颈外侧部病变的CT诊断和鉴别诊断

1　颈外侧部的ＣＴ解剖简介颈部ＣＴ分为位于中央区的器官部(包括咽、喉、气管、食管、甲状腺和甲状旁腺)、颈后部(包括颈椎、颈髓和周围的肌肉)和双侧颈外侧部4个部分。颈外侧部主要由各侧的颈动脉鞘及其周围的筋膜间隙所组成。颈动脉鞘由颈总动脉(或颈内动脉)、颈内静脉和迷走神经组成。本文介绍的颈外侧部病变,主要来自颈动脉鞘内的各组织,有的则来自颈动脉鞘周围。解剖上颈动脉鞘及其周围,被颈深筋膜分成多个筋膜间隙,即颈动脉间隙、咽后间隙、颈后间隙、咽旁间隙等。上述间隙除颈动脉间隙内主要包含颈动脉鞘的内容物外,其余各间隙内主…     

CT对鼻咽癌累及周围间隙规律的探讨

分析鼻咽癌对周围各间隙的影响。材料与方法；对１０５例鼻咽癌患治疗前的ＣＴ图像进行分析，探讨周围各间隙受累的规律。结果；各周围间隙受累的次序为咽粘膜间隙，咽旁间隙，咽后椎前间隙，血管间隙，颈后间隙。血管间隙，咽后椎前间隙，颅底骨质破坏与咽旁间隙受累相关。     

颈动脉间隙及相关颈间隙的CT(Ⅰ)解剖

“颈动脉间隙”居咽旁间隙之后藉茎突把二者分开。脊旁间隙颈动脉间隙之后两者被前斜角肌和长斜角肌分隔。咽旁间隙广义上是指由下颌骨升支、腮腺、乳突、脊柱、咽壁所围成的解剖隐窝。狭义的是将咽旁间隙解释为在吞咽肌和咀嚼肌层间的纤维脂肪间隙。在鼻咽水平,吞咽肌由腭肌;腭帆提肌和腭帆张肌组成。在口咽水平吞咽肌由缩肌代表,咀嚼肌外侧邻接外翼肌和内翼肌,特别是内翼肌。间隙的上方在颅底近破裂孔处由腭肌和翼肌的结合部封闭,间隙下方后侧由嵌入舌基底的茎突舌骨肌封闭。咽旁间隙下方还和二腹肌间隙相续,后者内含颌下腺,故咽旁间隙全部在舌骨上方。     

咽旁肿瘤的CT诊断

咽旁间隙由茎突和腭帆张肌的肌膜分为前方的狭义的咽旁间隙和后外侧的颈动脉间隙。狭义的咽旁间隙称咽旁间隙,以区别于颈动脉间隙和咽后间隙。作者对咽旁间隙和颈动脉间隙的10例原发性肿瘤行CT检查(咽旁间隙5例,颈动脉间隙4例),男3例,女7例,年龄23～71岁。扫描层厚5～13mm;扫描范围:咽旁间隙病变从颅底扫到舌骨;     

头颈部椎周间隙良性肿瘤的MR成像研究

目的：分析头颈部椎周间隙良性肿瘤MR成像特征及病变的诊断与鉴别诊断。方法：18例头颈椎周间隙良性肿瘤均经Philips0.5T超导型MR成像仪扫描,包括12例神经鞘瘤、2例神经纤维瘤和4例脊索瘤,其中13例行Gd-DTPA增强,结果：18例良性肿瘤于T2加权像上均呈高信号（大多数接近脑脊液）,增强后显著强化。6例神经鞘瘤、1例神经纤维瘤和4例脊索瘤信号不均匀,所有病例均位于椎周间隙椎前部分。其中7例位于舌骨上,结论：MR成像可清晰显示椎周间隙病变,划分椎周间隙在一定程度上能进行病变的定性诊断和鉴别诊断。     

颈深筋膜间隙感染的影像学表现及其临床意义

目的 分析颈深筋膜间隙蜂窝织炎和脓肿的CT和MRI表现，探讨深筋膜间隙感染的诊断标准。方法 回顾分析28例经临床及穿刺证实的颈深筋膜感染的CT和MRI表现。包括咽后间隙11例，咽旁间隙5例，嚼肌间隙4例，多间隙感染8例。结果 颈深部筋膜间隙感染包括蜂窝织炎和脓肿，15例蜂窝织炎，CT可见软组织肿胀，伴有脂肪间隙移位、变小或消失。炎性组织在T1WI呈等、低信号，T2WI呈高信号。13例脓肿，CT可见局部低密度灶，边界清或不清，有强化。脓肿在MRI T2WI上见显著高信号，边界可有强化。结论 CT和MRI对颈深筋膜间隙蜂窝织炎和脓肿的诊断和定位十分准确，能为临床医生提供十分有价值的信息。     

颈部感染及其在颈筋膜间隙中蔓延的CT观察

目的 研究颈部感染的CT征象以及感染在筋膜间隙中的蔓延特点。资料与方法 回顾分析44例临床确诊的有CT资料的颈部感染病例资料。所有病例均为横断面扫描,扫描范围为颅底至颈根部,其中31例为增强扫描,13例未作增强。结果 在44例颈部感染患者中,咽旁间隙9例,咽后间隙9例,椎前间隙5例,扁桃体5例,咀嚼肌间隙4例,颌下间隙2例,颈浅部2例,气管前间隙1例,另有7例为多间隙感染。30例有颈阔肌及其周围脂肪的异常改变,CT表现为颈阔肌明显均匀增粗,边缘模糊无强化。颈部筋膜间隙感染主要表现为间隙内的脂肪影消失,间隙旁组织肿胀。2例坏死性筋膜炎CT表现有：颈阔肌增粗、中断,胸锁乳突肌表面筋膜强化,颈深筋膜间隙内积液,颈间隙内气体积聚,纵隔内有感染。2例咽旁感染扩散到舌下间隙,1例到会厌前间隙;3例咽后间隙感染扩散到纵隔,2例到气管旁间隙;2例咀嚼肌间隙感染蔓延到颞肌间隙,2例到咽旁间隙,1例到颊肌间隙;1例椎前间隙感染蔓延到胸部。结论 CT可以准确诊断颈部感染并判断其范围,为临床诊治提供极大的帮助。同时,通过对颈部感染在颈部筋膜间隙中蔓延的CT表现进行分析,可以对颈部筋膜及其间隙的解剖进行更深入的研究。     

颈部节细胞神经瘤一例

患者 女,31岁.因咽痛半个月入院.体检:咽左侧壁可见肿物突起,表面光滑.实验室检查无异常.CT平扫示左颈部椭圆形均一低密度肿块,大小约5.1 cm×2.4 cm×8.5 cm,CT值21～29 HU,边界光滑,占据左咽旁间隙、颈动脉间隙,向后达椎前间隙;增强后动脉期肿块未见明显强化,静脉期肿瘤内部可见片絮状强化,CT值28～76 HU(图1).病变下端起源于颈动脉鞘内侧,椎前肌前方.同侧颈内动、静脉受压外移.印象:神经源性肿瘤.平扫MRI示肿块于T1 WI呈较均一低信号,在T2 WI呈不均一高信号,其内可见絮状等信号(图2);增强后肿块呈明显不均一强化(图3).印象:副神经节瘤.     

咽旁间隙解剖及病变的CT和MRI表现

咽旁间隙(parapharyngeal space)是位于咽外侧上颈深部的潜在性漏斗形间隙,位置较深,结构复杂,许多病变好发生于此或者累及此间隙。了解此间隙的解剖结构、毗邻及病变的影像学特点,对咽旁间隙病变的临床治疗或治疗方案的制订及对预后的评价具有重要意义。近几十年来,许多临床及科研工作者对此间隙的解剖与涉及的病变进行了大量研究,本文旨在对此间隙的解剖结构及病变的影像学进行综述。1咽旁间隙的大体解剖咽旁间隙位于咽肌环和咀嚼肌群之间,呈倒立的三菱锥形,底朝向颅底并紧靠颈静脉孔,尖朝向舌骨大角,外侧壁为翼内肌及腮腺深部,内侧壁为咽…     

磁共振常规序列在原发性肝癌高强度聚集超声疗效评估中的价值

目的探讨MR常规序列在原发性肝癌高强度聚集超声(HIFU)治疗后疗效评估中的价值。资料与方法采用1.5 T超导型MR成像系统及8通道体部相控阵线圈对75例原发性肝癌在HIFU治疗前、治疗后2周及3个月行MR常规平扫及动态增强扫描。扫描序列包括快速恢复快速自旋回波(FRFSE)序列横轴位T2WI;快速扰相梯度回波(FSPGR)序列结合饱和压脂技术横轴位T1WI;FSPGR序列横轴位双回波;冠状位稳态采集快速成像(FI-ESTA)以及肝脏快速容积采集(LAVA)序列行动态增强扫描。观察病灶HIFU治疗前后信号、大小、范围变化及强化特征,以此判断肿瘤坏死、残存或复发等情况。结果 79个(98.75%)病灶在HIFU治疗后2周内T2WI信号降低。1个(1.25%)病灶T2WI上病灶内部或周边仍可见结节状高信号。3个月后复查MRI,78个(97.5%)病灶T2WI信号无明显变化;2个(2.5%)病灶内部或周边出现不规则结节状高信号。在T2WI上,HIFU治疗后2周内原发肝癌病灶大小与治疗前比较无明显变化(t=-1.90,P>0.05);HIFU治疗后3个月,70个(87.5%)病灶大小与治疗后2周内比较无明显变化,8个...     

颈深筋膜间隙的薄层断面解剖与MRI、CT对照研究

目的：为颈深筋膜间隙疾病的影像识别与诊断提供断层解剖学依据。方法：利用低温冰冻技术，将15例成年男性尸体头颈制成厚度为3mm的连续横断面标本，并与相应层面的MRI、CT对照，观察颈深筋膜间隙。结果：颈部MRI轴位图像上可清楚显示颈深筋膜各间隙的形态和毗邻关系，并提出颈深部间隙的几个最佳显示平面。结论：颈深部疾病影像检查应首选MRI；影像诊断中，咽旁间隙是关键性结构，根据其位置的改变，可对颈深部疾病进行定位诊断。     

MR studies of extension and spread pattern of nasopharyngeal carcinoma

Seven patients with T2-T4 nasopharyngeal carcinoma were examined by MRI on a 0.5T superconducting system. The obtained MRI images were reviewed focusing on the signal intensity (SI) of tumors, and the extension of tumors into the related spaces from the pharyngeal mucosal space (PMS). Consequently, the SI of tumors demonstrated low on T1 weighted images and high on T2 weighted images. The parapharyngeal space was the first space where the tumors extended from the pharyngeal mucosa. The parapharyngeal space was an intermediate point of extension to the masticator space (MS), the carotid space (CS), the retropharyngeal space (RPS), and the prevertebral space (PVS). The PVS involvement by tumors was not a direct extension from the PMS, because the posterior portion of pharyngobasilar fascia worked as a barrier on MR. Therefore, the longus capitus muscle in the prevertebral space was considered to be involved via the parapharyngeal space (PPS). The masticator space involvement was indicated by slightly high SI of pterygoid muscle on T2 weighted images, and also the effacement of the PPS fat and parapharyngeal venous plexus were considered as a sign of involvement into the masticator space. The retropharyngeal lateral lymph node (Rouviere) metastases were recognized by MR. These metastasized lymph nodes were low on T1 weighted images and high on T2 weighted images.     

Infrahyoid spread of deep neck abscess: anatomical consideration

The aim of this study was to determine the pathway of infrahyoid extension of the oropharyngeal abscess considering the anatomy of the fascial spaces by cross-sectional imaging. CT scans and MR images were retrospectively reviewed in ten patients with known infrahyoid extension of oropharyngeal abscesses (eight with acute tonsillitis, two with acute phlegmonous oropharyngitis). In seven of eight patients tonsillar abscesses descended along the deep cervical fascia converging on the hyoid bone and further accumulated in the anterior cervical space through which extension to the mediastinum took place in four patients. In seven patients the abscesses involved the retropharyngeal space at the infrahyoid neck. In two of these seven patients the abscesses directly extended down into the upper mediastinum through the retropharyngeal space. In one patients of the seven mediastinal spread of an abscess occurred through the posterior cervical space, not through the retropharyngeal space. Cross-sectional imaging is valuable in the evaluation of deep neck abscesses and the pathway of spread. The anterior cervical space in the infrahyoid neck is important for mediastinal extension of pharyngeal abscesses. Received: 10 April 1997; Revision received 23 October 1997; Accepted 12 January 1998     

急性硬脊膜外血肿的MRI研究

目的 探讨急性硬脊膜外血肿(ASEH)的发病机制、MRI表现特征及鉴别诊断。方法 15例ASEH病人，男8例，女7例，平均37．8岁。5例有脊柱损伤史，1例有脊柱手术史，1例有腰硬脊膜穿刺史，其余8例无特殊病史。11例经手术证实，2例经CT引导穿刺抽吸治疗并证实，2例经临床相应检查及随访证实。所有病人均行矢状面SE T1WI和快速SE(FSE)或SE T2WI。12例行横轴面FSE T2WI，8例行SE T1WI。4例行SE T1WI增强扫描。结果 15例血肿共发生于18个脊柱节段，其中6例次(6／18)位于颈段、9例次(9／18)位于胸段、3例次(3／18)位于腰段。7例次(7／18)血肿位于硬膜囊前方，11例次(11／18)位于硬膜囊后方。血肿累及1～13个椎体高度，平均4．87个椎体高度。T1WI上，所有血肿与脊髓之间均显示有线样低信号区。T2WI矢状面和横轴面上，分别有4例(4／15)和8例(8／12)在血肿与蛛网膜下腔之间显示有低信号线。矢状面上13例(13／15)血肿呈长梭形，横轴面上均呈双凸镜形或半圆形。SE T1WI上，5例呈等T1信号，6例呈短T1信号，4例呈等、短T1混杂信号；T2WI上，5例呈短T2信号，10例呈短、长T2混杂信号。4例增强扫描无特异性。结论 ASEH的MRI表现具有特征性，可为诊断及鉴别诊断提供依据。     

Syncope as a sign of occult malignant recurrence in the retropharyngeal and parapharyngeal space: CT and MR imaging findings in four cases

Although rare, syncope may result from metastasis to the retropharyngeal or parapharyngeal space and involve or invade the glossopharyngeal nerve or internal carotid artery. We report the CT and MR imaging findings in four patients with syncope that preceded the diagnosis of recurrent squamous cell carcinoma in the pericarotid region. These findings suggest that recurrent carcinoma should be ruled out when a patient with head and neck malignancy and syncope is postoperatively examined.     

腮腺及其周围间隙MRI解剖标志对肿瘤定位的价值

目的评价腮腺及其周围间隙ＭＲＩ解剖标志对肿瘤定位的价值。方法１１０例累及腮腺及其周围间隙的肿瘤均行ＳＥ序列检查，１０７例经手术和病理证实，３例颈动脉体瘤经血管造影证实。用Ｔ１加权作为观察ＭＲＩ解剖标志的主要方法。结果翼内肌、咽旁间隙、颈内动脉和颈内静脉移位方向可作为嚼肌间隙、咽旁间隙、颈动脉间隙肿瘤的定位标志；腮腺深部与肿瘤之间有无脂肪平面是鉴别腮腺深部内外肿瘤的较可靠方法；腮腺内面神经及其主导管和下颌后静脉等经路上的解剖标志对肿瘤深、浅部定位的正确率为９４．９％；跨间隙生长的肿瘤均为恶性。结论腮腺及其周围间隙内的ＭＲＩ解剖定位标志对判断肿瘤的来源及手术计划的制定具有重要价值     

屈颈MRI对青年性上肢远端肌萎缩症的诊断价值

目的评价屈颈MRI对青年性上肢远端肌萎缩症的诊断价值。方法男性患者5例，平均年龄21岁，临床表现为一侧或两侧上肢远端肌萎缩。对照组为健康志愿者，21岁男性8例。2组均行常规及屈颈颈椎MR平扫，矢状、轴面SET1WI、T2WI、液体衰减反转恢复（FLAIR）序列扫描。结果常规颈椎扫描：5例患者下段颈髓变细；屈颈位MR扫描：下颈段颈6以下脊髓前屈、变扁平，矢状径4～6mm，硬膜囊后壁前移，硬膜后间隙明显增宽，可见多发条状、迂曲流空信号影及软组织信号。对照组：常规扫描，下颈段脊髓（颈6～胸2）可见颈膨大，屈颈位脊髓略变细（6～7mm），硬膜囊后壁无前移，硬膜后间隙未见扩张血管影。结论屈颈MRI有助于显示下颈段脊髓及硬膜囊改变，结合临床资料可准确诊断青年性上肢远端肌萎缩症。     

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。     

MRI of ranulas

We reviewed the MRI of 20 patients with a ranula (8 simple and 12 plunging) and ten with other cystic masses in the floor of the mouth and/ or suprahyoid portion of the neck (three haemangiomas, two neuromas, one monomorphic adenoma, one lipoma, two lateral cervical cysts and one dermoid cyst). Histological diagnoses were obtained in all cases with the exception of one presumed haemangioma. Ranulas were all well-defined, homogeneous masses giving low signal on T1-and markedly high signal on T2-weighted images. While simple ranulas were all confined to the sublingual space, plunging ranulas were centered on the submandibular space and tended to spill into one or more adjacent spaces. They extended into the sublingual space anteriorly (producung a so-called tail sign) in eight of 12 cases and into the parapharyngeal space superiorly in five. Although they sometimes filled a considerable part of the parapharyngeal space, displacement of surrounding muscles or vessels was usually slight, which was thought to reflect the nature of extravasation pseudocysts. All other cystic masses in our study had one or more MRI finding different from those of ranulas and could be easily differentiated from them. Received: 13 December 1999/Accepted: 3 April 2000