头颈部副神经节瘤的影像学诊断

目的:结合头颈部副神经节瘤的发生部位,分析其影像学表现和特点.材料和方法:回顾性分析23例头颈部副神经节瘤患者的影像学资料(5例鼓室球瘤,12例颈静脉球瘤,3例迷走体瘤和3例颈动脉体瘤),21例行CT检查(其中1例行动态增强检查),15例行MRI检查.结果:鼓室球瘤较小,多发生于鼓岬区;颈静脉球瘤以颈静脉孔为中心,较大的肿瘤侵犯咽旁间隙、中耳、外耳道、乳突和(或)颅内;颈动脉体瘤位于上颈部颈内外动脉分叉处,伴上述动脉明显分离移位;迷走体瘤位于咽旁颈动脉鞘区,血管移位不一.以上四类肿瘤CT平扫呈中等密度,强化显著,部分肿瘤内见强化的血管和囊性改变;MRI T1WI中低信号,强化显著,T2WI中高信号,部分肿瘤内见囊变,多数肿瘤中可见血管流空"盐和胡椒征"(鼓室球瘤和较小的颈静脉球瘤中不见).鼓室球瘤和颈静脉球瘤边缘不规则,后者侵犯咽旁间隙部分边缘光滑,骨质呈虫咬状破坏;颈动脉体瘤和迷走体瘤边缘光滑,无骨质破坏.结论:多数头颈部副神经节瘤具有特定的发生部位和特征性的CT和MRI表现,可据此确诊;发生于不同部位的肿瘤的影像学表现有所差别.     

头颈部副神经节瘤的影像学诊断

目的总结头颈部副神经节瘤的影像学表现,提高少见部位副神经节瘤的认识.资料与方法搜集1990年1月～2004年4月经手术病理证实的副神经节瘤27例,回顾性分析其超声、CT、MRI和DSA表现.结果 27例副神经节瘤中,19例(22个肿瘤)来自颈动脉体(其中3例双侧)均发生于颈总动脉分叉处,1例发生于迷走神经节,2例发生于颈静脉球,1例位于鼓室, 1例位于颏下,1例位于眶内肌锥外,2例恶性副神经节瘤,肿瘤破坏骨质.其共同影像学特点:实性肿块,血供丰富,强化明显,MRI显示肿瘤内有流空的血管影.结论头颈部副神经节瘤具有典型的影像学特征和特定的定位征象,对诊断有决定性价值.发生于罕见部位者,诊断困难,但如有上述典型征象,仍要考虑本瘤的可能.     

3.0T MRI对头颈部副神经节瘤的诊断

目的分析头颈部副神经节瘤的MRI特点,探讨MRI在其临床诊断中的应用价值。方法回顾性分析21例经术后病理诊断为头颈部副神经节瘤患者的临床及MRI资料,观察其MRI特点,包括病灶数量、位置、信号特点、占位效应及增强表现。结果颈动脉体瘤10例,位于颈总动脉分叉处,颈静脉球瘤8例,位于颈静脉窝6例,位于鼓室2例,迷走神经副节瘤2例,1例来源于颞下窝周围神经和自主神经。副神经节瘤MRI主要表现为T_1WI为等或稍低信号,T_2WI/FLAIR为高信号,边界清晰,未见占位效应及肿瘤周围水肿,部分病例可见"盐和胡椒"征,增强扫描后,病灶均强化明显。结论副神经节瘤的MRI表现具有一定的特征,MRI可作为临床诊断安全、准确的首选影像学检查方式。     

颈动脉体瘤的影像学诊断

目的:探讨比较颈动脉体瘤的超声、CT、MRI、DSA的影像学表现,提高术前诊断水平。方法:回顾性分析手术病理证实的14例颈动脉体瘤的各种影像学表现及特征。结果:各种检查均可显示肿瘤部位、大小及形态,颈动脉体瘤的彩色多普勒特点为中等偏低实质回声,境界清楚,大于3.0cm的肿瘤可见管道结构,但肿瘤上缘观察欠清,14例行彩色多普勒超声其中9例可显示瘤内网状血管,有1例神经鞘瘤误诊为颈动脉体瘤,诊断符合率为93%(14/15)。14例均行CT平扫加增强,CT增强显示为富血管肿瘤,其中12例肿瘤均匀强化,2例呈明显不均匀强化,CT值150～180HU,颈内、外动脉密度与瘤体等同难以分辨,术前CT诊断符合率为100%(14/14)。11例患者行MRI及MRA检查,MRI平扫特点为瘤内见流空的血管影像,明确显示颈内、外动脉分离和紧贴或镶嵌在肿瘤后外缘及前外缘,MRA能良好显示肿瘤与颈总动脉及其分叉的关系,术前MRI诊断符合率为100%(11/11)。其中8例同时行DSA血管造影,除能明确诊断和显示供血动脉外,DSA能清晰显示其血供及与颈内、外动脉的关系,术前DSA诊断符合率为100%(8/8)。结论:彩色多普勒超声、CT和MRI对颈动脉体瘤均有很高的诊断价值,差异无显著性意义。     

颈动脉体瘤影像学表现分析

目的 探讨颈动脉体瘤影像学表现及诊断价值.方法 33例颈动脉体瘤均经手术病理证实,均行X线平片及超声检查,其中28例经血管造影、20例行CT、16例行MRI和10例行MRA检查.回顾性分析颈动脉体瘤的各种影像学表现,评价其临床价值.结果 各种检查均可显示肿瘤部位及其形态,颈动脉体瘤的B型超声特点为中等偏低实质回声,＞3 cm的肿瘤可见管道结构,但肿瘤上缘观察欠清,2例行彩色多普勒超声显示瘤内网状血管.CT增强显示为富血管肿瘤,其中1例肿瘤均匀强化,颈内、外动脉密度与瘤体等同难以分辨.MRI的特点为瘤内见流空的血管影像,明确显示颈内、外动脉分离.MRA能良好显示肿瘤与颈总动脉及其分叉的关系.血管造影可明确显示供血动脉.结论 B超、CT和MRI对颈动脉体瘤的诊断各具一定的特征性.     

头颈部副神经节瘤的术前栓塞治疗

目的：分析头颈部副神经节瘤的ＤＳＡ表现及评价术前栓塞的作用。材料与方法，８例患者均行双侧颈总动脉及椎动脉ＤＳＡ检查，而后行患侧超选择性插管，以明胶海绵颗粒或真丝段作为栓塞材料。结果：５例颈静脉球瘤，２例颈动脉体瘤及１例迷走神经体瘤的动脉期均显示主要由颈外动脉的分支供血，如咽升动脉，耳后动脉，枕动脉等，颈静球瘤如侵犯后颅凹，颈内动脉或椎动脉的分支也可参与供血，实质期，肿瘤呈分叶状，不均匀染色，静脉期     

颈动脉体瘤的CT诊断(附7例报告)

目的：探讨颈动脉体瘤的CT表现。方法：收集CT资料完整、手术病理证实的颈动脉体瘤7例，其中3例还作了DSA检查，分析其CT、DSA表现。结果：7例肿瘤均位于颈总动脉分叉处，平扫为等密度或稍高密度、边界清楚，增强扫描呈明显强化，颈内外动脉分离、距离加大。DSA显示肿瘤明显染色，颈内外动脉分叉角度增大，病灶局部颈内、外动脉受压。结论：颈动脉体瘤的CT表现有一定的特征性，但应与颈动脉鞘内的其他占位性病变相鉴别。     

CTA与MRA在颈动脉体瘤中的诊断价值

目的：研究MRA与CTA在诊断颈动脉体瘤中的价值,从而指导临床手术。方法：本文14例颈动脉体瘤全部经手术病理证实,其中单侧10例,双侧4例。回顾性分析颈动脉体瘤的CTA与MRA影像学表现及特征。结果：两种检查均可显示肿瘤部位、大小及形态,14例均行CTA检查,CT增强显示病灶为富血供肿瘤,其中12例肿瘤均匀强化,2例呈明显不均匀强化,CT值达150～180HU,颈内、外动脉密度与瘤体等同难以分辨,术前CT正确诊断率为100％（14／14）。11例患者行MRI及MRA检查,MBI平扫特点为瘤内见流空的血管影像,明确显示颈内、外动脉分离和紧贴或镶嵌在肿瘤后外缘及前外缘,MRA能良好显示肿瘤与颈总动脉及其分叉的关系,术前MR／正确诊断率为100％（11／11）。结论：CTA和MILA对颈动脉体瘤均有很高的诊断价值,经统计无显著性差异。     

面神经肿瘤的CT和MRI诊断

目的：研究面神经各种类型肿瘤的影像学表现,提高对其影像学特点的认识。方法：回顾性分析21例经手术病理证实的各类型面神经肿瘤影像学表现特点。21例均行CT检查,其中2例同时行面神经管的多平面重建（MPR）;17例行MR平扫加增强扫描。结果：21例面神经肿瘤有面神经鞘瘤15例,分别涉及内听道段1例、迷路段2例、膝状神经节6例、鼓室段11例、乳突段7例、腮腺5例、外耳道3例、颈静脉球窝2例、后颅窝2例,中颅窝1例。面神经血管瘤有3例,均累及膝状神经节,涉及中颅窝1例、鼓室段2例。面神经纤维瘤有3例,2例广泛累及迷路段、鼓室段和乳突段,1例累及乳突段和鼓室段。影像学表现：CT表现：17例面神经管扩大和／或骨质破坏,1例血管瘤于膝状窝区可见蜂窝状骨样密度影;12例鼓室内软组织肿块;5例伴听小骨外移和／或破坏,3例伴外耳道后壁破坏,2例伴颈静脉球窝外侧壁破坏。MRI：16例肿瘤表现为结节状或不规则状软组织肿块,1例表现为面神经增粗。T1WI等信号,T2WI等或偏高信号,信号均匀或不均匀,增强后中等至明显强化,信号均为不均匀。结论：一个肿瘤常涉及多个面神经节段,CT有利于显示面神经肿瘤区骨质改变,MRI可很好地显示面神经肿瘤的部位、形态、范围和内部结构特征,两者结合有助于不同类型面神经肿瘤的鉴别诊断及其定位诊断,为临床制定手术方案和手术途径提供依据。     

CT和MRI动态强化在颈动脉体瘤中的诊断价值

目的:分析颈动脉体瘤的CT和MRI的动态强化特点,探讨CT与MR动态强化在诊断颈动脉体瘤中的作用,提高术前诊断水平。方法:回顾性分析经手术病理证实的颈动脉体瘤12例,术前均行64层CT动态强化及CT血管成像,注射速率4.5~5.0ml/s,有效层厚0.625mm;2例行MRI平扫,其中1例行MRI动态强化及MR血管成像。结果:12例病变均为单发,位于颈总动脉分叉处。9例病变颈内、外动脉夹角增大,呈典型的"杯口状"表现;3例病变较小,颈动脉分叉角度无明显变化。CT平扫10例病变密度均匀,呈等或略高密度,2例病变密度不均匀。增强后动脉期12例肿瘤均明显强化,CT值平均226.7HU,强化程度接近颈动脉血管,病灶均匀强化8例、不均匀强化4例,边界清楚;静脉期显示肿瘤进一步持续强化,强化程度稍低于颈动脉血管,均表现为均匀一致的强化。其时间-密度曲线峰值与颈内动脉峰值相比幅度稍小、出现稍晚。MR平扫T1WI呈等信号,T2WI呈略高信号,动态增强后病变显著均匀强化,变化规律与CT一致。结论:颈动脉体瘤动态强化影像学特征对颈动脉体瘤的诊断及鉴别诊断具有重要的临床实用价值。     

Intratumoral injection of cyanoacrylate glue in head and neck paragangliomas

BACKGROUND AND PURPOSE: Substantial intraoperative bleeding during surgical removal of head and neck paragangliomas may be a major problem in the management of these highly vascularized tumors. Traditional preoperative embolization via a transarterial approach has proved beneficial but is often limited by complex vascular anatomy and unfavorable locations. We report our experience with the preoperative devascularization of head and neck paragangliomas by using direct puncture and an intralesional injection of cyanoacrylate. METHODS: We retrospectively analyzed nine consecutive patients with head and neck paragangliomas who were referred for preoperative devascularization. Three patients were treated for carotid-body tumors; two for vagal lesions; and four, for jugular paragangliomas. Direct puncture of the lesion was performed by using roadmap fluoroscopic guidance. Acrylic glue was injected by using continuous biplane fluoroscopy. All patients underwent postembolization control angiography and immediate postoperative CT scanning. RESULTS: Angiograms showed that complete devascularization was achieved in all cervical glomus tumors, whereas subtotal devascularization was achieved in jugular paragangliomas. In this latter location, the injection of acrylic glue was limited by the potential risk of reflux into normal brain territory via feeders from the internal carotid or vertebral artery. The tumors were surgically removed and histologically examined. No technical or clinical complications related to the embolization procedure occurred. CONCLUSION: Percutaneous puncture of paragangliomas in the head and neck region and their preoperative devascularization by intralesional injection of acrylic glue is a feasible, safe, and effective technique.     

Paragangliomas of the jugular bulb and carotid body: MR imaging with short sequences and Gd-DTPA enhancement

Twenty-six patients with glomus jugulare (16), glomus tympanicum (three), or carotid glomus (seven) tumors were examined with contrast-enhanced CT scans and MR scans without and with Gd-DTPA. MR and CT scans had similar sensitivities, but the enhanced MR scans were diagnostically more specific than either CT or nonenhanced MR. Dynamic MR scanning permitted measurement of the degree of Gd-DTPA enhancement over time. We recommend contrast-enhanced MR with short sequences and a dynamic approach in patients with suspected carotid, tympanic, and jugular paragangliomas.     

From the archives of the AFIP. Paragangliomas of the head and neck: radiologic-pathologic correlation. Armed Forces Institute of Pathology.

Paragangliomas of the head and neck are ubiquitous in their distribution, originating from the paraganglia or glomus cells within the carotid body, vagal nerve, middle ear, jugular foramen, and numerous other locations. The typical patient is middle-aged and presents late in the course of the disease, with a painless slow-growing mass. Clinical manifestations include hoarseness of voice, lower cranial nerve palsies, pulsatile tinnitus, and other neuro-otologic symptoms. The overall prognosis of patients with a cervical paraganglioma is favorable, whereas its temporal bone counterpart often results in recurrence, residual tumor, and neurovascular compromise when in the advanced stage. Pathologic examination reveals a characteristic biphenotypic cell line, composed of chief cells and sustentacular cells with a peripheral fibrovascular stromal layer that are organized into a whorled pattern ("zellballen"). Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity at computed tomography; a salt-and-pepper appearance at standard spin-echo magnetic resonance imaging; and an intense blush at angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and help predict operative morbidity and mortality. Surgical treatment is definitive. Radiation treatment is included as a palliative adjunct for the exceptional paraganglioma not amenable to surgery.     

颈部副神经节瘤的DSA诊断研究(附17例分析)

目的 探讨颈部副神经节瘤的ＤＳＡ诊断价值。方法 总结经病理证实的动脉体瘤（ＣＢＴ）１２例、颈静脉瘤（ＣＪＴ）５例,研究ＤＳＡ表现,并与其他颈部肿块性病变进行对照。结果 副神经节瘤主富血供型（ＣＢＴ１１例,ＧＪＴ３例）,ＤＳＡ能清楚显示肿瘤血管细节及肿瘤与相邻血管的整体关系。ＣＢＴ颈总动脉分驻开大呈握球状（１２例）、枕动脉近段向前上推移（１２例）、咽升动脉肿瘤中心供血（１０例）具有特征性,３例恶变者     

Imaging and management of head and neck paragangliomas

Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). Diagnostic imaging can be considered in two clinical situations: (1) patients who present with clinical symptoms suggestive of a paraganglioma, and (2) individuals from families with hereditary paragangliomas. It is not only necessary to detect and characterize the lesion, but also to study the presence of multiplicity. For these purposes, MR imaging, and especially 3D TOF MRA, is the modality of choice. CT scanning is especially useful to show destruction of the temporal bone. Angiography in combination with embolization will mainly be used prior to surgical resection, but can also be used for diagnostic purposes when the diagnosis is not yet clear. Many parameters play a role in the decision to treat of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Resection however, should be balanced against a more conservative wait and scan policy or palliative treatments such as radiotherapy.     

颈静脉孔区及鼓室内颈静脉球瘤1例并文献复习

目的探讨颈静脉孔区及鼓室内颈静脉球瘤的临床表现、影像和病理特征及其鉴别诊断。方法回顾性分析1例经手术病理证实的颈静脉孔区及鼓室内颈静脉球瘤病人的影像及病理资料,并复习相关文献。结果CT检查示左侧颈静脉孔、中耳鼓室、鼓窦及乳突气房内可见软组织密度影,局部乳突骨质破坏,并突入左侧外耳道;颅底MRI示左侧颈静脉孔区不规则条状肿物,沿左侧颈静脉孔突出颅外,并伸入左侧咽旁间隙,凸向左侧中耳鼓室及乳突气房。术后病理诊断为副神经节瘤。免疫组织化学结果:Syn、NSE、CD56、CD34、Cg A阳性,CK阴性,ki-67增殖活性较低(1%),提示副神经节瘤。结论颈静脉孔及鼓室骨质破坏以及病变明显强化和速升速降的动态曲线支持颈静脉球瘤和鼓室球瘤的诊断。联合CT和MRI能够明确病变的范围。     

Preoperative embolization of the head and neck: indications, patient selection, goals, and precautions

Preoperative embolization was performed in 39 patients with 44 paragangliomas of the head and neck. Because of their complex vascular supply and their relation to vital structures such as the internal carotid artery and the lower cranial nerves, paragangliomas of the temporal bone represent challenging lesions to both the neuroradiologist and the otoneurosurgeon. Detailed classification by high-resolution CT and recognition of the multi- or monocompartmental vascular composition and of dangerous situations by selective angiography are essential prerequisites for safe and effective devascularization of paragangliomas of the temporal bone. Major complications that may occur if embolic material reaches intraaxial vessels through anastomoses between external carotid artery branches and the internal carotid and/or the vertebral artery can be avoided with the use of specific precautionary techniques. Palsies of the facial and lower cranial nerves can also be avoided if reabsorbable material is used for embolization of vessels supplying cranial nerves in asymptomatic patients. In selected cases with significant supply from the internal carotid artery, special interventional techniques, including embolization of the pericarotid tumor portion through the caroticotympanic artery and pre- or peroperative balloon occlusion of the petrous internal carotid artery, allow radical removal of extensive paragangliomas of the temporal bone. Techniques and selection of materials for embolization of carotid body, vagal body, and other paragangliomas of the head and neck mainly depend on the vascular composition of the tumor and on the specific vascular territory in which the tumor is located. In this series, preoperative embolization significantly improved surgical conditions of paragangliomas of any location in the head and neck and proved to represent an essential prerequisite for successful surgery of extensive paragangliomas of the temporal bone.     

Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32–82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.     

Glomus tumors of the head-neck-region

Glomus tumors of the head and neck are rare tumors of adulthood which arise from paraganglia or glomus cells within the carotid glomus, vagus nerve, middle ear or jugular foramen. The diagnosis of these mostly benign lesions is predominantly done with CT and MRI. DSA can provide important additional information. Besides surgical resection, one therapy option is radiological intervention with tumor embolisation. Because of the typical radiological imaging and the "salt and pepper appearance" in MRI, glomus tumors can be differentiated from other lesions in the head and neck. This review gives a survey of the classification, diagnosis and therapy of paragangliomas with images to demonstrate characteristic features.