B超等影像检查在脉络膜血管瘤诊断中的应用

目的 探讨B超等（CT和MR）影像检查对于脉络膜血管瘤的诊断价值。方法 回顾分析经临床证实的脉络膜血管瘤11例病例资料,均行B超检查,其中行CT增强扫描1例、 MR检查4例、眼底血管荧光造影2例。结果 11例B超检查呈梭形或橄榄形高回声占位,其中肿块实质均质8例,呈实质不均质占位3例; CT增强扫描示后极部球壁增厚1例,密度均匀,强化明显; MRI4例中T1WI呈等信号3例, T1WI呈高信号1例,T2WI均呈高信号,4例增强后瘤体显著强化。眼底血管荧光造影2例均显示动脉早期窦状强荧光,静脉期荧光渗漏,晚期瘤体高荧。结论 B超、增强CT和MRI对脉络膜血管瘤可作出定位的影像学诊断,B超（＋眼底血管荧光造影）在早期诊断方面有一定优势,MRI对该病的诊断及鉴别诊断较具特征性。     

MRI在听神经瘤检查中的作用探讨

目的 :探讨MRI在听神经瘤检查中的作用。方法 :2 0例听神经瘤均行MRI检查 ,取矢状位作定位像 ,行横断T1 WI、T2 WI扫描及矢状和冠状T1 WI/T2 WI扫描。均用造影剂Gd DTPA。结果 :肿瘤位于左侧 4例 ,右侧 1 6例。肿瘤直径 <2cm 4例 ,2 4cm 1 4例 ,>4cm 2例。T1 加权像呈等信号或低信号 ,T2 加权像呈高信号 ,出血或坏死可呈低高信号混杂。结论 :MRI是听神经瘤检查的首选方法 ,并在肿瘤的囊变、出血、周围情况了解上具有一定优越性 ,从而指导手术治疗     

原发性颅底软骨肉瘤CT和MRI诊断

目的分析原发性颅底软骨肉瘤的CT和MRI表现,探讨CT和MRI在颅底软骨肉瘤中的诊断价值。方法搜集经病理组织学证实的9例颅底软骨肉瘤,全部病例均行CT和MRI平扫及增强。结果 9例CT平扫表现为等或略低密度的分叶状或类圆形软组织肿块,伴有不同程度的钙化,且形态不规则,呈散在沙粒样或弧形及粗糙团块状,同时合并骨质破坏;增强后病灶呈非均匀强化。MRI检查T1WI呈等低信号混杂影,T2WI呈高低信号混杂影,肿瘤内钙化在T1WI、T2WI均为无信号区,增强扫描明显不均匀性强化。结论颅底软骨肉瘤有较特有的CT和MRI影像学表现,是诊断颅底软骨肉瘤的有效方法 。     

改良面中部掀翻进路鼻内镜辅助切除颌面海绵状血管瘤一例

患者女,17岁.右颌面部肿物17年,明显肿大6个月.患者自诉自幼发现右颌面有一小肿块,无不适感,随年龄增长肿块不断增大.近6个月来肿块明显增大,就诊于我院口腔科,作肿块穿刺可抽出血液,MRI示右侧颌面皮下软组织肿胀,边界不清,呈T1WI等低信号、T2WI散在高信号改变,增强扫描呈索片状不均匀轻度强化改变（图1）,诊断“右侧颌面部皮下良性占位病变,考虑海绵状淋巴管瘤”,后转入我科.     

颅底脊索瘤的CT和MRI影像分析

目的分析颅底脊索瘤的CT和MRI影像特点,探讨其影像诊断价值。方法回顾性分析2010年1月~2019年3月经手术病理证实颅底脊索瘤的62例患者的影像资料,所有患者术前均行CT和MRI检查,其中11例同时行CTA检查,观察病变部位、生长方式、密度或信号特点、强化方式。结果病变起源于斜坡46例, 伴脑干和基底动脉受压后移15例,筛窦、蝶窦受累10 例,单侧或双侧海绵窦受累8例,颅底受累5例,岩尖骨质受累6例; 起源于斜坡外16例,其中伴突入鞍上池9例,累及邻近岩骨、枕骨破坏4例,脑干受压3例。CT表现肿块为不均匀等或稍高密度软组织影,其中骨质破坏区边缘硬化4例,病变内见钙化或残存骨49例。MRI信号不均匀,T1WI稍低或等信号,T2WI高信号,夹杂T1WI高信号和/或T2WI低信号。增强检查表现呈不均匀强化,其中轻、中度强化53例, 强化显示“蜂房征”6例,边缘轻度环形强化3例。结论CT和MRI可清楚显示颅底脊索瘤的部位形态特点、侵犯周围组织范围、强化方式,对明确疾病诊断、制定手术计划及术后随访评估具有较大价值。     

头颈部血管平滑肌瘤临床特点分析

目的 分析总结头颈部血管平滑肌瘤(ALM)的临床特点，为其临床诊疗提供参考。方法 回顾性分析2009年11月—2021年7月收治的17例头颈部ALM患者的临床病历及随访资料。结果 17例头颈部ALM患者，其中男7例，女10例，平均年龄49.5岁。发病部位位于耳廓、面颊部各6例，鼻前庭1例，鼻腔2例，鼻咽部1例，左上唇侧前庭沟1例。位于鼻前庭者诉鼻塞，位于鼻咽部者诉鼻塞伴涕中带血，其余患者均表现为无痛性肿块。17例患者，6例行CT检查，其中4例行增强CT扫描后可见肿物血管丰富，呈明显强化或不均匀强化；6例行鼻内镜检查；5例行细针穿刺细胞学检查均查见血细胞。15例由HE染色确诊，2例由HE染色和免疫组化确诊。根据Morimoto分类方法，实体型8例，静脉型4例，海绵型4例，实体型-海绵型1例。所有患者均采用手术治疗，其中1例位于鼻咽部的肿物术中大量出血，约2 000 mL，予以电凝、压迫止血，其余病例术中均无明显出血。术后平均随访5年，均无复发、恶变。结论 头颈部ALM临床表现各异，组织学和免疫组化检测可明确诊断。对位于头颈部腔隙内、瘤体较大、完整切除困难且术前影像学检查提示瘤体血供丰富的病例，术前可考虑行瘤体血管栓塞以减少术中出血。手术切除预后良好。     

60例咽旁隙肿块的CT及MRI影像学特征分析

目的探讨咽旁隙肿块的CT及MRI表现,了解其影像学特征。方法回顾性分析2014年6月~2016年6月收治的60例咽旁隙肿块患者的CT及MRI影像学特征,观察肿块的位置、形态、与周围组织关系、密度、信号高低等情况。结果在60例咽旁隙肿块患者中,神经鞘瘤36例、涎腺混合瘤15例、颈动脉体瘤5例、鼻咽癌颅底咽旁隙转移4例。神经鞘瘤表现为包膜完整、边界光滑、呈椭圆形或圆形的肿块,与腮腺深叶间分界清楚,涎腺混合瘤为包膜完整的圆形肿块,与腮腺深叶间没有脂肪间隙,茎突、二腹肌、腭帆张肌等周围组织均出现移位。颈动脉体瘤表现为形态规则的软组织肿块,CT平扫呈等密度、增强后明显强化;MRI扫描,T1W1呈等或稍高于肌肉信号,T2W1呈不均性的高信号,并可见流空血管影像。鼻咽癌颅底咽旁隙转移的MRI显示,T1W1呈低密度信号的椭圆形肿块,增强后高信号内可见坏死囊变区。结论正确地认识咽旁隙肿块的CT及MRI影像学特征,有助于提高其临床诊断率,为咽旁隙肿块的治疗提供一定的依据。     

鼻颅底恶性肿瘤磁共振成像特征及颅底改变特点分析[论著]

目的　分析鼻颅底恶性肿瘤MRI特征及颅底改变特点，为诊断与治疗方案的选择提供依据。方法　回顾性分析经病理确诊的52例鼻颅底恶性肿瘤的MRI资料，其中横纹肌肉瘤17例、鳞状细胞癌13例、嗅神经母细胞瘤13例和弥漫大B细胞淋巴瘤9例，比较分析4种肿瘤的侧别、T1WI信号、T2WI信号、囊变坏死、DWI信号、强化方式、时间信号曲线（TIC）类型、眼眶受累情况、颅底受累部位、程度及颅内肿块形态特点有无差异。结果　肿瘤的T2WI信号（P=0.001）、DWI信号（P <0.001）、TIC类型（P =0.005）、颅底受累部位（P =0.012）及颅内肿块形态特点（P<0.001）在鼻颅底4种恶性肿瘤之间有显著差异。结论　鼻颅底恶性肿瘤MRI表现和颅底改变不同，分别具有一定特征，可有助于鉴别诊断与治疗方案的选择。     

三叉神经瘤影像学诊断的价值

三叉神经瘤14例,12例做CT检查,2例做MRI检查,14例术后均经病理检查证实.12例CT扫描呈混杂密度6例,均匀高密度5例,等密度1例,注射造影剂后多呈不均匀强化,肿瘤周围均无脑水肿.2例MRI图像T1加权像呈低信号,T2加权像呈高信号.X线平片示11例有岩骨、颅底骨吸收破坏.临床常伴有听神经、面神经等受累.CT和MRI是诊断三叉神经瘤的有效检查方法.三叉神经瘤应与脑膜瘤、胶质瘤及听神经瘤等相鉴别.     

MRI在鼻咽癌复发诊断中的价值

目的：探讨MRI在鼻咽癌放疗后复发（PNPC）和放疗后纤维化（RF）鉴别诊断中的价值。方法：对9例临床上难以鉴别是否鼻咽癌放疗后复发的病人进行MRI的平扫和钆剂增强扫描，分析RNPC和RF的信号变化。结果：3例RNPC表现为T1WI低信号、T2WI高信号，RF在T1WI和T2WI均为低信号或中等信号，增强扫描后RNPC表现为病灶有中等以上的强化，而RF病灶则无强化。结论：MRI平扫的T2WI和增强扫描的T1WI在RNPC和RF的鉴别诊断中有重要的参考价值，但应注意排除假阳性。     

Solitary fibrous tumor arising in the sphenoethmoidal recess: a case report and review of the literature

Recently, solitary fibrous tumors (SFTs) have been reported in the head and neck area, such as the nasal cavity, thyroid, salivary gland, etc. We present a rare case of SFT which arose from the sphenoethmoidal recess of the nasal cavity, penetrating into the sphenoid sinus, and which showed different intensities on magnetic resonance imaging (MRI) according to the occupied locations. T2 weighted magnetic resonance (MR) images showed low intensity in the nasal cavity, and iso-intensity in the sphenoid sinus. Enhancement with gadolinium contrast on T1-weighted images was more remarkable in the sphenoid sinus than in the nasal cavity. While the tumor in the nasal cavity showed abundant collagen and high cellularity in microscopic examination, numerous small vessels and dilated vascular spaces were remarkable in the tumor of the sphenoid sinus. MRI findings corresponded to pathological findings. We review SFTs in the head and neck area in the English literature.     

Nasal angiomyolipoma

Angiomyolipomas (AMLs) are hamartomatous lesions containing smooth muscle, vasculature and mature adipose tissue. AML occurs most frequently in the kidneys, with the liver being the second commonest site of involvement. Other localizations for AML are extremely rare and, to our knowledge, only six cases of AML of the nasal cavity have been reported to date. Our case involved a 52-year-old male who presented with a history of snoring and obstruction of the left nasal cavity. Physical examination revealed a 3-cm polypoid mass in the left nasal cavity, which was excised surgically. Histopathologic examination revealed that the lesion was composed of smooth muscle bundles, mature adipose tissue and blood vessels of different sizes. No epitheloid smooth muscle cells were observed and HMB-45 staining was negative. In conclusion, although nasal AML is a rare lesion, it should be considered in the differential diagnosis of polypoid nasal masses, especially when the mass occurs unilaterally.     

Nasal angiomyolipoma

Angiomyolipomas (AMLs) are hamartomatous lesions containing smooth muscle, vasculature and mature adipose tissue. AML occurs most frequently in the kidneys, with the liver being the second commonest site of involvement. Other localizations for AML are extremely rare and, to our knowledge, only six cases of AML of the nasal cavity have been reported to date. Our case involved a 52-year-old male who presented with a history of snoring and obstruction of the left nasal cavity. Physical examination revealed a 3-cm polypoid mass in the left nasal cavity, which was excised surgically. Histopathologic examination revealed that the lesion was composed of smooth muscle bundles, mature adipose tissue and blood vessels of different sizes. No epitheloid smooth muscle cells were observed and HMB-45 staining was negative. In conclusion, although nasal AML is a rare lesion, it should be considered in the differential diagnosis of polypoid nasal masses, especially when the mass occurs unilaterally.     

Vascular leiomyoma of the head and neck

OBJECTIVES/HYPOTHESIS: Vascular leiomyoma, a benign tumor composed of smooth muscle cell and vascular endothelium, is rare in the head and neck region. The authors report their experience with 21 patients. STUDY DESIGN: Retrospective review. METHODS: From 1988 to 2001, the clinical records of 21 patients with vascular leiomyoma of the head and neck were reviewed. The pathological material of each tumor was reviewed again for confirmation of the diagnosis and histological classification proposed by Morimoto. RESULTS: Twelve male and 9 female patients were studied. The mean age was 48 years. The locations and numbers of cases of the tumors were as follows: auricle, five; nasal cavity, three; external nose, 3; neck, 3; lip, 3; inner canthus, 2; forehead, 1; and hard palate, 1. All tumors were painless, and most were less than 2 cm in diameter. Three vascular leiomyomas of the neck were larger than 2 cm. Two of the three tumors originating in the nasal cavity presented with nasal obstruction or epistaxis. Regarding histological subtype, 14 of 21 (67%) tumors were solid type; 6 (28%) were cavernous type, and only one (5%) was venous type. Only one tumor (5%) recurred after excision. CONCLUSION: Vascular leiomyoma usually presents as a small, painless mass. Auricle, nose, lip, and neck are the most common sites of occurrence. Unusually large vascular leiomyomas are developed in the deep space of the neck. Imaging study or cytological examination is not helpful for diagnosis. Histological classification is not necessary. Simple excision yields excellent results.     

Intramuscular hemangiomas of the mylohyoid and sternocleidomastoid muscle

Intramuscular hemangiomas of the head and neck are uncommon benign vascular tumors. They arise frequently in the masseter and trapezius muscle. However, intramuscular hemangiomas arising from the mylohyoid and sternocleidomastoid muscle are extremely rare. We, herein, report additional two cases with intramuscular hemangioma of the mylohyoid and sternocleidomastoid muscle, and review the literatures pertaining to this condition. Imaging studies such as magnetic resonance image (MRI) were diagnostic and the tumors were resected completely with the cuff of normal surrounding muscle. At follow-up examination the patients have been well, without evidence of tumor recurrence after surgery. Intramuscular hemangioma of the head and neck, despite its rarity, should be considered in the differential diagnosis of the head and neck masses.     

Intranasal glomus tumor

The glomus tumor, or glomangioma, is a hyperplastic or hamartomatous lesion of the glomus body. It is composed of vascular channels surrounded by characteristic "epithelioid" cells, which are probably derived from smooth muscle. Glomus tumors rarely occur in the head and neck. We encountered the fifth documented case, to our knowledge, of a glomus tumor presenting in the nasal cavity. Although the lesion in this case was asymptomatic, intranasal glomus tumors producing nasal obstruction, pain, and epistaxis have been described. The complete excision of a glomus tumor normally cures the condition.     

Rhabdomyoma of the base of the tongue

The histopathological and imaging findings of a rhabdomyoma of the base of the tongue were studied. An immunohistochemical examination of the tumour cells showed positive immunostaining for myoglobin, desmin, and striated muscle actin, but negative immunostaining for smooth muscle actin. Electron microscopy showed many glycogen granules and mitochondria in the tumour cells. The T2-weighted and contrast-enhanced magnetic resonance images (MRI) clearly delineated morphological features of this tumour, but T1-weighted MRI and computed tomography (CT) images showed no important features. These findings are typical for an adult extracardiac rhabdomyoma located in the head and neck region, and they will be useful for diagnosis of this tumour.     

Solitary fibrous tumor (SFT) of the nasal mucosa

PATIENT: A case of a 76-year-old-man is reported who was referred to the department because of an increasing tumor of the right nasal cavity. After surgical treatment of the neoplasm histological examination revealed a solitary fibrous tumor (SFT) of the nasal mucosa. DISCUSSION: Solitary fibrous tumors mostly occur as pleural neoplasms. Extrapleural locations of this mesenchymal tumor species are rarely found in the head and neck region. These extrapleural tumors are sometimes difficult to diagnose because of their histologic variability. Solitary fibrous tumors typically show intense staining for CD 34, vimentin, bcl-2 and sometimes for desmin. These immunohistochemical features have made differentiation from other lesions in the head and neck region much easier. Most pleural and extrapleural solitary fibrous tumors behave in a benign fashion with good prognosis, though aggressive lesions with local invasion or distant metastases have been reported. Definitive surgical treatment with complete tumor removal is recommended in literature. Encouraging chemotherapy or radiotherapy results have not been reported so far.     

喉癌颈部淋巴结转移的MRI诊断

目的：探讨ＭＲＩ在喉癌颈部淋巴结转移术前诊断中的作用。方法：对１９例（２４侧）喉癌患者的颈部术前触诊、ＭＲＩ扫描及颈清扫标本病理检查结果进行了对比研究。结果：喉癌颈辨别志移淋巴结在ＭＲＩ影像上基本呈圆形或类圆型,个别可表现为数个淋巴结的融合;ＭＲＩ和临床触诊诊断颈部淋巴结转移的敏感率、特异率和准确率分别为８５．７％、９０．０％、８７．５％和６４．３％、７０．０％、６６．７％,ＭＲＩ诊断的准确率明显     

头颈部炎性肌纤维母细胞瘤

目的 炎性肌纤维母细胞瘤（inflammatory myofibroblastic tumor,IMT）是一种可发生于头颈部的罕见肿瘤,本文就其临床表现、病理组织学特征、治疗及预后进行探讨.方法 回顾性分析4例头颈部IMT患者的临床资料,并进行光镜检查及免疫组化染色.结果 IMT肿瘤组织学由具有平滑肌细胞和纤维母细胞特征的梭形肿瘤细胞、大量慢性炎性细胞及黏液血管样背景构成.免疫组化：平滑肌特异性肌动蛋白（smooth muscle actiVe,SMACTIN）、波形蛋白（Vimentin）呈强阳性表达.术后随访9～21月,2例声带IMT无复发,1例上颌窦IMT无复发,另1例上颌窦鼻腔IMT术后4个月再次复发.结论 IMT是兼有纤维母细胞及平滑肌细胞特征的肿瘤,具有局部复发倾向.治疗以根治性手术切除为主,术后放疗、化疗效果不确定.鼻窦I MT极易复发,具有局部浸润行为,手术切除须彻底.