尤其是对于有高手术风险的患者,具有微创、简单、有效的优点。     

Imaging and management of head and neck paragangliomas

Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). Diagnostic imaging can be considered in two clinical situations: (1) patients who present with clinical symptoms suggestive of a paraganglioma, and (2) individuals from families with hereditary paragangliomas. It is not only necessary to detect and characterize the lesion, but also to study the presence of multiplicity. For these purposes, MR imaging, and especially 3D TOF MRA, is the modality of choice. CT scanning is especially useful to show destruction of the temporal bone. Angiography in combination with embolization will mainly be used prior to surgical resection, but can also be used for diagnostic purposes when the diagnosis is not yet clear. Many parameters play a role in the decision to treat of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Resection however, should be balanced against a more conservative wait and scan policy or palliative treatments such as radiotherapy.     

Magnetic resonance imaging or metaiodobenzylguanidine scintigraphy for the demonstration of paragangliomas?

Paragangliomas are tumours arising from paraganglionic tissue dispersed from the base of the skull to the pelvic diaphragm. These tumours produce symptoms by secreting catecholamines (functioning tumours) or by local tumour expansion. They can be part of several hereditary disorders. The introduction of magnetic resonance (MR) imaging and metaiodobenzylguanidine (MIBG) scintigraphy has provided new insights into paragangliomas and has tremendously changed the topographic diagnosis of paragangliomas. Both techniques have proven to be adequate in localising paragangliomas. In this report, the performance of these two non-invasive imaging methods in the examination of paragangliomas is compared and the merits and deficits of the two techniques are discussed. Both techniques produce comparable results in the detection of functioning paragangliomas. MR imaging, however, also demonstrates tumours that do not take up MIBG. MR imaging does not involve the use of ionising radiation and is not hampered by medication. Moreover, MR imaging has a higher spatial resolution. Because of these merits it is concluded that for demonstration of paragangliomas, wholebody MR imaging is the preferred and initial method of investigation. MIBG scintigraphy, on the other hand, continues to be a reliable method for non-invasive detection of functioning paragangliomas. At present it is clearly faster in whole-body imaging than MRI and it is definitely patient-friendly (no claustrophobia). It could be reserved for cases where a strong suspicion of a functioning paraganglioma persists, despite normal MR imaging findings, and for cases where doubt exists about the functional activity of one or more multicentric tumours. MIBG scintigraphy must be used in the evaluation of patients referred for iodine-131 MIBG treatment. Correspondence to: E.K.J. Pauwels     

CT and MR imaging of unusual locations of extra-adrenal paragangliomas (pheochromocytomas)

Our review was undertaken to describe CT and MRI features of unusual extra-adrenal paragangliomas (pheochromocytomas). We retrospectively reviewed CT and MRI findings in 29 patients with 39 extra-adrenal paragangliomas. For each tumour, site, size, MRI characteristics, CT appearances and enhancement after gadolinium and iohexol were recorded. There were 17 carotid body tumours, 1 mediastinal, 1 intra-cardiac, 15 retroperitoneal extra-adrenal paragangliomas, 2 bladder, 1 pelvic sidewall and 2 intra-spinal paragangliomas within the lumbo-sacral spine. All 39 paragangliomas were shown on MRI. Of the 32 lesions studied by MRI and CT, CT detected 30. Of the two lesions missed on CT, one was an intra-cardiac paraganglioma and the second a bladder wall paraganglioma. At detection, 25 tumours were larger than 4 cm, of which 20 were heterogeneous lesions on CT and MRI with variable contrast enhancement. The 14 smaller paragangliomas were smooth in contour and demonstrated avid, homogeneous contrast enhancement. Our review of extra-adrenal paragangliomas highlights their unusual sites and appearances. MRI demonstrated the greatest variability in the appearances of larger tumours, provided additional information compared to CT for surgical planning and is a useful screening tool for patients at high risk of extra-adrenal paragangliomas.     

Observations on the function of normal adrenomedullary tissue in patients with phaeochromocytomas and other paragangliomas

¹²³I-MIBG is a norepinephrine analogue used for imaging phaeochromocytomas and other paragangliomas. In this study 7 normal volunteers and 31 subjects with high or borderline high plasma catecholamine and urinary metanephrine and VMA levels were investigated. In the normals the uptake by the adrenal medulla was in the range of 0.01%–0.21% of the injected dose at 22 h. In 22 subjects there was no evidence for any paraganglioma, with the uptake by the adrenal medulla in the range of 0.01%–0.22% of the injected dose at 22 h. In nine patients there was evidence of a paraganglioma on imaging which was confirmed on surgery. The uptake by the tumours was in the order of 0.001%–0.14% of the injected dose per gram of tumour tissue. In all nine cases the non-tumorous adrenal medulla could be visualized; the uptake in the adrenals was in the range of 0.01%–0.21% of the injected dose. This study shows that in the presence of elevated plasma catecholamines of tumour origin the unaffected adrenal medullary tissue retains the capacity for ¹²³I-MIBG uptake. In the two cases also studied by adrenal venous sampling, catecholamine release was also within the normal range.     

Pediatric interventional radiology: Current practice and innovations

The purpose of this article is to provide an update of pediatric interventional procedures for the interventionalist, and especially for those who treat children infrequently. Most pediatric interventional procedures are modifications of techniques devised for adults, in that some are unique to pediatrics. These are stressed in the presentation.     

头颈少见部位副神经节瘤

目的提高对头颈部罕见部位副神经节瘤的认识和诊断水平。方法搜集1990年1月至2003年12月经手术病理证实的6例头颈部罕见部位副神经节瘤，详细分析其临床和影像学表现。结果2例位于颈静脉窝，其中1例侵入鼓室；1例突入后颅窝；1例局限于鼓室；1例发生于左C1～C2椎体后部，肿瘤破坏椎板骨质，侵入椎管和后颅窝，浸润硬膜；1例位于颏下口底；1例位于眶内肌锥外。B超、CT和MRI显示肿瘤为实性，肿瘤内及其周围血管增多，强化明显，MR血管成像(MRA)和DSA均显示肿瘤染色和丰富的供血动脉。结论这些肿瘤虽然发生的部位不典型，但是具有共同的影像学特点，结合临床术前多可以诊断。     

可脱性球囊栓塞治疗Barrow A型颈动脉海绵窦瘘

目的探讨可脱性球囊栓塞治疗创伤性颈动脉海绵窦瘘的疗效及应用价值。资料与方法 18例Bar-row A型创伤性颈动脉海绵窦瘘,采用可脱性球囊经股动脉途径闭塞颈内动脉破口处或破口处患侧颈内动脉主干。结果术后18例颅内血管性杂音立即消失,16例闭塞了瘘口,颈内动脉主干保持通畅;2例同时闭塞了瘘口及颈内动脉主干。随访6～12个月,无复发。结论使用可脱性球囊栓塞治疗创伤性颈动脉海绵窦瘘创伤小、恢复快、安全可行,近期疗效确切。     

Carotid paragangliomas. Alternatives for presurgical endovascular management

Carotid paragangliomas (CP) are rare tumors, representing 0.6% of the head and neck tumors. These tumors have their origin in the carotid body located in the adventitia of the vascular wall of the carotid bifurcation. Among their principal characteristics are hypervascularity, primarily dependent on branches of the external carotid artery, the proximity and possible involvement of the cranial nerves IX, X, XI, XII, and extension to the base of the skull. Complete surgical resection is the first line of management; however, this procedure can be a surgical challenge due to the potential risk of bleeding, intraoperative neurovascular injuries, and prolonged surgical time. Tumor embolization, carotid stenting, and tumor embolization with carotid stenting have been developed as alternative presurgical endovascular techniques that decrease tumor vascularity and/or provide structural vascular support, reducing bleeding and facilitating tumor dissection. Two cases of carotid tumors of the same classification, Shamblin II, are presented, one treated by preoperative embolization and the other managed with a carotid stent; the indications, advantages, and possible complications of each one are discussed. Two cases of Shamblin II carotid tumors are presented, one treated preoperatively with a carotid stent and the other with preoperative embolization. A literature review was carried out, with a search in PubMed that includes case reports, case series, review articles, meta-analyses on CP, presurgical tumor embolization, presurgical carotid stent placement, and surgical treatment of carotid body tumor. Hypervascularity and adhesion to the carotid wall are the leading causes of difficulties in surgical resection of CP. Optimal tumor embolization and/or preoperative carotid stent placement reduce intraoperative bleeding and provide vascular structural support, reducing intraoperative and postoperative complications.     

颅内动脉瘤的可脱性球囊栓塞治疗

目的：探讨可脱性球囊在颅内动脉瘤介入治疗中的价值及缺点,并探讨不同大小动脉瘤的栓塞技巧。方法：20例动脉瘤患者中,小动脉瘤8例（12mm）,大动脉瘤7例（12－25mm）,巨大动脉瘤5例（＞25mm）。15例患者行动脉瘤腔内直接栓塞治疗,6例行载瘤动脉闭塞。结果：14个采用球囊行瘤腔内栓塞的动脉瘤中,3个月后DSA随访,10个动脉瘤被完全栓塞,4个动脉瘤部分栓塞。6例采用球囊行载瘤动脉闭塞的动脉瘤患者,3个月DSA随访皆未见动脉瘤显影。结论：颅内大动脉瘤或巨大动脉瘤的可脱性球囊瘤腔内直接栓塞治疗是一种行之有效的治疗方法,外科不能手术或行瘤腔内直接栓塞治疗难度较大的某些动脉瘤,载瘤动脉的闭塞治疗仍不失为一种有效的治疗方法。