眼眶炎性假瘤的CT诊断及鉴别诊断(附58例报告)

目的　探讨不同类型眼眶炎性假瘤的CT表现 ,以提高对该病诊断和鉴别诊断的水平。方法　回顾性分析 58例经临床或手术病理证实的眼眶炎性假瘤的CT资料。结果　 58例眼眶炎性假瘤按影像学表现分为 5种类型 :肿块型 ,占 8.6% (5/ 58) ,CT表现为眶内软组织肿块 ;弥漫型 ,占 8.6% (5/ 58) ,CT表现为球后脂肪间隙密度增高 ,无明显肿块 ;肌炎型 ,占 3 7.9% (2 2 /58) ,CT表现为眼外肌受累增粗 ,肌腱肥大 ;泪腺型 ,占 10 .3 % (6/ 58) ,CT表现为泪腺肿大 ;混合型 ,占 3 4 .5% (2 0 / 58) ,CT表现为肿块邻近的眼外肌增粗 ,增粗的眼外肌周围脂肪间隙密度增高 ,肿大的泪腺相邻外直肌增粗等。伴发不同程度的鼻副窦炎症占眼眶炎性假瘤的 3 7.9% (2 2 / 58) ,CT显示上颌窦和 /或筛窦炎症改变。结论　CT在眼眶炎性假瘤的诊断和鉴别诊断中具有重要作用。     

CT、MRI在眼眶炎性假瘤的诊断价值

目的:探讨CT和MRI对眼眶炎性假瘤的诊断和鉴别诊断价值。方法:回顾性分析经临床、病理证实的63例眼眶炎性假瘤的影像学表现。结果:根据病变累及部位及形态学表现分为:①隔前型2例,表现为眼睑肿胀;②巩膜周围炎型1例,表现为眼球壁增厚;③视神经束膜炎型3例,表现为视神经增粗;④弥漫型10例,病变可同时累及眶隔前组织、眼肌、视神经、眼环、泪腺、眶内脂肪或眶周组织;⑤肿块型12例,表现为边界清楚的肿块;⑥泪腺炎型9例,表现为泪腺肿大;⑦肌炎型26例,表现为1条或数条眼外肌增粗、肥大。结论:CT和MRI能对眼眶炎性假瘤确切定位及分型,为临床治疗方案提供重要依据,二者的结合极大地提高了眼眶炎性假瘤的正确诊断率。     

眼眶内炎性病变的CT分析

目的：提高对眼眶内炎性病变CT表现的认识.方法：29例眼眶内炎性病变均行眼眶CT扫描,比较分析炎性病变的CT影像表现.结果：炎性假瘤22例,肿块游离缘锐利,其中9例累及泪腺,7例绕眼球生长,2例表现为眶尖部视神经及眼外肌增粗,4例主要表现为眼肌弥漫性增粗;肉芽肿性炎症4例,在眶内呈铸形生长;慢性泪囊炎1例表现为内眦部泪囊区囊性肿块;慢性泪囊周围炎1例表现为内眦部泪囊区中央可见液性密度的小肿物;蜂窝织炎1例表现为右侧眶内眼球外侧密度增高,边缘模糊不清.结论：眼眶内炎性病变CT表现有一定特征性可做出初步诊断.     

眼眶炎性假瘤的CT分析

目的：提高眼眶炎性假瘤ＣＴ诊断的正确性。材料和方法：分析本院１９８４－１９９５年经病理或治疗（抗菌素和激素）证实的５０例眼眶炎性假瘤的资料。结果：显示眼眶炎性假瘤的ＣＴ表现多种多样，但在部位、形态和密度等方面仍有一定的特征。结论：ＣＴ检查对诊断眼眶炎性假瘤有重要价值。     

常规头颅CT对眼眶内侧壁骨折的诊断价值分析

目的评价常规头颅CT对眼眶内侧壁骨折的诊断价值。方法对40例常规头颅CT可疑眼眶内侧壁骨折者行眼眶CT扫描。结果40例中35例在眼眶CT上确诊为眼眶内侧壁骨折,常规头颅CT显示的眼眶内侧壁骨折征象包括:眼眶内侧壁内陷、内直肌增粗、筛窦密度增高及眶内积气。结论常规头颅CT可以作为眼眶内侧壁骨折诊断或筛查手段。     

眼眶炎性假瘤的CT诊断

总结分析眼眶炎性假瘤的ＣＴ表现,并眼眶假瘤的ＣＴ分型进行探讨,材料与方法,回顾性分我院１０年间资料完整的眼眶假瘤４６例。结果沔泉炎型１５例。７例双侧泪腺增大,８例单侧增大,密度均匀,边界清楚,前部假瘤５例,位于眼球后方,与眼球紧贴边缘不清楚,密度不均,２例伴眼外肌增粗,１例视网膜脱落     

肺孤立性结节薄层动态螺旋CT扫描与病理研究

目的　探讨薄层动态螺旋CT扫描对孤立性肺结节 (SPN)的诊断与鉴别诊断价值。方法　对 3 8例SPN先行薄层平扫 ,再注入优维显 10 0ml ,延迟 3 0s、1min、2min、5min、10min及 15min薄层动态扫描。结果　肺癌、炎性假瘤强化程度明显高于结核与错构瘤 ,以 2 0HU为CT差阈值 ,敏感性为 10 0 % ,特异性为 96% ;肺癌强化峰值约为 2min ,炎性假瘤约为 5min ;炎性假瘤强化持续时间较肺癌长 ;结核与错构瘤均无明显强化 ,但部分结核有典型环形强化。薄层扫描能更多地发现有鉴别诊断意义的征象 ,对CT值的测量更准确。结论　薄层动态螺旋CT扫描对SPN有重要诊断与鉴别诊断价值     

肝脏炎性假瘤的CT表现及鉴别诊断

目的:探讨肝脏炎性假瘤的CT表现和诊断价值.材料和方法:回顾性分析经病理证实的肝脏炎性假瘤19例之CT表现.结果:17例单发病灶,2例多发病灶.19个病灶呈低密度,2个病灶呈等密度;增强扫描动脉期无明显增强,门脉期、延迟期病灶为边缘增强、间隔增强及中心或壁结节增强.结论:大部分炎性假瘤CT三期动态扫描能够正确诊断.     

眼眶神经纤维瘤病的CT表现

目的:探讨眼眶CT扫描诊断神经纤维瘤病 I 型(NF1)的应用.材料和方法:回顾性分析17例具有完整临床资料的NF1眼眶CT征象,全部病例均经手术病理和/或临床证实.结果:NF1眼眶CT的主要表现为:上睑肥厚,眶周及颞、颧部丛状神经纤维瘤;蝶骨发育不良,蝶骨大小翼或额骨眶板缺失;颅眶骨畸形,眶腔不对称性扩大,眶上、下裂及视神经孔扩大;眼球突出,体积增大;眶内软组织肿块;泪腺肿大,眼外肌肥厚,视神经增粗.结论:眼眶CT扫描对NF1病变侵犯范围、能否手术和手术方式选择具有重要的应用价值.     

IgG4相关眼病的影像诊断

目的 探讨IgG4相关眼病的影像诊断.方法 回顾性分析经病理形态学及免疫组化诊断的19例IgG4相关眼病患者的CT及MRI表现.结果 19例患者CT/MRI表现为眼眶组织受累,19例均累及泪腺,多为双侧泪腺对称性弥漫性肿大.5例眶上、下神经增粗,6例眼外肌增粗,少数病例涎腺、眶下裂、翼腭窝受累,1例合并眼眶淋巴瘤.MRI信号为T1WI等T1或稍长T1信号,T2WI等T2或稍长T2信号,增强扫描明显均匀强化.CT病变呈等密度,增强扫描明显均匀强化.结论 IgG4相关眼病CT及MR检查能准确地显示眼部病变部位、数目、形态.     

CT characteristics of orbital pseudotumors and other orbital inflammatory processes

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that may mimic a true orbital neoplasm, specifically lymphoma. It exhibits a highly variable clinical and radiographic presentation. Thirty-nine patients with a presumptive diagnosis of orbital inflammatory disease were examined with CT and evaluated with respect to 13 findings associated with inflammatory disease of the orbit. Pseudotumor was included as part of the differential diagnosis in 25 patients. Twenty-one cases received a final (clinical) diagnosis of pseudotumor. The remainder were comprised of a broad range of orbital inflammatory conditions. Key radiographic features required to entertain or exclude the diagnosis of pseudotumor included establishing the presence of an orbital mass, extraocular muscle enlargement, bony erosion, enhancement, and associated paranasal sinus disease.     

Invasive orbital pseudotumor — CT demonstration of extension beyond orbit

Summary Two cases of orbital pseudotumor are described with computed tomographic (CT) studies showing extension of the pseudotumor beyond the confines of the bony orbit. In one patient with orbital pseudotumor involving the medial rectus muscle, the pseudotumor extended through the medial wall of the orbit into the ethmoid sinus. A second patient had extension of orbital pseudotumor into the infraorbital fissure causing enlargement of the infraorbital fissure and foramen. Both lesions were confirmed by biopsy.     

单眼突出的CT诊断

目的：回顾性分析47例单眼突出病变的CT表现作了以期提高对单眼突出病变的诊断认识。方法：经手术,病理或其他方法证实的47例单眼突出病例,男34例,女13例,均行轴位CT扫描,其中34例作了增强扫描,9例增加冠状扫描,采用Somatom CRF机,层厚和层距均为4mm,结果：球外眶内病变28例,眶壁／眶周病变19例,其中肿瘤20例,炎症15例,血管性病变4例,其它8例,眶炎性假瘤表现为眶内局限性或弥漫性肿块,泪腺肿大,伴有眼环增厚,眼肌增粗,其它眶内肿瘤表现为眶内软组织肿块,病灶发现率为100％,结论：CT对大部分单眼突出病因可以确诊。     

Surface-coil MR of orbital pseudotumor

Fifteen patients with clinical presentations compatible with idiopathic inflammatory orbital pseudotumor were examined by CT and MR imaging to determine if MR could add specificity to the CT appearance of this entity. MR was performed on a 1.5 T system, using surface-coil and head-coil techniques. Idiopathic pseudotumor was confirmed in nine patients on the basis of response to steroid therapy in the absence of local cause or systemic illness. One other patient had biopsy-proven idiopathic pseudotumor. Five patients proved to have other orbital entities, including metastases, infectious myositis, hemorrhage, and orbital sarcoid. In all 10 patients with confirmed pseudotumor, CT and MR were abnormal. MR abnormalities in 10 of 10 patients with pseudotumor were hypointense to fat and isointense to muscle on T1-weighted images. On T2-weighted images the lesions of pseudotumor were isointense or only minimally hyperintense to fat in nine of 10 cases; in one case, the enlarged muscle was markedly hyperintense to fat. The MR signal intensity of pseudotumor was similar to that found in infectious myositis and sarcoid. These findings contrasted to the MR appearance of the other disease entities examined. Metastases appeared markedly hyperintense to fat on T2-weighted images, while hematoma was hyperintense to muscle and isointense to fat on T1-weighted images and markedly hyperintense to fat on T2-weighted images. In our preliminary series, surface-coil MR appears to add specificity to the CT appearance of orbital pseudotumor.     

颈动脉海绵窦瘘的临床及MSCT表现特征

目的:分析颈动脉海绵窦瘘(CCF)的临床及MSCT表现特征,提高对CCF的诊断准确率。材料和方法:采用16层螺旋CT对13例CCF病人进行扫描,图像后处理分别行MPR、MIP及VR成像,其中10例外伤性CCF还采用骨窗重建。结果:CCF的主要临床表现为眼球突出、视力减退、结膜充血、血管杂音等,MSCT的直接征象为海绵窦扩大13例(100%),眼上静脉扩张13例(100%),瘘口显示6例(46.2%),大脑中、浅静脉早显8例(61.5%)。间接征象为眼突、眼肌肥厚、眶内软组织肿胀、颅面部骨折等。MSCT检查结合临床病史可以对外伤性CCF作出准确的诊断,自发性CCF临床表现不典型,需与炎性假瘤、眼眶肿瘤、Craves眼病、血管畸形等眼部疾病进行鉴别诊断,本组采用MSCT对CCF的诊断准确率为100%。结论:MSCT具有安全、快速、准确的检查优势,多种成像技术结合使用,能清楚显示CCF的直接征象和间接征象,为临床及介入治疗提供可靠的诊断依据。     

眼眶炎性假瘤的CT诊断和鉴别诊断(附40例分析)

目的：旨在描述炎性假瘤的ＣＴ表现,提高对本病诊断和鉴别诊断水平。方法：分析４０例经手术病理或临床证实的炎性假瘤ＣＴ资料。结果：４０ 例炎性假瘤有５９个区域被累及按主要受累部位分四型：眼肌型、泪腺型、球后型、混合型。炎性假瘤ＣＴ特征性表现为：（１）眼肌肥大为眼肌全程肥大（包括眼肌前部肌腱处）;（２）眼球后脂肪、眶内标志完全消失。结论：具典型ＣＴ表现,炎性假瘤诊断不难;缺乏典型ＣＴ表现,需结合临床、有时需做病理活组织检查才能诊断,并且需与其它病变相鉴别。     

肺部孤立球形病变的X线、CT对比研究

目的探讨肺部孤立球形病变的X线、CT表现差异,提高对肺部孤立球形病变的正确诊断率。方法手术及病理证实的肺部孤立球形病变51例,其中周围型肺癌26例,炎性假瘤14例,结核球11例,全部病例均摄取胸部正侧位片及CT片。结果（1）征象特点小泡征、胸膜凹陷征、阻塞性肺炎仅见于周围型肺癌;小于3cm薄壁空洞为周围型肺癌的少见征象之一;炎性假瘤、结核球可出现不规则厚壁偏心空洞;棘状突起除周围型肺癌多见外,炎性病变亦可出现;支气管充气征、长毛刺、胸膜尾征炎性假瘤出现率高;钙化、胸膜肥厚结核球多见。（2）X线、CT表现差异肿块密度、分叶、棘状突起、纵隔淋巴结肿大的观察CT优于胸片,病灶形态、边缘的显示胸片较CT优越。（3）CT对周围型肺癌、炎性假瘤、结核球定性诊断的准确性优于X线（Ρ＜0.05）。结论认识肺部孤立球形病变的征象差异并合理选用X线、CT检查,有助于提高肺部孤立球形病变的正确诊断率。