影像学检查在眶颅沟通性肿瘤诊断中的价值

目的 探讨眶颅沟通性肿瘤病变的超声、CT和MRI的影像学表现特征,从而为眶颅沟通性肿瘤的准确诊断提供辅助信息.方法 1998年1月～2011年12月就诊于我院60例患者,男28例,女32例.发病年龄5～70岁,平均45岁.均经手术及病理证实.所有病例术前均行超声检查,CT扫描,MRI普通扫描,其中20例行MRI强化扫描.结果 本组资料影像学检查显示眶颅沟通性肿瘤常有3个沟通渠道.经过视神经管沟通20例,包括视神经胶质瘤8例,CT示肿瘤呈哑铃形,MRI对视神经胶质瘤的显示具有特异性;视神经鞘脑膜瘤8例,CT显示双轨征,增强后显示更明显;视网膜母细胞瘤4例,侵犯视交叉及海绵窦,CT表现为含高密度钙化的肿块,视神经增粗.经过眶上裂沟通17例,神经鞘瘤6例,MRI显示T1WI上呈中低信号,T2WI上呈高信号,不均匀强化,无强化区较具特征性;视神经鞘脑膜瘤8例,CT及MRI显示同视神经管沟通途径;特发性眼眶硬化性炎症3例,侵犯同侧海绵窦,MRI显示肿块在T1WI呈略低信号,T2WI呈低信号,增强后明显增强.经过眶壁骨质缺损与颅内沟通23例,有皮样囊肿5例,蝶骨脊脑膜瘤4例,泪腺腺样囊性癌6例,眶壁转移瘤8例.CT可较好的显示眶壁骨质的破坏,MRI可较好的显示肿瘤的颅内转移.结论 在眶颅沟通性肿瘤的影像学检查中超声、CT、MRI各有特点,综合运用超声、CT和MRI等影像学检查方法可提高诊断和鉴别诊断水平,为临床治疗提供重要和直接的依据.

Evaluation of Imageology in Diagnosis of Orbit-cranial Communicating Tumors

Objective To investigate the characteristics of ultrasonic equipment, CT and MRI in orbit- cranial communicating tumors, and evaluate the clinical role of Imageology. Methods We studied sixty cases of orbit - cranial communicating tumors, including male 28 and famale 32. The patient, s age ranged from 5 to 70 years, and the average - age was 45. All of the cases were confirmed by operation and pathology. Routine ultra- sonic equipment, CT and MRI were performed in all 60 cases, and Gd - DTPA enhancenment MRI was com- pleted in 20 cases. Results The Imageology shown there were three familiar communicating passages in orbit - cranial communicating tumors. There were 20 cases with communicating between the orbital cavity and the c/＇a- nial cavity through optic canal, including 8 optic gliomas, CT of tumor is＂dumbbell shape＂. Display of MRI has the specificity; Optic nerve sheath meningioma 8 cases, CT showed the＂dual- track＂appearance, enhanced showed more obvious; Retinoblastoma 4 cases, some lesions were involved optic chiasm and sinus cavernosus. CT performance for containing high density calcified lump, optic nerve enlargement. The communicating through superior orbital fissure was 17 cases, 6 cases of neurilemmomas, MRI showed in low signal on TIWI, has high signal on T2WI, uneven reinforcement, without reinforced region with a characteristic; 8 cases of optic nerve sheath meningioma , CT and MRI show the same as communicating through optic canal. 3 idiopathic sclerosing inflammation of the orbit, and some lesions were involved the same side of sinus cavernosus, MRI showed mass slightly low signal in TlWI, T2WI in low signal, enhanced showed more obvious. In addition, the communicating passage of bone walls defect caused by tumor destruction was 23 cases, including 5 dermoid cyst, 4 menin- gioma of sphenoid bone, 6 adenoid cystic carcinomas of lacrimal gland, and 8 orbital metastatic carcinomas. CT can better display the orbital wall bone destruction, MRI can better display of intracranial tumor metastasis. Conclusion Orbito- cranial tumors of imaging examination in ultrasonic equipment, CT and MRI have their own characteristics. Comprehensively appling checking way of Imageology, such as ultrasonic equipment, CT and MRI, etc. improving the standard of diagnosis and differential diagnosis, providing the important and direct evidence for clinical treatment.