23例颞下颌关节弥漫性腱鞘巨细胞瘤的CT和MRI特征分析

目的 分析发生于颞下颌关节（temporomandibular joint,TMJ）区的弥漫性腱鞘巨细胞瘤（diffuse tenosynovial giant cell tumor,D-TSGCT）的临床资料和影像学表现,以提高该疾病的诊断准确性。方法 回顾分析2015年11月-2018年5月上海交通大学医学院附属第九人民医院经手术病理证实的23例TMJ区D-TSGCT病例的临床病史和CT、MRI图像。结果 23例患者的临床症状主要为耳前区肿块伴肿胀、疼痛。颌面部CT示TMJ区肿块,平均CT值（72±20.49）HU,增强平均值（125.3±22.68）HU;9例（39.1%）肿块内出现不规则或类圆形相对低密度灶,增强后无强化;14例（60.1%）肿块内出现钙化灶;16例（69.6%）出现TMJ关节间隙增宽;14例（60.1%）出现髁突骨质破坏;17例（73.9%）出现关节窝骨质破坏;6例（26.1%）出现中耳鼓室壁破坏。颌面部MRI示6例（66.7%）肿块T1WI呈等低混杂信号、T2WI呈高低混杂信号;2例（22.2%）肿块T1WI、T2WI均呈低信号;1例（11.1%）肿块T1WI呈等信号,T2WI呈低信号;5例（55.6%）肿块内出现囊性变。结论 TMJ区的D-TSGCT主要临床症状为耳前区肿块伴疼痛。影像学特征为TMJ区肿块,CT平扫密度高,增强后强化明显,可有钙化,多伴有髁突、鼓室壁、关节窝骨质破坏。T2WI示肿块内特征性低信号,可出现囊性变。联合运用增强CT与MRI检查能明显提高TMJ区D-TSGCT的诊断准确性。     

颌骨骨促结缔组织增生性纤维瘤的影像学特点和鉴别诊断

目的:探讨颌骨骨促结缔组织增生性纤维瘤的影像学征象,以提高对其诊断和鉴别诊断的准确性。方法:回顾分析8例颌骨骨促结缔组织增生性纤维瘤患者的影像学资料,其中男3例,女5例;年龄2～70岁(平均28岁);2例为上颌骨,6例为下颌骨。8例中4例有局部复发,复发的平均年限为1a。无远处转移。结果:X线平片上,病灶长轴沿上、下颌骨的长轴走向,呈现偏心性或中心性生长。骨质破坏呈膨胀性、溶骨性,肿瘤骨与正常骨之间的过渡带较窄,无明显的骨质反应线(除1例复发的小病灶外)。骨皮质膨胀变薄,无骨膜反应。病灶内部可有分房或切迹。CT像上,髓腔密度增高,正常骨小梁被软组织密度肿块所取代,软组织肿块基本均匀,病变突破骨皮质,侵犯周围组织形成肿块,肿块内无钙化和骨化。MRI上,T1WI为均匀等信号,T2WI为不均匀的高信号;增强后病灶无明显强化。波谱见胆碱波。下颌骨病变发生于下颌角、后牙区、下颌支,上颌骨发生于后牙和上颌结节区。结论:了解骨促结缔组织增生性纤维瘤的影像学特点非常重要,因其较其他的纤维性病变更具有侵袭性,手术需要更大的局部切除范围和更长期密切的随访,以防局部复发。     

颌骨动脉瘤样骨囊肿的临床及影像学分析

目的：探讨颌骨动脉瘤样骨囊肿的影像学特征和临床表现，以提高对其诊断和鉴别诊断的能力。方法：回顾分析27例颌骨动脉瘤样骨囊肿患者的临床表现和影像学资料。结果：27例患者中．男10例．女17例：年龄0．6．62岁（平均年龄23.4岁）；上颌骨7例，下颌骨20例。7例为继发性，20例为原发病变。X线平片显示．病灶长轴沿下颌骨长轴走向13例（76％）；骨质破坏呈膨胀性，病变骨与正常骨之间边界欠清，无明显的骨质反应线．骨皮质膨胀变薄或断裂，无骨膜反应；13例病灶内部有分房。CT为边界清楚的囊实性软组织肿块，内含切迹，7例骨性房隔，3例出现液-液平面。MRI上T1WI为低、等信号，T2WI均匀的高信号。27例病变中，15例（56％）为偏心型，12例（44％）为中心型．1例为骨旁型。结论：影像学检查有助于提高对本病的认识和明确诊断。     

颌骨促结缔组织增生性纤维瘤的影像特征及鉴别（附病例报道）

目的：探讨颌骨促结缔组织增生性纤维瘤（DFB）的影像学特征和鉴别诊断。方法：根据1例DFB病例进行影像学分析及文献复习。结果：DFB在X线上表现为溶骨性骨质破坏,无骨膜反应;CT上见骨小梁吸收破坏,为软组织密度肿物取代,增强检查可见强化;MRI上表现为正常骨质信号消失,软组织信号出现,T1WI为均匀等信号,T2WI为不均匀高信号。结论：DFB是罕见的起源于结缔组织的原发骨肿瘤,是具有侵袭性生长特点的良性肿瘤,治疗上宜采取术区扩大切除防止复发。因此,术前从影像学上鉴别DFB对于术式选取以及治疗效果至关重要。     

19例腮腺腺泡细胞癌的MRI影像表现分析

目的: 总结腮腺腺泡细胞癌（acinar cell carcinoma,AciCC）的MRI特征,探讨MR功能成像的诊断价值。方法: 分析269例经手术病理证实的颌面部AciCC的临床资料。其中,19例腮腺AciCC行术前MRI检查（1例平扫,18例增强）,17例行DWI扫描, 15例行DCE扫描。回顾分析19例患者的MRI表现,分析病灶大小、部位、形态、边缘、内部结构、强化方式及功能成像特点。采用SPSS 25.0软件包对数据进行统计学分析。结果: 269例颌面部AciCC中,男108例,女161例,男∶女=1∶1.49。年龄4~89岁,平均年龄（45.95±17.33）岁。84.4%（227/269）的发病部位位于腮腺。MRI表现为78.9%（15/19）病变边界清晰,57.9%（11/19）呈圆形或椭圆形,36.8%（7/19）呈分叶状结节。1例病变形态不规则,且侵犯外周。病灶最大径6~56 mm,平均（24.8±15.3） mm。内部结构为57.9%（11/19）呈囊实性,42.1%（8/19）呈实性,31.6%（6/19）有出血。T2加权像52.6%（10/19）可见包膜结构,15.8%（3/19）内部见低信号分隔;38.9%（7/18）强化均匀,61.1%（11/18）强化不均匀。功能成像显示肿瘤平均ADC值为（1.026±0.194）×10^-3 mm²/s（n=17）,86.7%（13/15）TIC为Ⅱ型。结论: 绝大部分颌面部AciCC位于腮腺。常规MRI显示,AciCC形态学上与良性肿瘤较难鉴别。功能成像ADC值较良性肿瘤低,TIC曲线类型多为Ⅱ型。将形态学与功能成像相结合,可提高该病的诊断准确率。     

颞下颌关节弥漫型巨细胞瘤的CT表现

目的:研究发生于颞下颌关节(temporomandibular joint,TMJ)的弥漫型巨细胞瘤的CT影像特点。方法:回顾性分析8例经病理检查证实、发生于TMJ区的弥漫型巨细胞瘤的CT图像。结果:8例中,男女比例为1∶1,平均年龄45.1岁,所有8例病变都表现为膨胀性生长的软组织肿块,且增强后有不同程度的强化。其中,6例肿块密度增高,关节间隙增宽。髁突骨质改变7例,另外6例颞骨关节面骨质破坏并侵犯颅内。结论:发生于TMJ的弥漫型巨细胞瘤的CT影像学特征表现为较高密度的软组织肿块,伴强化,髁突及颅底骨质破坏并侵犯颅内。     

口腔颌面部恶性神经鞘瘤的影像学和病理学分析

目的:系统分析口腔颌面部恶性神经鞘瘤的影像学和病理学特征,提高对该疾病的认识。方法 :收集2005—2013年我院收治并经病理检查确诊的8例口腔颌面部恶性神经鞘瘤的病历资料,系统分析其CT和MRI影像学表现,以及组织病理学特征。结果:颌骨内恶性神经鞘瘤的CT检查表现出骨质破坏、牙根吸收等恶性肿瘤特征。而软组织恶性神经鞘瘤的MRI检查表现为边界不清,T1WI呈等信号、T2WI压脂像呈高信号,信号不均匀,有不均匀强化等特点。病理学上,Vimentin免疫组织化学染色在所有病例的恶性神经鞘瘤细胞中为强阳性,S-100和Ki-67表现为部分肿瘤细胞表达阳性。CD34在7例患者肿瘤细胞中表达为阴性。结论:CT和MRI影像学检查可帮助确定颌面部恶性神经鞘瘤的性质、范围、形态和破坏程度及与周围组织的关系。Vimentin、S-100和Ki-67免疫组织化学染色可用于肿瘤术后的确诊。     

颞下颌关节弥漫型腱鞘巨细胞瘤的CT影像特征

目的 探讨颞下颌关节弥漫型腱鞘巨细胞瘤CT影像的特征性表现,提高对该疾病的认识及影像诊断能力。方法 回顾性分析北京大学口腔医院2013年3月—2017年3月收治的10例经手术及病理诊断为颞下颌关节弥漫型腱鞘巨细胞瘤患者的CT表现及临床资料。结果 10例患者均表现为高密度软组织肿块伴不同程度钙化,6例患者的增强扫描影像均表现为显著强化,7例患者出现髁突骨质吸收或破坏,6例患者伴有颅底骨质破坏。结论 颞下颌关节弥漫型腱鞘巨细胞瘤的CT特征表现为高密度软组织肿块伴钙化和显著强化,可伴有髁突和颅底骨质的吸收或破坏。     

47例青少年鼻咽纤维血管瘤的临床及影像学特征分析

目的：总结青少年鼻咽纤维血管瘤的临床及影像学特点。方法：47例青少年鼻咽纤维血管瘤患者平均年龄16.5岁。治疗前有完整的CT、MRI和DSA影像学资料。利用CT、MRI评价肿块的位置、范围并进行Fisch分期。DSA主要评价肿块的供血动脉、血流速度、是否存在颅内外异常交通。结果：本组病例中,原发病例39例,复发8例。均有鼻塞症状,41例有鼻腔反复出血史,其中伴面中部隆起11例、眼球突出7例、视力下降或复视5例、听力障碍或耳鸣4例、头晕、头痛2例。CT扫描可见鼻咽部软组织肿块,增强CT扫描可见肿块明显强化,CT可以很好显示颅底颞骨的破坏。在MRI的T1WI上,JNA呈低或等信号,T2WI上信号增高,注射Gd-DTPA后T1加权增强扫描可见＂椒盐征＂。血管造影可见肿瘤的供血动脉主要来自颈外动脉分支,如上颌动脉的蝶腭支和腭降支以及面动脉和咽升动脉等。随着肿瘤的生长,颈内动脉岩段分支、海绵窦支以及筛支也参与供血。结论：结合临床症状和影像学特征,青少年鼻咽纤维血管瘤可以明确诊断,需注意与面深间隙的恶性肿瘤相鉴别。     

8例颌骨尤文肉瘤的临床及影像学特征分析

目的 探讨颌骨尤文肉瘤的临床表现及CT影像学特征。方法 回顾性分析2010年1月—2022年6月经病理证实的8例颌骨尤文肉瘤的临床表现及CT影像学特征。结果 8例颌骨尤文肉瘤病例的发病平均年龄为29.4岁，男女比例为7∶1，发病部位下颌骨后部多见（75%），早期多数有下唇麻木及淋巴结肿大表现。下颌骨尤文肉瘤影像学表现为颌骨内混杂低密度骨质破坏伴软组织肿块形成，纤维索条状及毛刷状瘤骨为其特征型影像学表现。上颌骨尤文肉瘤主要变现为溶蚀状骨质破坏，伴软组织肿块形成。骨膜成骨少见。结论 颌骨尤文肉瘤具有一定的临床及影像学特征，这有助于其影像诊断。     

咽旁颞下区肿瘤的诊断和手术治疗体会

目的:探讨位于颞下窝、咽旁间隙肿瘤的临床表现及诊断方法 ,分析颈侧入路及耳屏前入路的手术疗效,总结治疗心得体会。方法:回顾分析2010—2014年间,15例颞下窝、咽旁间隙肿瘤患者临床资料,包括影像学、组织学检查,分别采用单纯颈侧入路、颈侧入路+下颌骨劈开外旋术或耳屏前切口入路方式切除肿瘤。结果:15例患者均完整切除肿瘤,术后随访1~5年,13例良性肿瘤均无复发,2例恶性肿瘤患者无瘤生存3~5年。结论:术前行增强CT和MRI可明确颞下窝、咽旁肿瘤占位及大小,对手术方案的制定有一定帮助,但不应完全依照影像学检查结果实施手术。利用颈侧软组织可让性,能有效切除咽旁间隙体积较小的肿瘤。对于位置较高且粘连较重的良性肿瘤及侵袭性较强的恶性肿瘤,可考虑采用"颈侧入路+下颌骨劈开外旋术"或"耳屏前切口入路+颧弓切断术"切除。     

Initial investigation of the value of CT in pulmonary metastases originating from head and neck malignant tumors]

CT image and its diagnostic value were analyzed and compared with plain chest film on 12 cases of pulmonary metastases originating from malignant tumors of head and neck,all cases were pathologically verified.CT scan performed on each cases who had definite or suspicious lesion on plain chest film.The result presents that CT can:(1)confirm the suspiciousness of metastatic lesion.(2)confirm the number of metastatic lesion.(3)early detection on pulmonary metastasis. 4.identification on occult pulmonary metastasis. 5.Find out costal bone and pleural metastasing accuracy of pulmonary metastasis,but also provide information for clinical selecting treatment.     

Management of fronto-orbital sphenoidal and facial osteosarcoma: a case with uncommon localization

Osteogenic sarcomas of the head and neck are rarely seen; approximately 6% to 13% these tumors occur in the head and neck, and less than 2% occur in the cranium. Not only eradication of the tumor but reconstruction to achieve satisfactory esthetic and functional results are the main issues regarding these tumors. In this report, a case of osteogenic sarcoma that invaded the infratemporal area, fronto-orbital region, and sphenoid wing is presented. The surgical results of eradication and reconstruction are also presented.     

Head and neck sarcomas in adulthood: current trends and evolving management concepts

Sarcomas are rare, malignant bone and soft-tissue tumours of mesenchymal origin, and their overall incidence accounts for 1% and 0.2%, respectively, of all malignancies. The aim of this article is to provide a reference on the evolving management concepts and trends of treatment of adult sarcomas of the head and neck in a major head and neck sarcoma centre. Early diagnosis remains a challenge due to non-specific symptomatology. Imaging such as ultrasound (US), magnetic resonance (MRI), computed tomography (CT), and positron emission tomography (PET) CT assist with diagnosis and staging, and biopsy is essential for diagnosis, tumour differentiation, and grading. Staging is dependent on histological grade, size of tumour, and metastasis. Sarcomas spread via the haematogenous route. Adequate clearance of locoregional disease and prevention of distant micrometastases are key to improved disease-free survival outcomes so multimodal treatment at a sarcoma reference centre is imperative. In the head and neck, the treatment for most bone sarcomas is neoadjuvant chemotherapy followed by compartmental resection. The interim tumour response to neoadjuvant chemotherapy is evaluated by PET CT and MRI. Heavy-particle therapy (proton beam) in combination with surgery is increasingly being used to treat otherwise unresectable disease, particularly in children. For soft tissue sarcomas of the head and neck, treatment is complex and depends on grade. Surgery is the principle mode of treatment in low-grade tumours that are amenable to resection. High-grade tumours can be treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. In such cases, the response to the chemotherapy might be used as a guide of potential biological aggressiveness, and has an impact on the planning of the operation and the type and extent of radiotherapy. As a general rule, radiotherapy is reserved for high-grade, advanced soft-tissue sarcomas of the head and neck. Those of bone are radioresistant, and radiotherapy is only administered for palliative purposes when no surgical option exists, an exception being Ewing sarcoma. The role of proton beam therapy is promising, but to our knowledge no long-term data currently exist. The survival advantage of innate immune-modulation remains uncertain for disease in the head and neck.     

Posterior cranial fossa box expansion leads to resolution of symptomatic cerebellar ptosis following Chiari I malformation repair

Chiari I malformation occurs when the cerebellar tonsils herniate downward through the foramen magnum into the upper cervical spinal canal. If the posterior fossa craniectomy during corrective surgery leads to excessive enlargement of the foramen magnum, the complication of cerebellar ptosis may result. To treat this difficult problem a posterior cranial fossa box expansion was devised and studied. Patients who developed symptomatic cerebellar ptosis (confirmed by MRI) following cranial vault decompression for Chiari I malformations underwent a posterior fossa box expansion (n=7). This procedure involved coverage of posterior aspect of the enlarged foramen magnum with a split-thickness calvarial bone graft box. The box reconstruction provided separation between the neck musculature, soft tissues from the neural tissue; prevention of cerebellar prolapse; and expansion of the posterior cranial vault. Patients had a mean of 12+/-1 months between initial suboccipital craniectomy and confirmation of symptomatic cerebellar ptosis. Mean age at the time of posterior fossa box reconstruction was 31+/-9 years (range of 14 to 44 years). Preoperative symptoms of headache (7/7, 100%), upper extremity numbness (5/7, 71%) or paresthesias (3/7, 43%), respiratory disturbance (2/7, 29%) and inability to walk (2/7, 29%) improved in all patients postoperatively. At more than 12 month follow-up 6/7 patients (86%) were both disease-free (MRI confirmation) and symptom-free. One out of seven patients had return of headache in a more mild form. Thus, in our patient group the posterior fossa box reconstruction led to resolution of symptomatic cerebellar ptosis following Chiari I malformation repair.     

18F-FDG PET显像在头颈肿瘤诊断中的作用评价

目的:比较~(18)F脱氧葡萄糖正电子发射体层显像(~(18)F-FDG PET)与CT/MRI检查在头颈肿瘤诊断中的应用价值。方法:54例头颈肿瘤患者在术前2周分别进行PET与CT、MRI检查,以病理结果为金标准,分析2种方法在敏感度、特异度及准确率方面的差异,采用SPSS13.0软件包对数据进行X~2检验。结果:PET和CT、MRI分别准确判断了54例肿瘤中的48和43例,PET在敏感度、特异度及准确率方面分别比CT、MRI高7.4%、15.3%和9.3%,但差异均无显著性。结论:PET在头颈肿瘤诊断的敏感度、特异度及准确率方面优于CT、MRI,但结果无统计学差异。     

265例舌癌的临床特点及其对肿瘤颈淋巴结转移的预测价值

目的探讨舌癌颈淋巴结转移的临床特点,为临床治疗提供参考。方法回顾265例舌癌患者的临床资料,根据术前发病时间、肿物大小、肿瘤部位、TNM分类、肿瘤类型、CT表现特点和颈淋巴结转移情况进行分析。结果 265例舌癌患者术后证实颈淋巴结转移者54例。舌鳞状细胞癌260例,其中舌高分化鳞状细胞癌181例,转移11例(6.1%);舌中分化鳞状细胞癌71例,转移35例(49.3%);舌低分化鳞状细胞癌8例,转移5例(62.5%),不同分化程度舌癌转移率差异具有统计学意义(χ2=69.68,P<0.001),低分化(χ2=63.834,P<0.001)、中分化(χ2=24.615,P<0.001)比高分化转移机会大,差异有统计学意义。舌黏液表皮样癌2例,同侧Ⅰ区淋巴结转移1例(50%);舌平滑肌肉瘤1例,同侧颌下淋巴结转移;舌基底细胞癌1例,无淋巴结转移;舌肉瘤样癌1例,同侧Ⅲ区淋巴结转移。不同部位肿瘤转移率差异有统计学意义(χ2=32.76,P<0.001)。肿物位于舌前缘187例,转移21例(11.2%);位于舌中后份78例,转移33例(42.3%),其中双侧63例中转移35例(55.6%)。临床分期,0期2例,Ⅰ期18例,Ⅱ期180例,Ⅲ期33例,Ⅳ期32例;术前作CT检查185例,提示淋巴结直径大于1.0 cm 15例,转移7例,转移率46.6%(7/15),对87例病灶大小判断较模糊。结论舌癌术后颈淋巴结转移与肿瘤部位、大小、分化程度、肿瘤类型密切相关,CT检查对颈淋巴结评估价值不大,舌癌手术方式应主要根据肿瘤类型、部位、大小、分化程度综合考虑。     

正电子发射体层摄影术诊断头颈部恶性肿瘤颈部淋巴结转移的临床价值探讨

目的 与CT、MRI和临床触诊比较,评价正电子发射体层摄影术(positron-emission tomography,PET)在判断头颈部恶性肿瘤颈部淋巴结转移中的应用价值.方法 40例头颈部恶性肿瘤患者于术前两周分别进行PET、CT或MRI检查,分别获取①PET影像;②CT或MRI影像;③临床触诊的淋巴结状况.以病理结果 为金标准,分析3种方法 判断颈部淋巴结转移的敏感性、特异性及准确率方面的差异.结果 PET在判定淋巴结转移的敏感性方面较CT、MRI和临床触诊高14.3%(P=0.648);特异性比CT或MRI和临床触诊分别高15.4%(P=0.188)和7.7%(P=0.482).PET、CT或MRI和临床触诊的准确率分别是85.0%、70.0%和75.0%.结论 PET在头颈癌颈部淋巴结转移判定中的敏感性、特异性及准确率方面略好于CT、MRI和临床触诊.虽然结果 差异无统计学意义,但PET在头颈癌淋巴结转移判定中作为一种辅助方法 有其重要的作用.     

Value of PET/CT 3D visualization of head and neck squamous cell carcinoma extended to mandible

Purpose

To study an original 3D visualization of head and neck squamous cell carcinoma extending to the mandible by using [18F]-NaF PET/CT and [18F]-FDG PET/CT imaging along with a new innovative FDG and NaF image analysis using dedicated software. The main interest of the 3D evaluation is to have a better visualization of bone extension in such cancers and that could also avoid unsatisfying surgical treatment later on.

MRI结合动脉造影检查在头颈部血管畸形中的应用价值

目的：建立头颈部血管畸形合理的影像检查流程。方法：采用磁共振（ＭＲＩ）检查４５例头颈部血管畸形患者。其中１５例还进行了增强ＣＴ检查,１５例进行了动脉造影（ＤＳＡ）检查。比较这３种检查手段的影像特征。结果：ＭＲＩ对各种头颈部血管畸形检查都有意义,多于其它任何一种血管影像方式可提供的病变信息。但在显示高流速及混合性血管畸形的供应动脉及回流静脉方面,ＤｓＡ明显优于ＭＲＩ。结论：以ＭＲＩ作为头颈部血管畸形的最初检查手段,在高流速及混合性血管畸形中结合ＤＳＡ。