泪腺腺样囊性癌CT表现的研究

目的 分析泪腺腺样囊性癌常见的CT图像特征,从而探讨CT(computed tomography)影像对于泪腺腺样囊性癌的诊断价值.方法 病历来源为天津医科大学眼科中心及天津医科大学第二医院,经病理确诊的眼眶腺样囊腺癌39例.其中原发肿瘤20例,复发肿瘤19例,均为单眼发病,所有患者均行眼眶CT检查,获取水平及冠状扫描图像.结果 泪腺腺样囊性癌中原发肿瘤形状多为厚扁平状,贴附于眶壁增长,在体层像上呈锥形者10例、不规则形5例;复发肿瘤形状为不规则型8例、厚扁平状,贴附于眶外上壁向后增长者8例.原发与复发泪腺腺样囊腺癌的好发位置位于眶外上方分别为18例与11例.结论 CT可清晰显示肿瘤的位置,形状,范围、眶骨壁改变,对于泪腺腺样囊性癌的诊断和制定治疗方案具有重要指导意义.     

眼眶泪腺上皮性肿瘤的影像学诊断

目的 分析34例泪腺上皮性肿瘤的影像学特微,方法 对20例泪腺良性多形性腺瘤（复发性7例）,11例腺样囊性癌（复发性9例）,恶性多形性腺瘤2例（均为复发性）和1例粘液表皮癌的超声,CT和MRI进行分析。结果 良性多形性腺瘤呈圆形,帝界清楚,骨窝形成,腺样囊性癌体积较大,形状不规则,骨破坏明显。结论 根据肿瘤的位置,形状,帝界和继发性改变（泪腺窝扩大,骨破坏,钙化,病变向周围结构蔓延）等影像学表现可作出较准确的术前定性诊断。     

超声、CT、MRI对泪腺腺样囊性癌诊断价值比较

目的：探讨泪腺腺样囊性癌X线、超声、CT及MRI的影像学特征,以及各种检查方法对疾病诊断价值的比较。方法：回顾性分析1977－1999年经病理组织学确诊的泪腺腺样囊性癌46例,对X线（8例）、B超（39例）、CDI（7例）、CT（37例）、MRI（4例）的特征进行比较。结果：X线可以发现眼眶密度增高及眶骨破坏;B超可以发现眶内占位病变,且对病变内部的钙斑、液化腔等组织结构的显示良好;CDI可以提供肿瘤内部血液供应情况;CT可以揭示病变范围、生长方式、肿物与眶内正常结构的关系、眶骨及眶周结构的改变;MRI对于显示肿瘤颅内和颞凹蔓延,优于以上检查方法。结论：联合应用多种影像学检查方法,可以提高术前诊断率。     

泪腺腺样囊性癌CT表现的研究

目的 分析泪腺腺样囊性癌常见的CT图像特征,从而探讨CT(computed tomography)影像对于泪腺腺样囊性癌的诊断价值.方法 病历来源为天津医科大学眼科中心及天津医科大学第二医院,经病理确诊的眼眶腺样囊腺癌39例.其中原发肿瘤20例,复发肿瘤19例,均为单眼发病,所有患者均行眼眶CT检查,获取水平及冠状扫描图像.结果 泪腺腺样囊性癌中原发肿瘤形状多为厚扁平状,贴附于眶壁增长,在体层像上呈锥形者10例、不规则形5例;复发肿瘤形状为不规则型8例、厚扁平状,贴附于眶外上壁向后增长者8例.原发与复发泪腺腺样囊腺癌的好发位置位于眶外上方分别为18例与11例.结论 CT可清晰显示肿瘤的位置,形状,范围、眶骨壁改变,对于泪腺腺样囊性癌的诊断和制定治疗方案具有重要指导意义.

Abstract：

Objective To analyze imaging characteristics of adenoid cystic carcinoma(ACC)of lachrymal gland on CT for the diagnosis of ACC in clinic. Methods Thirty-nine patients with ACC consisting of 20 cases of primary tumor and 19 cases of recurred tumors confirmed by pathology were collected from The Eye Centre of Tianjin Medical University and The Second Hospital of Tianjin Medical University. All the patients were unilateral, and examined by CT. The imaging characteristics of ACC on CT were analyzed. Results The most common shape of primary ACC included 10 cases of conical-shape, 5 cases of irregular-shape. The recurred cases contained 8 cases of irregular-shape, 8 cases of conical-shape. The primary and recurred ACC usually existed on superior-external side, with which there were 18 cases and 11 cases respectively. Conclusions CT examination can exactly reveal the shape, size, position, and ossa orbitale destruction of ACC and played an important role in the diagnosis of ACC.     

泪腺腺样囊性癌

一、命名、发病率腺样囊性癌系起源于腺体组织,恶性度较高的肿瘤。通常发生在唾液腺、泪腺、也可在气管、乳腺、皮肤汗腺等处发生。眼眶部泪腺腺样囊性癌是泪腺最常见的恶性肿瘤。在泪腺癌中,腺样囊性癌的发病率是25％和35％。本病最初由Billroth在1859年命名为圆柱瘤,他描述此肿瘤原发于鼻窦,以后穿透到     

130例原发泪腺上皮性肿瘤的诊断分析

目的分析130例泪腺上皮性肿瘤临床特点,明确诊断依据。设计回顾性病例系列。研究对象130例原发泪腺上皮性肿瘤。方法收集130例经病理检查确诊的泪腺上皮性肿瘤的临床资料、影像学资料和组织病理学资料。主要指标临床表现,影像学表现,组织病理学表现。结果泪腺上皮性肿瘤临床表现主要为眼球突出、视力下降、疼痛、复视等。良性肿瘤中以多形性腺瘤(43．8％)为多,恶性肿瘤占前三位的分别为腺样囊性癌(38．5％),恶性混合瘤(8．5％),腺癌(3．8％)。眼眶B超、CT、MRI都有典型的影像学特征。组织病理学改变是最终诊断依据。结论将影像学表现和临床资料结合起来可对泪腺上皮性肿瘤作出初步诊断,最终诊断要依靠组织病理学检查。     

眶颅沟通复发性泪腺腺样囊性癌的多学科病例讨论

44岁男性患者,4年前曾因左眼泪腺腺样囊性癌行手术切除联合放射治疗.此后间断性头痛,近2年左眼视力下降.眼眶MRI和CT显示左侧泪腺区恶性肿瘤,外直肌弥漫性增粗并邻近肌锥外异常强化信号,左侧眼眶外壁和蝶骨大翼骨质缺损,病变累及左侧海绵窦、圆孔、卵圆孔及翼腭窝,考虑肿瘤复发可能.眼科联合神经外科医师在全麻下行左眼眶颅沟通...     

鼻窦源性肿瘤侵犯眼眶52例临床分析

目的 探讨侵犯眼眶的继发于鼻窦肿瘤的临床、影像学特点及治疗方法.方法回顾性分析52例侵犯眼眶的鼻窦肿瘤患者的临床表现、CT和MRI特点及治疗.结果 患者首发症状为单眼眼球突出.其中副鼻窦黏液囊肿29例,腺样囊性癌11例,鳞状上皮癌6例,其他恶性肿瘤6例.CT检查平扫25例,增强扫描5例,表现为鼻窦内形状不规则软组织肿块,眶内侧壁及眶下壁可见骨质中断,可见肿物向眶内突出,增强后肿瘤眼明显强化.MRI检查12例,均为平扫＋增强扫描,可见上颌窦或筛窦肿块与眼眶内肿块信号相等且连续.增强后肿瘤明显强化.58例全部行手术治疗.结论 鼻窦肿瘤易侵及眼眶,临床多以眼球突出为首发症状.CT、MRI检查有助诊断.多学科联合诊治,对提高鼻窦肿瘤的诊断和综合治疗水平有十分重要的临床意义.     

泪腺肿瘤的影像学表现

泪腺肿瘤在眼眶病中构成比较大，患者发病年龄跨度大，无明显性别差异。临床表现主要为眼球突出、鼻侧移位，眼球运动受限，泪腺区可扪及肿物等。了解泪腺肿瘤影像学特点有助于病情预后的判断及手术方案设计。本文对属于泪腺上皮性肿瘤的多形性腺瘤、腺样囊性癌、粘液表皮癌、嗜酸性细胞癌、泪腺腺癌、泪腺上皮囊肿，以及属于非上皮性肿瘤的泪腺炎性假瘤、泪腺良性淋巴上皮病变、泪腺淋巴瘤及多发性骨髓瘤等影像学特点进行总结，旨在为泪腺肿瘤的诊治提供帮助。（国际眼科纵览，2016，40：196-200）     

MRI对泪腺占位性病变的诊治价值

目的 探讨分析MRI在泪腺占位性病变诊断治疗中的价值.方法 回顾性分析36例泪腺占位性病变患者的MRI表现.主要观察指标为:病变范围、病变形态、病变边界、内部信号特点(T1及T2加权像)、病变强化显像的情况以及临近骨组织的改变.结果 36例泪腺病变的患者中,泪腺炎4例,炎性假瘤9例,淋巴瘤8例,泪腺多形性腺瘤7例,泪腺腺样囊性癌8例.泪腺炎多为双侧发病,MRI可见病变累及眶内及眼睑,形状不规则边界不清,T1加权像为中等信号,T2加权像为低信号.炎性假瘤和淋巴瘤多累及眶内,形状不规则边界不清与眼球呈铸造型,在T1和T2加权像均为中信号.泪腺多形性腺瘤可见病变累及眶内为圆形或椭圆形边界清楚,可伴有骨质增生,在T1加权像为中信号和T2加权像为高信号.泪腺腺样囊性癌多为形状不规则的病变,多伴有骨破坏,在T1加权像为中信号和T2加权像为高信号.以上泪腺病变的MRI强化显像均为中等强化.结论 MRI对于泪腺占位性病变的鉴别诊断具有一定意义,尤其有助于区别炎性病变和实体性肿瘤以及良性肿瘤和恶性肿瘤,并且结合MRI强化显像技术可以对手术切除病变的范围起到一定的指导作用.     

泪腺腺样囊腺癌的MRI特征分析

目的 探讨泪腺腺样囊腺癌（adenoid cystic carcinoma,ACC）的MRI特征,为临床早期诊断提供依据。设计 回顾性病例系列。研究对象 北京同仁医院经手术证实ACC患者26例,术前均行MRI扫描。方法 所有ACC患者常规MRI扫描;同时对动态增强磁共振成像（DCE-MRI）及磁共振扩散加权成像（DWI）图像进行后处理获得相应量化指标。主要指标 ACC动态增强的峰值强化指数（CIpeak）、峰值强化时间（Tpeak）、最大强化指数（CImax）、强化指数曲线（I型为持续上升型,II型为平台型,III型为流出型）、肿瘤平均表观扩散系数（ADC）值。结果  26例均起自泪腺眶部,20例形态不规则,14例边界不清,12例边界清晰,6例累及颅内,9例出现骨质破坏。T1WI呈等或略低信号,其中3例内部出现高信号区;T2WI呈等或稍高信号为主,增强后仅1例强化均匀,25例呈不均匀强化,其中16例伴有内部囊变、坏死区。泪腺ACC峰值强化指数（CIpeak）为0.9±0.41,峰值强化时间（Tpeak）为（109.3±58.5）s, 最大强化指数（CImax）为0.95±0.45。22例时间强化指数曲线中2例为I型,14例为II型,6例为III型。平均ADC值为（1.25±0.30×10-3）mm2·s－1。结论 MRI可以清晰显示泪腺ACC的部位、形态、范围、边界及骨质侵犯,DCE-MRI及DWI为肿瘤的诊断及鉴别诊断提供辅助量化特征。（眼科,2013, 22： 314-319）     

泪囊区原发恶性肿瘤的MRI表现及临床病理分析

目的 探讨眼眶泪囊区不同恶性肿瘤的MRI表现与临床病理的关系。设计 回顾性病例系列。研究对象 北京同仁医院2005-2014年13例经病理证实为泪囊区恶性肿瘤患者的MRI表现及临床资料。方法  所有患者均行眼眶MRI平扫及增强检查,其中10例行动态增强扫描,根据时间-信号强度曲线（TIC）分为三种类型（Ⅰ型稳定增强型,Ⅱ型平台型,Ⅲ型流出型）。11例手术切除,2例活检。主要指标 MRI表现,强化程度,TIC类型及病变的累及范围。结果 病变主体均位于泪囊窝内。病理结果显示淋巴瘤5例、恶性黑色素瘤2例,睑板腺癌、基底细胞癌、基底样鳞状细胞癌、腺样囊性癌、低分化腺癌、皮脂腺癌各1例。MRI表现：淋巴瘤T1WI、T2WI均呈等信号,增强扫描轻度均匀强化。恶性黑色素瘤T1WI呈高信号、T2WI呈低信号,增强扫描轻中度均匀强化。睑板腺癌及低分化腺癌T1WI、T2WI均呈等信号。另4例T1WI呈等信号,T2WI呈略长信号,增强扫描呈轻中度强化。TIC：Ⅰ型、Ⅱ型各2例,Ⅲ型6例。12例病变累及鼻泪管,9例累及邻近皮肤,7例累及眼睑,2例累及眼眶肌锥内间隙。结论 泪囊恶性肿瘤因病理类型不同MRI表现不同,常累及邻近结构,MRI可准确显示肿瘤累及范围。TIC三型均有,以流出型为主。（眼科,2015, 24： 313-316）     

眼眶泪腺上皮性腫瘤的影像學診斷

目的分析34例泪腺上皮性腫瘤的影像學特徵.方法對20例泪腺良性多形性腺瘤(復發性7例),11例腺樣囊性癌(復發性9例),惡性多形性腺瘤2例(均爲復發性)和1例粘液表皮癌的超聲,CT和MRI進行分析.結果良性多形性腺瘤呈圓形,邊界清楚,骨窩形成.腺樣囊性癌體積較大,形狀不規則,骨破壞明顯.結論根據腫瘤的位置,形狀,邊界和繼發性改變(泪腺窩擴大,骨破壞,鈣化,病變向周圍結構蔓延)等影像學表現可作出較準確的術前定性診斷.     

Magnetic resonance imaging of unilateral lacrimal gland lesions

Purpose To report the findings on magnetic resonance imaging (MRI) of various benign and malignant unilateral lacrimal gland lesions.Methods This is a retrospective noncomparative interventional case series. Thirty-one consecutive patients with a unilateral lacrimal gland lesion were analyzed. The preoperative MRI findings were correlated with the pathology results. The main outcome measures were anatomic extent, configuration, margins, angulation, internal features on T1- and T2-weighted images (with respect to extraocular muscles and cerebral gray matter), contrast enhancement of the lesion and adjacent bone change on MRI.Results Of the 31 patients, 21 had chronic dacryoadenitis, 3 had lymphoid tumors, and 7 had epithelial tumors including pleomorphic adenoma (3), adenoid cystic carcinoma (3), and pleomorphic adenocarcinoma (1). The results of the patients with chronic dacryoadenitis demonstrated involvement of the orbital lobe alone in 13 patients (62%), involvement of both orbital and palpebral lobes in 8 (38%), a molded configuration with ill-defined margins, sharp angles in 13 (62%), round angles in 8 (38%), lack of bone change, an isointense internal signal on T1-weighted images, a hypointense signal on T2-weighted images, and moderate contrast enhancement. The patients with lymphoid tumors demonstrated involvement of the orbital lobe, a molded configuration with ill-defined margins and sharp angles, lack of bone change, an isointense internal signal on T1-weighted images, an isointense signal on T2-weighted images, and moderate contrast enhancement. Those with epithelial tumors showed involvement of the orbital lobe, a well-circumscribed oval configuration, and round angles. Pleomorphic adenoma demonstrated smooth margins, bone expansion in two patients , and no bone change in one. Adenoid cystic carcinoma and pleomorphic adenocarcinoma showed irregular margins and bone destruction. All epithelial tumors demonstrated an isointense internal signal on T1-weighted images, a hyperintense signal on T2-weighted images, and moderate contrast enhancement.Conclusions It is difficult to uniformly correlate the MRI features and histopathologic findings in lacrimal gland lesions. However, MRI seems to be useful in determining the etiology of a unilateral lacrimal gland lesion. Internal tissue features on T1- and T2-weighted images of MRI are most helpful in categorizing these lesions. Although the number of patients is small, our findings suggest that there are differences in orbital MRI findings of inflammatory lesions and lymphoid tumors as compared to benign and malignant epithelial tumors in the lacrimal gland fossa.Presented in part as a free paper at the 10th International Congress of Ocular Oncology, Amsterdam, the Netherlands, 17–21 June 2001An erratum to this article can be found at     

Orbital schwannomas: findings from magnetic resonance imaging in 62 cases

PurposeTo evaluate the diagnostic value of magnetic resonance imaging (MRI) and illustrate the common MRI features of orbital schwannoma.MethodsWe reviewed 62 consecutive cases of pathologically proven orbital schwannoma investigated by MRI. All cases were examined using T1- and T2-weighted images. Enhanced T1-weighted images were obtained after administration of gadopentetate dimeglumine. The images were analysed and compared.ResultsCone-shaped lesions were the most frequent (16, 26%), followed by dumbbell-shaped (10, 16%), oval (9, 15%) and round lesions (8, 13%). The most common site was the superior aspect of the orbit (17, 27%), followed by the medial superior (12, 19%) and the orbital apex (12, 19%). On unenhanced T1-weighted images, 53 (85%) lesions showed isointensity or small patches of hypointensity. The patterns of enhancement seen on T1-weighted images correlated with the signal characteristics of unenhanced T2-weighted images. Five patterns emerged in our series. Among these patterns, the most common sign, found in 18 (29%) cases, was peripheral (ring) enhancement on enhanced T1-weighted images, which showed peripheral isointensity with central hyperintensity on T2-weighted images. Lesions with homogeneous or heterogeneous enhancement were seen in 16 (26%) and 26 (42%) cases, respectively.ConclusionsMRI is a valuable diagnostic method for orbital schwannoma, particularly when contrast is applied. The locations and shapes of tumours can be seen distinctly. T1-weighted images are relatively nonspecific. T2-weighted and enhanced T1-weighted images provide information about the pathology of tumours. In particular, peripheral enhancement should be considered a target sign of schwannoma.Eye (2008) 22, 1034-1039; doi:10.1038/sj.eye.6702832; published online 20 April 2007.     

眼眶神经鞘瘤的MRI影像研究

目的评价磁共振成像（megnetic resoance imaging,MRI）影像对于眼眶神经鞘瘤的诊断价值,并提出常见的MRI图像特征。方法收集我院病理确诊的眼眶神经鞘瘤62例,均为单眼发病,所有患者均行眼眶MRI检查,获取T1和T2加权像。注射钆喷酸葡胺后获取强化T1加权像。回顾性分析并比较所有MRI图像。结果眼眶神经鞘瘤常见的肿瘤形状为圆锥形（16例）、哑铃形（10例）、椭圆形（9例）和圆形（8例）。神经鞘瘤的好发部位为眶上部（17例）、眶内上方（12例）和眶尖部（12例）。在T1加权像,53例显示均一的等信号或伴小片状低信号区。强化T1加权像的图像特征与T2加权像具有相关性,增强类型可分为5类。最常见的增强类型是环形强化征,有18例。均匀增强和不均匀增强各为16例和26例。结论MRI对于眼眶神经鞘瘤具有重要的诊断价值,尤其是在使用造影剂后。MRI可清晰显示肿瘤的形状和位置。T1加权像无明显特异性。T2和增强的T1加权像可提供肿瘤的组织学信息。环形强化征可作为神经鞘瘤的靶特征。     

Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit

Wooden foreign bodies in the orbit are not detectable by standard roentgenography. Reports in the literature on the ability of computed tomography (CT) to detect orbital wooden foreign bodies have varied. To evaluate whether magnetic resonance imaging (MRI) would offer any advantage over CT in detecting wood in the orbit. MRI and CT were performed on an in vitro model of wooden foreign bodies in the orbit. Woods of different types and sizes were studied in vegetable fat backgrounds chosen to simulate orbital fat. On CT, most types of wood were hypodense to fat. Appropriate window settings were critical in the detection of wood by CT: in this model, a window width of 1000 Hounsfield units was optimal. On MRI, all types of wood were hypointense to fat. Small pieces of wood were surrounded by an MRI truncation artifact consisting of hyperintense spots. T1-weighted images demonstrated wood better than T2-weighted images and required less scanning time than either proton density or T2-weighted images, MRI was superior to CT in detecting the smallest pieces of wood. The role of MRI in the detection of orbital wooden foreign bodies in clinical practice remains to be determined.