头颈部副神经节瘤的影像学诊断

目的总结头颈部副神经节瘤的影像学表现,提高少见部位副神经节瘤的认识.资料与方法搜集1990年1月～2004年4月经手术病理证实的副神经节瘤27例,回顾性分析其超声、CT、MRI和DSA表现.结果 27例副神经节瘤中,19例(22个肿瘤)来自颈动脉体(其中3例双侧)均发生于颈总动脉分叉处,1例发生于迷走神经节,2例发生于颈静脉球,1例位于鼓室, 1例位于颏下,1例位于眶内肌锥外,2例恶性副神经节瘤,肿瘤破坏骨质.其共同影像学特点:实性肿块,血供丰富,强化明显,MRI显示肿瘤内有流空的血管影.结论头颈部副神经节瘤具有典型的影像学特征和特定的定位征象,对诊断有决定性价值.发生于罕见部位者,诊断困难,但如有上述典型征象,仍要考虑本瘤的可能.     

3.0T MRI对头颈部副神经节瘤的诊断

目的分析头颈部副神经节瘤的MRI特点,探讨MRI在其临床诊断中的应用价值。方法回顾性分析21例经术后病理诊断为头颈部副神经节瘤患者的临床及MRI资料,观察其MRI特点,包括病灶数量、位置、信号特点、占位效应及增强表现。结果颈动脉体瘤10例,位于颈总动脉分叉处,颈静脉球瘤8例,位于颈静脉窝6例,位于鼓室2例,迷走神经副节瘤2例,1例来源于颞下窝周围神经和自主神经。副神经节瘤MRI主要表现为T_1WI为等或稍低信号,T_2WI/FLAIR为高信号,边界清晰,未见占位效应及肿瘤周围水肿,部分病例可见"盐和胡椒"征,增强扫描后,病灶均强化明显。结论副神经节瘤的MRI表现具有一定的特征,MRI可作为临床诊断安全、准确的首选影像学检查方式。     

跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学诊断

目的：提高对跨中、后颅窝轴外肿瘤及肿瘤样病变的影像学认识。方法：60例经病理证实的跨中、后颅窝轴外肿瘤及肿瘤样病变按位置分为中央型和外侧型，后者又分中颅窝型、后颅窝型及骑跨型，分析各型构成情况及影像学特征。结果：中央型12例，脊索瘤5例，垂体瘤3例，鼻咽癌2例，颅咽管瘤、脑膜瘤各1例。外侧型48例，三叉神经肿瘤14例，脑膜瘤12例，表皮样囊肿11例，硬膜型海绵状血管瘤4例，皮样囊肿、转移瘤各2例，血管外皮瘤、颈静脉球瘤、鼻咽癌各1例。多数病变可根据影像学特点做出诊断并明确范围。结论：按位置特征对跨中、后颅窝轴外肿瘤及肿瘤样病变分型．有助于定性诊断及范围描述，有较高的临床应用价值。     

迷走神经副神经节瘤的MRI诊断(附6例报告及文献复习)

目的 分析迷走神经副神经节瘤的MRI表现。方法 对6例迷走神经副神经节瘤（良性4例，恶性2例）进行回顾性分析，重点分析其部位、信号、大血管移位和转移情况。结果 6例肿瘤中，4例位于上颈部，中、下颈部各1例；右颈部病变4例，左颈部2例；肿瘤类似纺锤形或不规则形；6例信号均欠均匀，其中4例出现“盐和胡椒征”，以“胡椒”表现最为显著；6例病变均有明显强化。对4例病变行MR血管造影，见颈动脉均向前、内移位，颈内静脉向后、外移位。2例恶性肿瘤中，1例破坏颈静脉孔区域骨质并颈部淋巴结和双肺内转移，1例出现颈部淋巴结的转移。结论 迷走神经副神经节瘤有其特定的部位和MRI信号，手术前可以进行定性诊断。     

头颈罕见部位副神经节瘤的CT和MRI诊断

目的 探讨头颈区少见部位副神经节瘤的影像诊断.方法 收集2000-01-2009-03本院经手术病理证实的10例头颈罕见部位的副神经节瘤,男6例,女4例,年龄15~53岁,平均35.4岁.详细分析其临床与影像学表现.结果 颈静脉孔区3例,其中2例长入桥小脑角区,斜坡1例长入鼻腔;舌根部1例;颌下1例;颈后部2例;鼓室1例;颈椎椎管1例,长入一侧神经孔.10例均为单发,8例周围骨质有不同程度破坏.CT平扫呈等低密度或混杂密度;MRI平扫病灶信号不一;CT及MRI增强扫描均显示肿瘤实性部分中等至明显强化.结论 生长部位不典型的头颈区副神经节瘤,有其共同的影像特点,结合临床,术前多可以诊断.     

头颈部副神经节瘤的影像学诊断

目的:结合头颈部副神经节瘤的发生部位,分析其影像学表现和特点.材料和方法:回顾性分析23例头颈部副神经节瘤患者的影像学资料(5例鼓室球瘤,12例颈静脉球瘤,3例迷走体瘤和3例颈动脉体瘤),21例行CT检查(其中1例行动态增强检查),15例行MRI检查.结果:鼓室球瘤较小,多发生于鼓岬区;颈静脉球瘤以颈静脉孔为中心,较大的肿瘤侵犯咽旁间隙、中耳、外耳道、乳突和(或)颅内;颈动脉体瘤位于上颈部颈内外动脉分叉处,伴上述动脉明显分离移位;迷走体瘤位于咽旁颈动脉鞘区,血管移位不一.以上四类肿瘤CT平扫呈中等密度,强化显著,部分肿瘤内见强化的血管和囊性改变;MRI T1WI中低信号,强化显著,T2WI中高信号,部分肿瘤内见囊变,多数肿瘤中可见血管流空"盐和胡椒征"(鼓室球瘤和较小的颈静脉球瘤中不见).鼓室球瘤和颈静脉球瘤边缘不规则,后者侵犯咽旁间隙部分边缘光滑,骨质呈虫咬状破坏;颈动脉体瘤和迷走体瘤边缘光滑,无骨质破坏.结论:多数头颈部副神经节瘤具有特定的发生部位和特征性的CT和MRI表现,可据此确诊;发生于不同部位的肿瘤的影像学表现有所差别.     

头颈部副神经节瘤影像学诊断

目的:探讨头颈部副神经节瘤的影像学特征。方法:回顾性分析19例头颈部副神经节瘤的CT、MRI和DSA表现,其中颈静脉球瘤3例,鼓室球瘤2例,颈动脉体瘤12例,迷走体瘤2例。结果:颈静脉球瘤的CT特征为颈静脉孔扩大和虫蚀骨质破坏,1例双侧因肿瘤为1cm首次平扫漏诊;鼓室球瘤均较小,发生于鼓岬区,临床特征为搏动性耳鸣和鼓膜充血;颈动脉体瘤位于颈总动脉分叉处,特征为颈内、外动脉分离和动脉镶嵌于肿瘤边缘或肿瘤内;迷走体瘤与颈动脉体瘤的区别在于颈内、外动脉受压后均向前移位。增强后肿瘤均见明显强化,MRA图像有助于确认肿瘤内的滋养血管,术前栓塞是治疗的有效方法,能减少约50%~70%肿瘤供血。结论:头颈部副神经节瘤具有特定的解剖学位置和影像学表现,对临床诊断和治疗有重要价值。     

肺上皮样血管内皮瘤二例

肺上皮样血管内皮瘤（pulmonary epithelioid hemangioendothelioma，PEH）是1种罕见的肺内低度恶性血管源性肿瘤，其影像学表现的报道不多。现报道2例经病理证实的PEH的影像学表现，以提高对该病的认识。     

后颅窝肿瘤的影像诊断和鉴别诊断

目的：总结分析38例后颅窝肿瘤的CT或MRI特征,提高对后颅窝肿瘤的诊断和鉴别诊断水平。方法：38例肿瘤中34例经手术病理证实,4例经临床影像诊断。所有患者均行CT平扫和增强扫描,其中8例行MR检查。结果：听神经瘤9例,脑膜瘤5例,Ⅰ级星形细胞瘤2例,Ⅱ－Ⅲ级星形细胞瘤4例,少枝胶质细胞瘤1例,血管母细胞瘤3例,室管膜瘤、髓母细胞瘤、三叉神经瘤、单发脑转移瘤各2例,胆脂瘤及蛛网膜囊肿各1例,以上均为手术病理证实;经临床影像诊断转移瘤4例。结论：后颅窝瘤有其好发部位,CT和MRI可清晰显示后颅窝肿瘤的不同特点。     

罕见部位神经源性肿瘤的临床及影像学诊断(附8例报告)

目的 探讨罕见部位神经源性肿瘤的影像表现，并提高术前诊断准确性。方法 本组8例患者，CT检查4例，胃肠道造影检查3例，胸部X线、B超、MRI和DSA检查各1例。所有病例均经病理证实为神经源性肿瘤。结果 影像检查并经病理证实，8例患者中，左前上纵隔恶性神经鞘瘤1例，左肺下叶支气管壁神经鞘瘤1例，回盲部肠系膜巨大神经鞘瘤1例，胃部神经源性肿瘤3例(腔内2例，腔外1例)，十二指肠降部腔外神经纤维瘤1例，以及盆腔右侧骶骨恶性孤立性神经纤维瘤l例。结论罕见部位神经源性肿瘤缺乏影像学特征，术前影像学检查大多能够做出正确的定位诊断，但与其相应部位的其他恶性肿瘤不易鉴别，确诊有赖于病理组织学检验。     

Paragangliomas in an endemic area: from genetics to morphofunctional imaging. A pictorial essay

The aim of this pictorial essay is to illustrate the morphological [computed tomography (CT) and magnetic resonance imaging (MRI)], vascular (angiography) and functional (nuclear medicine) features of paragangliomas, uncommon lesions of the head and neck region and even more of the thorax, abdomen and pelvis, arising in an endemic area in northern Italy. These hypervascular, well-circumscribed masses usually have innocuous clinical manifestations as slowly enlarging soft-tissue lesions; however, more rarely, they can cause cranial-nerve palsy, particularly lesions arising near the skull base, or symptoms related to their secreting activity. Most paragangliomas are benign and their prognosis is directly related to the location of the tumour: those arising at the carotid body have the best outcome, whereas those located at the skull base have a less favourable prognosis. Angiography is required preoperatively in larger paragangliomas for surgical planning (vascular mapping) and, rarely, for preoperative embolisation. Morphological and functional imaging is also mandatory for surgical and/or radiometabolic treatment planning and follow-up.     

颈动脉造影及选择性栓塞术在颈部副神经节瘤诊治中的价值

目的 评价颈动脉造影及介入栓塞在颈部副神经节瘤诊治中的价值。资料与方法 回顾性分析12例颈部副神经节瘤的诊治情况,其中5例行造影及栓塞术。结果 6例颈动脉体瘤（CBT）中4例未行动脉造影均诊断不明确或误诊,2例行颈动脉造影明确诊断并行术前栓塞,术中出血平均140ml,术后均无严重并发症发生,其中有一侧瘤体仅行栓塞术随访半年肿瘤未见增大。6例颈静脉球瘤（JP）中5例行外科全部或大部分切除,其中1例恶性者术中出血500ml,未完全切除后行介入栓塞残留瘤体,2例经造影明确诊断并行栓塞术,后行切除术中平均出血125ml,明显少于未行栓塞者。患者随访期间症状未见加重。结论 颈部副神经节瘤诊断中常规行颈动脉造影,必要时予以血管内栓塞治疗,可以减少术中出血及降低手术的风险,同时也可作为一种姑息性治疗方式。     

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.     

Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas

BACKGROUND AND PURPOSE: Substantial intraoperative bleeding during surgical removal of head and neck paragangliomas may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial approach has proved beneficial but is often limited by complex vascular anatomy and unfavorable locations. We report our experience with the preoperative devascularization of head and neck paragangliomas by using direct puncture and an intralesional injection of cyanoacrylate. METHODS: We retrospectively analyzed nine consecutive patients with head and neck paragangliomas who were referred for preoperative devascularization. Three patients were treated for carotid-body tumors; two for vagal lesions; and four, for jugular paragangliomas. Direct puncture of the lesion was performed by using roadmap fluoroscopic guidance. Acrylic glue was injected by using continuous biplane fluoroscopy. All patients underwent postembolization control angiography and immediate postoperative CT scanning. RESULTS: Angiograms showed that complete devascularization was achieved in all cervical glomus tumors, whereas subtotal devascularization was achieved in jugular paragangliomas. In this latter location, the injection of acrylic glue was limited by the potential risk of reflux into normal brain territory via feeders from the internal carotid or vertebral artery. The tumors were surgically removed and histologically examined. No technical or clinical complications related to the embolization procedure occurred. CONCLUSION: Percutaneous puncture of paragangliomas in the head and neck region and their preoperative devascularization by intralesional injection of acrylic glue is a feasible, safe, and effective technique.     

Extraadrenal paragangliomas of the body: imaging features

OBJECTIVE: This article illustrates the anatomic distribution of the healthy paraganglion system and the imaging and pathologic features of various extraadrenal paragangliomas occurring in the head and neck, chest, and abdomen. CONCLUSION: Although paragangliomas can occur in a variety of anatomic locations, the majority are seen in relatively predictable regions of the body. Extraadrenal paragangliomas have nearly identical imaging features, including a homogeneous or heterogeneous hyperenhancing soft-tissue mass at CT, multiple areas of signal void interspersed with hyperintense foci (salt-and-pepper appearance) within tumor mass at MRI, and an intense tumor blush with enlarged feeding arteries at angiography.     

Clinical impact of somatostatin receptor scintigraphy in the management of paragangliomas of the head and neck.

Paragangliomas are neuroendocrine tumors expressing somatostatinergic receptors and, thus, may be imaged by somatostatin receptor scintigraphy (SRS). The purpose of the study was to assess the contribution of SRS in the management of paraganglioma of the head and neck. METHODS: (111)In-Pentetreotide (148 MBq) was intravenously administered to 3 groups of patients. Group A consisted of 9 patients with tumors of the head and neck that did not exhibit typical radiologic features of paragangliomas and required further diagnostic evaluation. Group B consisted of 28 patients with known paragangliomas or paraganglioma metastatic lymph node who required staging and assessment of multicentricity. Group C consisted of 5 asymptomatic relatives of affected individuals who required screening. All patients underwent clinical, laboratory, radiologic, and audiovestibular evaluation. RESULTS: In group A (n = 9), SRS was positive in 6 cases, 4 paragangliomas and 2 meningiomas, and negative in 3 patients in whom the initial diagnosis of paraganglioma was excluded. In group B (n = 28), SRS was strongly positive in all of the 34 head and neck masses diagnosed on conventional imaging to be paragangliomas; it localized 1 primary malignant paraganglioma and revealed 9 unexpected foci. In group C (n = 5), SRS was positive in 3 of the 5 relatives, CT or MR scan confirming the diagnosis of paraganglioma in all cases. CONCLUSION: Because of very high sensitivity in detecting paraganglioma, SRS should be included in a multiple-step strategy for patients' management. It could be useful in ruling out the diagnosis of schwannoma, but its major advantage may involve patients' staging. Once biologic genetic testing of affected patients' relatives evidenced the predisposing mutation, SRS could be proposed to identify individuals who express the disease.     

Spindle cell lipoma of the head and neck: CT and MR imaging findings

Introduction

Spindle cell lipoma (SCL) is an uncommon benign lipomatous tumor, most commonly occurring in the posterior neck and shoulder. The purpose of this study was to investigate the CT and MR imaging features of SCL in the head and neck.

Methods

CT (n?=?5) and MR (n?=?3) images of seven patients (five men and two women; mean age, 54 years) with surgically proven SCL in the head and neck were retrospectively reviewed. The location and morphologic characteristics of SCL were documented as well.

Results

Six lesions were well-defined and located in the subcutaneous fat of the posterior neck (n?=?4), anterior neck (n?=?1), and buccal space (n?=?1). One lesion was ill-defined and located deeply in the supraclavicular fossa, infiltrating the adjacent shoulder muscles. Intratumoral fat was identified in five lesions in various amounts. Compared with the adjacent subcutaneous fat, intratumoral fat was slightly hyperattenuated on CT scans and slightly hypointense on T1-weighted MR images. In five of six lesions in which postcontrast CT and/or MR images were obtained, significant enhancement was seen in the nonadipose component of the lesion.

Conclusion

Various components of the adipose and nonadipose tissues may cause difficulty differentiating between SCL and other adipocytic tumors including liposarcoma radiologically. Although nonspecific, the radiologist should know the various imaging features of SCL, because the tumor can be cured by simple excision.     

Glomus tumors of the head-neck-region

Glomus tumors of the head and neck are rare tumors of adulthood which arise from paraganglia or glomus cells within the carotid glomus, vagus nerve, middle ear or jugular foramen. The diagnosis of these mostly benign lesions is predominantly done with CT and MRI. DSA can provide important additional information. Besides surgical resection, one therapy option is radiological intervention with tumor embolisation. Because of the typical radiological imaging and the "salt and pepper appearance" in MRI, glomus tumors can be differentiated from other lesions in the head and neck. This review gives a survey of the classification, diagnosis and therapy of paragangliomas with images to demonstrate characteristic features.     

Glomustumoren der Kopf-Hals-Region

Glomus tumors of the head and neck are rare tumors of adulthood which arise from paraganglia or glomus cells within the carotid glomus, vagus nerve, middle ear or jugular foramen. The diagnosis of these mostly benign lesions is predominantly done with CT and MRI. DSA can provide important additional information. Besides surgical resection, one therapy option is radiological intervention with tumor embolisation. Because of the typical radiological imaging and the “salt and pepper appearance” in MRI, glomus tumors can be differentiated from other lesions in the head and neck. This review gives a survey of the classification, diagnosis and therapy of paragangliomas with images to demonstrate characteristic features.