良性对称性脂肪过多症头颈部CT分析

目的 分析良性对称性脂肪过多症（BSL）CT表现,评价CT诊断价值。资料与方法 回顾性分析16例经临床证实的BSL患者的CT资料。15例行CT平扫,其中5例同时行CT增强扫描;1例直接行增强扫描。结果 所有患者均表现为颈部脂肪蓄积增厚,无包膜,边界不清,左右对称,蓄积脂肪内无钙化;病变主要分布于颈前舌骨下区（16例）,颈前舌骨上区（14例）,胸锁乳突肌深面（15例）,颈后区皮下（15例）,脊柱旁肌肉间隙（11例）,上背部皮下（10例）,下枕部皮下（9例）,斜方肌深面（8例）,双侧锁骨上窝（7例）及胸骨切迹（7例）,也见于面颊部（4例）、气管前间隙（5例）、颈椎前间隙（3例）及喉旁间隙（1例）。结论 BSL具有特征性头颈部CT表现,CT能清楚显示病变累及范围,在术前定量诊断方面具有重要价值。     

Madelung综合征累及头颈部的CT诊断

目的：探讨CT对Madelung综合征累及头颈部的诊断价值。方法：回顾性分析24例Madelung综合征累及头颈部患者的CT表现,全部病例均行CT平扫,15例行增强扫描,18例采用2D多平面重组（MPR）和3D容积再现（VR）技术进行图像后处理。结果：24例均显示脂肪组织对称分布,无包膜,边界不清。男性患者病变主要分布于下枕部、后颈部及上背部皮下间隙、胸锁乳突肌及斜方肌深面、椎旁肌间隙、颈前区、腮腺区、面颊部、颈后三角区和锁骨上区;女性患者病变主要累及后颈部皮下间隙。部分病例见肌肉、腺体、大血管、上气道和消化道受压。此外,CT扫描发现头颈部偶发病变5例,包括会厌癌、真菌性上颌窦炎、枕大池蛛网膜囊肿、腮腺Warthin瘤和锁骨上血管畸形各1例。结论：CT是评价Madelung综合征累及头颈部的有效手段,结合2DMPR和3DVR重组技术,可准确显示脂肪组织的分布情况,病灶与肌肉、腺体和大血管的关系以及上气道和消化道受压的程度等,同时可发现头颈部其它偶发病变,对本病的诊断和治疗具有重要价值。     

Madelung综合征的影像表现(附4例报告)

目的探讨Madelung综合征的CT与MRI表现特征。方法搜集4例Madelung综合征患者。2例患者行CT增强扫描,2例行MRI平扫。分析其临床特点及影像表现。结果 4例Madelung综合征患者均有长期大量饮酒史,表现为颈及肩背部浅层皮下脂肪及深层脂肪增多。CT显示病变部位增厚的脂肪组织,CT值为-100HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示病变部位脂肪增多,呈短T1、长T2信号,在脂肪抑制序列上呈低信号,脂肪组织间有纤维组织分隔。CT与MRI均能显示喉内及其周围结构脂肪组织浸润,双侧背阔肌、胸锁乳突肌缩小变薄,肌间隙稍增宽。结论 CT与MR检查对Madelung综合征可明确诊断,为临床治疗提供有价值的信息。     

Madelung’s病的影像学表现(附3例报道及文献复习)

目的探讨Madelung’s病的影像学表现,从而提高临床对该疾病的诊断能力。方法结合相关文献,回顾性分析2013～2018本院收治的三例Madelung’s病患者影像学表现。结果本组三例患者均为Madelung’s病Ⅰ型, CT表现为双侧颌面部、颈背部、上胸部及肩部弥漫性、对称性脂肪密度组织堆积。病灶无明显包膜,其内无钙化或骨化。MRI表现为上述部位弥漫性脂肪堆积,累及双侧腮腺、咽旁间隙及喉咽周围,STIR上信号减低,增强扫描无强化。结合患者长期饮酒病史,根据CT、MRI对病灶的良好显示,三例均在术前作出初步诊断,与病理结果一致。结论 CT和MRI检查对Madelung’s病的诊断具有重要价值,且能为手术治疗提供明确解剖结构关系。     

小儿甲状舌管囊肿的CT诊断

目的：探讨甲状舌管囊肿的CT表现及诊断价值。材料和方法：回顾性分析28例经CT诊断为甲状舌管囊肿病例的CT表现，并与手术和病理对照研究。结果：28例中经手术病理证实为甲状舌管囊肿25例，其CT表现为颈前正中囊肿16例，偏左侧者7例，偏右侧者2例；25例中11例位于舌骨水平，并紧贴舌骨，14例位于舌骨下方水平，其中3例紧贴甲状腺。CT平扫囊肿呈低密度15例，等密度10例。25例中24例行增强CT检查，24例囊内容物均无强化，15例囊壁光整，增强后无强化，9例囊壁毛糙，有强化，6例囊肿间见分隔影。CT诊断符合率89．3％（25／28）。结论：CT对小儿甲状舌管囊肿具有较高的定性价值。     

颈深淋巴结转移癌侵犯颈动脉的CT诊断

术前判断淋巴结转移癌是否侵及颈动脉，对于制定手术方案及判定预后均有重要临床意义。CT对于诊断头颈部肿瘤原发灶及颈部淋巴结转移有重要价值，是常用的检查手段。对颈深淋巴结的分布、引流及与颈动脉的解剖关系和颈深淋巴结转移癌侵及颈动脉的CT影像学的研究现状加以论述，并分析了单螺旋CT及多层螺旋CT的技术优势。     

MRI诊断头颈部木村病的临床价值

目的探讨MRI诊断头颈部木村病的临床价值。方法选取我院2010年4月~2016年4月收治的头颈部木村病患者43例作为研究对象,所有患者均行MRI检查,记录患者的病灶情况、临床表现、MRI表现以及病理学表现。结果 43例患者中,发现59个病灶,其中37例患者病灶部位在单侧,6例患者病灶在双侧。而病灶部位主要在腮腺及皮下肿块(11例)、腮腺(9例)、右侧腮腺及右侧耳周(7例)、左侧腮腺及右侧颌下腺(7例)、双侧腮腺及下颌腺(6例)、右侧腮腺及颞区皮下肿块(3例)。经MRI检查显示59个病灶中有56个病灶(94.92%)浸润到皮下组织,产生弥漫性肿块,显示边界欠清晰,病灶形态不规则。结论临床上对木村病的诊断需须结合相关实验室检查及临床表现来确诊,而影像学检查中MRI诊断头颈部木村病的诊断准确率更高,值得临床广泛应用。     

颈深淋巴结转移癌侵犯颈动脉的CT诊断

术前判断淋巴结转移癌是否侵及颈动脉，对于制定手术方案及判定预后均有重要临床意义。CT对于诊断头颈部肿瘤原发灶及颈部淋巴结转移有重要价值，是常用的检查手段。对颈深淋巴结的分布、引流及与颈动脉的解剖关系和颈深淋巴结转移癌侵及颈动脉的CT影像学的研究现状加以论述，并分析了单螺旋CT及多层螺旋CT的技术优势。     

颈肩部韧带样型纤维瘤病CT与MRI表现

目的探讨颈肩部韧带样型纤维瘤病CT和MRI表现,了解其影像特征及其诊断价值。方法回顾性分析本院4例经手术病理证实的颈肩部韧带样型纤维瘤病CT及MRI表现,术前4例均行CT平扫加增强检查,2例行MRI检查。结果全部病例均表现为沿肌纤维长轴生长;1例呈卵圆形,3例呈不规则形侵袭性生长,边缘模糊;全部病例累及1块或多块肌肉及肌间隙,3例可见推移、压迫相邻的重要大血管,其中1例累及臂丛神经和侵袭相邻的椎体骨质,并包埋斜角肌和头臂血管。CT平扫1例密度均匀,低于肌肉,3例表现为不均匀低、等密度;增强后1例周边强化,3例呈不均匀轻度强化。MRI平扫T2WI肿瘤呈高、等混杂信号,内见斑片状或条带状分布的低信号,其中1例包埋低信号斜角肌。结论 CT和MRI可显示韧带样型纤维瘤病大小、形态、侵袭范围及与重要大血管的关系,肿瘤的MRI信号比CT密度更能反映有助于诊断的瘤内组织学成分。     

鳃裂囊肿的CT诊断

目的：探讨鳃裂囊肿的CT表现及其诊断价值。方法：收集我院CT诊断并经手术治疗的鳃裂囊肿15例，复习有关献，对其CT征象进行分析。结果：本组鳃裂囊肿均位于胸锁乳突肌上1/3的前缘，相当于舌骨平面，颈动脉鞘的外侧，左侧8例，右侧7例。注射造影剂后无强化现象。囊肿与周围结构界限清楚。囊肿邻近结构有不同程度受压移位。结论：CT可定位定性地诊断鳃裂囊肿，对指导临床治疗有很高的价值。     

Madelung综合征的CT与MRI表现

目的 探讨Madelung综合征的CT与MRI表现特征.方法 搜集5例Madelung综合征患者,5例中Ⅰ型3例,Ⅱ型2例.5例患者均行CT检查,1例行CT增强扫描,2例行MR平扫.分析其临床特点及影像表现.结果 3例Ⅰ型Madelung综合征表现为躯干上部浅层皮下脂肪及颈深层脂肪增多,肿物弥漫分布于颈部、上胸及肩部,呈现"马颈圈"、"牛颈"样特征性表现;2例Ⅱ型表现为四肢近端、前胸壁皮下脂肪明显增厚,呈"大力水手"的特殊外观;5例患者均有腹直肌前方、腹股沟皮下脂肪增厚及阴囊内脂肪堆积.CT显示病变部位浅层皮下脂肪增多,CT值为-30～-70 HU;MR T1WI、T2WI及T2WI脂肪抑制序列均能显示增厚的脂肪组织,呈典型的短T1、长T2信号,在脂肪抑制序列上呈低信号,脂肪组织间有纤维组织分隔.结论 结合长期大量酗酒史,CT与MR检查对Madelung综合征可明确诊断,并明确病变范围及周围组织分界,对手术治疗方案提供有价值的信息.

Abstract：

Objective To determine the CT and MR findings of Madelung syndrome. MethodsFive cases of Madelung syndrome were collected in our hospital from February 2006 to June 2009, including 3 cases of typeⅠMadelung syndrome and 2 cases of typeⅡ Madelung syndrome. The 5 cases were all examined by CT, meanwhile 1 case by CT enhancement scanning and 2 cases by MR. The clinical characteristics and imaging manifestations were analyzed. Results CT and MR images in 3 patients of typeⅠMadelung syndrome displayed fat accumulation within the subcutaneous tissue of the upper trunk and deep layer tissue of neck. The diffuse masses were located around the neck, upper chest and shoulders, which were called "horse collar"and " buffalo humps". The other 2 cases of type Ⅱ Madelung syndrome displayed fat thickening within the subcutaneous tissue of the proximal extremities, anterior chest wall, showing special appearance of "vigorous sailor". All the 5 patients showed fat deposit within the subcutaneous tissue of the anterior rectus abdominis, inguina and fat accumulation within the scrotum. CT showed proliferated fat at the subcutaneous tissue of the involved regions. The CT value of proliferated fat were between -30 and -70 HU. The proliferated fat tissue all could be displayed on MR T1WI,T2WI and T2WI fat suppression sequence, with typical hypointensity on T1WI and hyperintensity on T2WI, hypointensity on fat-suppression sequence and fibrous septation presenting among fat tissue. Conclusion Combination with the history of long-term alcohol abuse, the Madelung syndrome could be diagnosed by CT and MR, which had great value in the surgical planning for identifying the extent of disease.     

头颈部木村病的CT诊断

目的：探讨头颈部木村病的CT表现,提高对该病的认识及诊断水平。方法：回顾性分析3例经病理证实的头颈部木村病患者的临床特征、CT表现及病理特点。结果：CT表现：2例表现为病侧腮腺弥漫性肿大,伴有结节或软组织肿块,累及相邻筋膜和皮下脂肪,腮腺区及同侧或双侧颈部淋巴结成堆、成串肿大,肿大淋巴结密度均匀,明显增强,无坏死、囊变和融合。1例表现为腮腺内孤立的结节。病理表现：HE染色光镜下腮腺组织内大量的嗜酸性粒细胞及淋巴细胞浸润。结论：发生于头颈部特别是腮腺区无痛性不能扪及边界的肿块或结节,累及邻近颈部筋膜及脂肪间隙,引流区淋巴结成堆成串肿大,结合实验室外周血嗜酸性粒细胞增高,应考虑木村病可能。     

Multiple symmetric lipomatosis (MSL) of neck in a child (Madelung's disease): report of a rare presentation

A case of multiple symmetric lipomatosis (MSL) of neck, also known as Madelung's disease or Launois-Bensaude syndrome, is reported in an 8-year-old girl who presented with bilateral swellings in the neck. MSL is characterized by large subcutaneous fat masses distributed around the neck, shoulders and other parts of the trunk, often associated with abnormalities of the nervous system. This is commonly seen in middle-aged men with a history of alcohol abuse. Metabolic disturbances and malignant tumours have also been associated with this disorder. MSL is rare in children and there was only one prior report in the literature describing MSL that affected two children. With an initial clinical suspicion of bilateral cystic hygroma, imaging was sought. CT demonstrated multiple compartmentalized, unencapsulated fat-containing lesions on either side of the neck extending into the mediastinum. This radiographic appearance was strongly suggestive of lipomatous tissue within the neck and eventually confirmed by histopathology. The recognition of this disease is important as, in addition to cosmetic abnormality, it can compress the important neurovascular structures. These fatty deposits were later surgically excised.     

Pilomatricoma in the head and neck: CT findings in three patients

We report three cases of pilomatricoma, one in the infrahyoid neck and the others in the preauricular area. In all cases, CT showed well marginated soft tissue masses that were located mainly in the subcutaneous fat, partly attaching to the overlying skin. There was no evidence of infiltration to deeper structures. Substantial amounts of calcification were found in one tumor. Pilomatricoma should be included in diagnostic consideration when CT shows a well marginated subcutaneous soft tissue mass adherent to the skin with or without visible calcification in the head and neck region.     

头颈部嗜酸性淋巴肉芽肿的影像及病理学分析

目的 探讨头颈部嗜酸性淋巴肉芽肿(KD)的影像表现及病理特征,以提高对该病的术前诊断率。方法 回顾性分析8例经病理证实的头颈部KD患者的临床影像及病理表现。结果 8例KD患者中,单发与多发各4例;部位:腮腺6例、口底(颌下腺区)1例、眼睑1例,其中2例累及腹股沟。CT和MRI征象:①累及腮腺者(4例):患侧腮腺、面部弥漫性增大,结节边界欠清或较清,密度略高于腮腺,T1加权像多为等信号,T2加权像信号则多为等、低信号,增强扫描有不同程度强化;②累及头颈部其他部位(如颌下腺区、眼睑等)者:病变密度、信号、强化程度亦与累及腮腺者类似,但可有周围组织的受累(如颅骨);③周围淋巴结常不同程度受累、增大,密度、信号均匀,边界清楚,无坏死,无融合;往往累及局部皮下组织,邻近皮肤增厚。病理:KD组织成分基本一致,均由淋巴细胞、嗜酸性粒细胞、小血管和纤维组织以不同比例组成。结论 KD有一定的好发部位和临床特点,结合影像学检查与病理分析,可大大提高其术前诊断的正确率。     

Kimura病的CT、MRI表现

目的 探讨Kimura病的CT、MRI表现,提高该病的术前诊断水平.方法 回顾性分析11例经病理证实的Kimura病患者的临床特征、CT及MRI表现.11例Kimura病患者发生于(或累及)腮腺区7例,颌面部2例,硬腭1例,腹股沟1例(其中3例为异位复发,2例为原位复发).均表现为无痛性肿物,平均病程2年以上;嗜酸性粒细胞均明显增高.结果 CT和MRI表现:5例单发结节,6例多发结节;最小者约6 mm×3 mm,最大者约60 mm ×34 mm;较大结节边界不清楚,较小者边界清楚,邻近脂肪间隙内见条索影浸润,10例颌面部病灶均位于浅筋膜下;CT显示9例密度均匀,稍低于肌肉密度;3例在MR T2WI上呈稍高信号,在T1 WI上呈等或稍低信号;11例肿块呈中度至重度、均匀或不均匀强化;9例肿块(8例颌面部、1例腹股沟)伴有同侧(或双侧)引流区淋巴结肿大,边界清楚,无坏死,无融合,强化明显.结论 Kimura病具有一定的临床和影像特征,结合实验室检查,可以进行正确诊断.     

Soft-tissue changes after head and neck radiation: CT findings

To identify possible soft-tissue changes of the head and neck after radiation therapy, 102 CT scans from 78 patients with head and neck tumors were reviewed to assess (1) skin thickening, (2) epiglottic thickening, (3) stranding of subcutaneous fat, and (4) stranding of deep cervical fat. Scans were obtained after radiation therapy alone (10 cases), after radiation and surgery (27 cases), after surgery alone (24 cases), or before either surgery or radiation (41 cases). Skin thickening, epiglottic thickening, and stranding of subcutaneous fat were seen more frequently after radiation therapy than before such treatment. However, skin thickening and stranding of subcutaneous fat were sometimes also associated with tumor involvement and/or previous surgery, while epiglottic thickening was only occasionally associated with tumor involvement. Stranding of deep cervical fat was noted with increased frequency after radiation or surgery, but postradiation effects could not be reliably distinguished from postsurgical or tumor effects. We conclude that soft-tissue changes of the head and neck on CT may commonly be associated with previous radiation therapy, but these postradiation effects are not always distinguishable from postsurgical effects or tumor.     

Selective neck dissection: CT and MR imaging findings

BACKGROUND AND PURPOSE: Selective neck dissection (SND) has become a common surgical procedure for selectively treating known or potential metastatic nodal disease from head and neck cancer while preserving functional structures. The purpose of this article is to describe the expected CT and MR findings after SND. METHODS: CT (26/27) or MR images (1/27) from 27 consecutive patients treated with SND for either staging or nodal control of head and neck malignancy were retrospectively reviewed by two experienced head and neck radiologists. One patient had bilateral SND. The quantity of deep cervical fat was subjectively assessed, as was patency of the ipsilateral internal jugular vein (IJV) and asymmetry in size and contour of the sternocleidomastoid (SCM), trapezius, and infrahyoid strap muscles. The presence of the submandibular gland was noted. RESULTS: Twenty-seven of 28 necks had marked decrease in fat beneath the SCM muscle. This resulted in the muscle directly abutting the paraspinal muscles in most cases. The SCM muscle contour and size was asymmetric or flattened and atrophic in 16/28 necks. Atrophy of the infrahyoid strap muscles was seen in 8/28 necks. Six of 28 had no detectable IJV, and it was presumably thrombosed. Submandibular gland was not present in 17/28 cases. CONCLUSION: The imaging findings after SND are characteristic and reflect the type of surgery performed. If level I nodes are removed, the submandibular gland is absent. Marked decrease in deep cervical fat is common. Changes in and around the SCM muscle are routinely seen and include posterior and medial displacement of the muscle, distortion and flattening of the muscle, or atrophy, despite surgical preservation of spinal accessory nerve. Finally, although the IJV is not resected in SND, nonvisualization of the vein on postoperative images may reflect thrombosis.