成人颞骨先天性胆脂瘤的CT和MRI表现

目的探讨成人颞骨先天性胆脂瘤的CT和MRI表现。方法回顾性分析2001年2月~2015年7月,经过病理证实的4例成人颞骨先天性胆脂瘤的临床及CT、MRI影像资料。结果 4例成人颞骨先天性胆脂瘤中,单纯高分辨率CT平扫检查2例,高分辨率CT和MRI平扫检查2例,MRI增强检查2例。病变单纯位于鼓室2例,CT平扫表现为鼓室内类圆形软组织密度影;病变同时累及鼓室、鼓窦及乳突2例,CT平扫表现为鼓室、鼓窦及乳突片状软组织密度影,周围岩骨膨胀性破坏,2例听小骨、半规管、面神经管鼓室段及迷路段侵蚀破坏,1例耳蜗、前庭、内听道及乙状窦前壁破坏。MRI扫描表现为鼓室、鼓窦及乳突片状等T_1长T_2异常信号,周围岩骨膨胀性破坏,DWI表现为环状高信号,增强未见明显强化。结论成人颞骨先天性胆脂瘤的CT和MRI表现具有一定的影像特征,结合临床病史可减少误诊。     

胆脂瘤型中耳炎对面神经管破坏的高分辨率CT评价

目的 探讨HRCT及图像后处理技术对胆脂瘤型中耳炎继发面神经管破坏的诊断价值.方法 对80例胆脂瘤型中耳炎患者进行颞骨轴位HRCT扫描,利用多平面重建(MPR)、双斜位MPR及曲面重建(CPR)技术进行面神经管重建.结果 71例患者为单侧胆脂瘤,9例为双侧胆脂瘤(共89耳).64耳发现面神经管骨质破坏,表现面神经管壁骨质模糊、缺损,以鼓室段最多见,占73.44%(47/64),Austin Ⅲ～Ⅳ度胆脂瘤累及面神经管的比例占87.5%(56/64),其中13耳为多节段破坏.手术发现39耳面神经管骨质缺损,破坏范围>5 mm占82.05%(32/39).结论 HRCT扫描及图像后处理技术能准确诊断中耳胆脂瘤继发的面神经管破坏,对临床手术有重要指导意义.     

颞骨段-鼓室内面神经鞘瘤误诊1例分析

颞骨段-鼓室内面神经鞘瘤极为少见,临床首发症状多为面瘫,早期诊断困难,易误诊为贝尔面瘫或者听神经瘤.影像学上和颈静脉球瘤的鼓室型、胆脂瘤型中耳炎鉴别困难;当肿瘤破坏岩骨后壁侵入脑桥小脑角池后,和岩骨后壁硬膜起源的脑膜瘤,及小脑脑桥角(CPA)脉络膜起源的脉络丛乳头状瘤也难以鉴别,确诊多依靠手术和病理证实.笔者曾遇见1例,临床误诊为胆脂瘤型中耳炎或鼓室型颈静脉球瘤,现结合文献复习报道如下.     

面神经鞘黏液瘤1例

该文报道了1例面神经神经鞘黏液瘤。CT显示左侧颞骨乳突部及面神经管乳突段骨质破坏。MRI平扫显示左侧颞骨乳突部及中耳腔软组织肿物, T1WI呈不均匀稍低信号, T2WI和DWI呈稍高信号, ADC图为高信号, 增强扫描呈环形明显强化, 延迟期强化, 对比剂有向内填充的趋势。     

MSCT的MPR矢状位重建对慢性化脓性中耳炎的临床应用价值

目的探讨MSCT的MPR矢状位重建对慢性化脓性中耳炎的临床手术应用价值。方法对61例76耳慢性化脓性中耳炎行MSCT检查,在轴位HRCT及矢状位MPR图像上观察中耳结构及病变显示情况并与手术结果进行对照。结果矢状面MPR图像可良好显示颞骨结构及其周围结构的毗邻关系,对面神经鼓室段及垂直段、乙状窦板及颈静脉球等结构显示尤佳。在MPR矢状位重建图像上38耳中耳炎可见中耳骨壁及听骨链的“人”字形结构有不同程度的破坏。16耳(肉芽肿型5耳,胆脂瘤型11耳)面神经管破坏鼓室段12耳,乳突段4耳,其中3耳胆脂瘤型的面神经管鼓室段和乳突段均有骨质破坏;骨性半规管受累伴骨质破坏12耳;解剖变异有乙状窦前置8耳,乙状窦的前壁至外耳道后壁的最短距离约0.4～0.8cm,平均0.6cm;2例高位颈静脉球;均得到手术证实。结论矢状位MPR图像对慢性中耳炎累及面神经骨管损伤程度、位置及与周围位置的毗邻关系的显示具有重要的临床应用价值。     

面神经管病变的多层螺旋CT评价

目的:分析面神经管病变CT表现,评价多层螺旋CT的临床价值。方法:回顾性分析面神经管病变患者35例CT资料,男24例,女11例,年龄4～51岁,平均27岁,所有患者均行多层螺旋CT扫描,常规行多平面重建和面神经管曲面重建。结果:面神经管骨折15例,其中鼓室段骨折8例,乳突段骨折5例,迷路段骨折2例;胆脂瘤型中耳炎侵犯面神经管15例;面神经瘤1例,乳突段面神经管前移2例,颞骨骨纤维异常增殖症累及面神经管2例。结论:多层螺旋CT及后处理成像能清晰显示面神经管病变,对临床诊断和治疗有重要价值。     

改良颞骨Stenver位摄影术的探讨

改良颞骨Ｓｔｅｎｖｅｒ位摄影术的探讨于兹喜，朱延好，孙勇，冯树理，崔崔，朱应利Ｓｔｅｎｖｅｒ位是摄取颞骨岩乳部水平展开像的位置，临床上应用此位置检查乳突、外中内耳病变，如乳突炎、胆脂瘤和听神经瘤等，应用频率较高。以前的摄影方法是让病人俯卧于摄影台上，...     

颞骨岩锥先天性胆脂瘤的CT和MRI表现

目的　分析总结颞骨岩锥先天性胆脂瘤的CT和MRI表现 ,评价其临床价值。方法　回顾性总结临床病理证实的颞骨岩锥先天性胆脂瘤 2 7例 ,其中CT检查 2 6例 ,CT平扫 2 2例 ,增强扫描 8例 ;MRI检查 11例 ,2例行增强扫描。结果　先天性胆脂瘤位于左侧 10例 ,右侧 16例 ,双侧 1例。 2 3例CT典型表现为岩锥骨内膨胀性软组织占位 ,破坏内耳周围骨质 ,肿块边缘骨质因受压呈现为薄壳样硬化改变 ;3例不典型表现为岩锥骨边缘毛糙或有骨质局部吸收破坏或缺损。MRI均显示岩锥髓脂肪大部分被软组织病灶侵占 ,T1W为中等或偏低信号 ,T2 W则均为高信号 ,增强后肿块无强化表现 ,肿块部分边缘呈弧线样增强。结论　颞骨岩锥内先天性胆脂瘤CT典型表现为与岩锥骨长轴一致的椭圆形膨胀性、均质低密度占位病变 ,以内耳为中心破坏内耳周围骨质 ,可向周围骨质扩展。MRI典型表现为T1W为中等或偏低信号 ,T2 W则为高信号的软组织 ,侵占内耳膜迷路和岩锥髓脂肪     

颞骨郎格尔汉斯细胞组织细胞增生症的CT及MRI表现

目的 探讨颞骨郎格尔汉斯细胞组织细胞增生症的CT及MRI影像学特点。方法 回顾性分析10例经病理证实的颞骨郎格尔汉斯细胞组织细胞增生症，10例均经过CT检查，其中5例作过MRI检查。结果 5例仅见颞骨病变，其余5例同时累及其他脏器。CT发现10例都累及外耳道和乳突，8例并纱及岩部和鳞部，7例累及中耳、听小骨及内耳骨迷路破坏各2例。CT显示10例颞骨病变区均呈大块溶骨性破坏，轮廓不整，8例边缘清楚无硬化，伴大的软组织肿块，有明显强化；MRI发现5例都累及外耳道和乳突。4例并累及岩部及鳞部。3例累及中耳，1例内耳膜迷路破坏，MRI显示5例颞骨病变在T1WI呈等或低信号，T2WI呈高信号，其中3例呈明显强化。结论 CT可清晰显示颞骨郎格尔汉斯细胞组织细胞增生症的骨质改变，具有重要诊断价值；MRI能清楚显示病变范围，帮助选择最佳治疗方案；2种影像检查方法结合对颞骨郎格尔汉斯细胞组织细胞增生症的诊断、治疗和随访具有重要意义。     

颞骨骨折性面神经瘫痪的手术治疗

目的 探讨颞骨骨折性面瘫的处理方法。方法 对60例颞骨骨折性面瘫患者实行手术治疗。48例行颞下颅中窝径路面神经减压术，8例行乳突耳径路面神经减压术，另4例行颅内外联合径路面神经全段减压术。结果 手术中发现面神经损伤部位位于迷路段及膝状神经节周围者48例，位于水平段8例，4例膝状神经节及水平段均受损伤。以House-Brackmann（H—B）分级法作为疗效评价标准，术后随访1年达到H—B分级Ⅰ级39例，Ⅱ级18例，Ⅲ级2例，Ⅳ级1例。结论 对于颞骨骨折性面瘫的患者，应尽早明确面神经受损的程度及部位．尽早实施手术，并根据术前确定的面神经损伤的部位来决定手术径路。     

Middle ear cholesteatoma extending into the petrous apex: evaluation by CT and MR imaging

CT and MR imaging findings were reviewed in four cases of acquired cholesteatoma of the middle ear that extended medially into the petrous apex and middle cranial fossa. In one case the lesion further extended anteromedially into the sphenoid sinus. CT demonstrated the lesions as nonenhancing hypodense masses with bone destruction, extending medially from the middle ear cavity to the petrous apex region. On MR imaging, the lesion was slightly hypointense relative to brain on T1-weighted images and hyperintense on T2-weighted images. MR imaging clearly delineated the extraaxial location of the lesion and associated brain displacement. The medial extension of the cholesteatomas seems to have proceeded via a detour around the bony labyrinth into the petrous apex region by following normal pathways of temporal bone pneumatization.     

Cholesterol granuloma of the petrous apex: CT diagnosis

Cholesterol granuloma of the petrous apex is a readily recognizable and treatable entity that is more common than previously realized. Cholesterol granuloma grows slowly in the petrous apex as a mass lesion until it produces hearing loss, tinnitus, vertigo, and facial twitching. Twelve cases of cholesterol granuloma of the petrous apex are illustrated; ten of these are analyzed in detail, especially with respect to CT findings. A sharply and smoothly marginated expansile lesion in the petrous apex, isodense with brain and nonenhancing on CT, is in all probability a cholesterol granuloma. Cholesterol granuloma and cholesteatoma of the petrous apex are different lesions and treated differently. Cholesterol granuloma can be treated simply and effectively by drainage and permanent fistulization. Preoperative recognition by CT is important for planning proper treatment.     

跨中后颅窝肿瘤的CT诊断

报告30例跨中后颅窝肿瘤的CT 表现。所有肿瘤都紧邻颅底骨结构。86.6%有颅底骨质破坏,发生的部位为岩尖,斜坡,中颅窝底,鞍旁和内听道。12例瘤周无水肿,18例有轻度水肿。29例肿瘤有清楚边界。肿瘤占位表现为相邻脑组织的受压移位,脑底池变形闭塞,三、四脑室移位及脑积水。本组资料表明,岩尖和相邻的斜坡是跨中后颅窝肿瘤易侵犯的部位,破坏多见。CT 能清楚显示跨中后窝肿瘤的大小、形态和累及范围,定位准确。跨中后颅窝肿瘤多属脑外肿瘤,常见的有脑膜瘤,三叉神经瘤,听神经瘤和胆脂瘤。作者讨论了它们的CT 定性诊断和鉴别。     

Facial nerve neuromas: CT findings

Although neuromas of the facial nerve are rare, they present with uniform clinical and radiological findings. Their pluridirectional tomography findings have been well described; however, the appearance of the intracranial extension of the neuroma which is best visualized by CT has not been emphasized. We report five cases of facial nerve neuromas with particular attention to their intracranial extension. For comparative purposes we also have reviewed 10 cases of acoustic and eight cases of trigeminal neuromas, all involving the cerebellopontine angle (CPA) and the middle cranial fossa. Two of the five facial nerve neuromas affected the second and third segments of the facial canal, and three involved both the CPA and the middle cranial fossa spreading across the midpetrosal bone. This type of tumor extension seems to be characteristic of facial nerve neuromas. In acoustic and trigeminal neuromas the tumor crossing toward the middle fossa takes place via the tentorial hiatus (acoustic) and the petrous apex (trigeminal).     

面神经瘤的CT和MRI诊断(附六例报告)

目的 探讨CT,MRI对面神经瘤的诊断价值,方法 回顾分析了6例经手术病理证实的面神经瘤CT,MRI表现,结果 6例面神经瘤中位于颞内段4例（迷路段1例,鼓室段2例,鼓室段＋乳突段1例）,颅,内脑池段,内听段及颞内段（迷路段＋鼓室段）1例,颞内段（鼓室段＋乳突段＿并颅外肋腺段1例,肿瘤的影像学表现与肿瘤的部位有关,CT影像上,颞内段面神经瘤显示受累段面神经管扩大,破坏;中耳腔和（或）乳突软组织肿块及膝状神经窝区内质破坏,如肿瘤扩展到中颅窝或肋腺也可一并显示,1例起源于内听道,桥脑小脑角区的面神经瘤,CT,MRI清楚地显示了桥脑小脑角区肿块,内听道扩大,迷路段面神经管扩大,以及扩展到膝状神经窝区的病灶。结论 CT和MRI能准确地描绘面神经瘤的受累情况,CT在显示骨破坏细节方面极佳,而增强MRI对肿瘤本身的显示优于CT。     

颞骨内面神经病变的影像学表现

目的总结分析面神经病变的影像学检查方法和表现,提高诊断准确性。资料与方法回顾性分析31例经手术病理或临床跟踪随访证实的面神经病变的CT和MRI表现,31例行MR扫描,其中28例行平扫和增强扫描,3例仅行平扫;19例行CT扫描。结果（1）面神经损伤13例,8例行CT扫描,6例显示面神经管骨折,2例表现正常;13例MRI扫描均表现为面神经增粗,其中10例增强扫描显示面神经明显强化。（2）面神经炎14例,7例行CT扫描,1例因岩尖胆脂瘤致面神经管迷路段、前膝部、鼓室段前部骨质破坏,6例面神经管未见异常;14例MRI增强扫描显示面神经节段性异常强化。（3）面神经鞘瘤4例,CT表现为受累面神经管骨质破坏和软组织肿块;MRI表现为面神经节段性增粗,呈长T1、长T2信号,信号不均匀,增强后不均匀强化。经统计学处理,MRI显示颞骨内面神经病变明显优于CT（P＜0．01）。结论HRCT可显示面神经管的异常,MRI尤其是MR增强扫描可显示面神经病变的形态、部位、范围及强化表现,有助于病变的诊断和鉴别诊断。     

The bony crescent sign--a new sign of facial nerve schwannoma.

Schwannomas of the facial nerve are rare slowly growing lesions that have a predilection for the geniculate ganglion. Radiological evaluation is important in their diagnosis and in the assessment of their extent. In our series of 4 cases the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed sign of facial nerve schwannoma which appears on the basis of this small series to be strongly indicative of the presence of this tumour. Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate CT scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. Lesions occurring in the petrous area are all rare. The differential diagnosis includes cholesterol granuloma, epidermoid, carotid aneurysm and, very rarely, primary and secondary bone tumours. We describe a new sign associated with facial nerve schwannoma on CT, that of a bony crescent. Recognition of this sign makes those tumours arising in the region of the geniculate ganglion easy to diagnose prospectively.     

Cholesterol granuloma in the middle cranial fossa: report of two cases

We report two cases of cholesterol granuloma in the middle cranial fossa. On CT the lesions appeared as a nonspecific, nonenhancing soft-tissue mass with bone erosion. On MRI they were seen as areas of high signal intensity surrounded by a low-intensity peripheral zone on both T1- and T2-weighted images. Cholesterol granuloma is thought to occur when pneumatised cellsin the temporal bone become obstructed. Although this lesion usually occurs in the petrous bone, it can extend to the middle cranial fossa. The diagnosis and surgical management are discussed.     

External auditory canal cholesteatoma: clinical and imaging spectrum

BACKGROUND AND PURPOSE: Cholesteatoma is an inflammatory lesion of the temporal bone that uncommonly involves the external auditory canal (EAC). In this large case series, we aimed to define its imaging features and to determine the characteristics most important to its clinical management. METHODS: Thirteen cases of EAC cholesteatoma (EACC) were retrospectively reviewed. Clinical data were reviewed for the history, presentation, and physical examination findings. High-resolution temporal bone CT scans were examined for a soft-tissue mass in the EAC, erosion of adjacent bone, and bone fragments in the mass. The middle ear cavity, mastoid, facial nerve canal, and tegmen tympani were evaluated for involvement. RESULTS: Patients presented with otorrhea, otalgia, or hearing loss. Eight cases were spontaneous, and five were postsurgical or post-traumatic. CT imaging in all 13 cases showed a soft-tissue mass with adjacent bone erosion. Intramural bone fragments were identified in seven cases. This mass most often arose inferiorly (n = 8) or posteriorly (n = 8), but it was circumferential in two cases. We noted middle ear extension (n = 5), mastoid involvement (n = 4), facial canal erosion (n = 2), and tegmen tympani dehiscence (n = 1). CONCLUSION: Temporal bone CT shows EACC as a soft-tissue mass within the EAC, with adjacent bone erosion. Bone fragments may be present within the mass. The cholesteatoma may extend into the mastoid or middle ear, or it may involve the facial nerve canal or tegmen tympani. Recognition of this entity and its possible extension is important because it may influence clinical management.     

Epidermoidomas of the cerebellopontine angle and temporal bone: CT and MR aspects

Epidermoidomas were found in four locations within and adjacent to the temporal bone: cerebellopontine angle, petrous apex, facial geniculate ganglion region, and tympanic-mastoid cavity. Lesions in each of these locations presented different clinical and imaging characteristics. Cerebellopontine angle epidermoidomas were seen on computed tomography (CT) as low-attenuation masses in the posterior fossa. Petrous apex and geniculate ganglion region lesions destroyed and expanded the bone of their respective regions. Tympanic-mastoid cavity epidermoidomas were relatively nonspecific, soft-tissue masses. CT study of the brain and temporal bone was the single most informative imaging procedure in the preoperative evaluation of these lesions. Magnetic resonance images complemented CT scans for evaluation of the size and extent of the abnormality but were relatively nonspecific and did not allow preoperative differentiation of epidermoidomas from other temporal bone lesions.