颈动脉间隙及其占位性病变的影像研究

目的:探讨正常颈动脉间隙的影像特点及比较CT、MRI对颈动脉间隙占位性病变的诊断及鉴别诊断价值。方法:分析3例正常男性颈动脉间隙的影像特点;回顾15例经手术病理证实的颈动脉间隙占位性病变,CT检查11例,MRI检查4例。结果:颈部MRI轴位图像上可清楚显示颈深筋膜各间隙的形态和毗邻关系。神经鞘瘤可显示囊变和钙化,MRI显示T2WI呈明亮高信号为其特征。颈动脉体瘤增强后肿瘤显著强化。鳃裂囊肿有其相对固定的发病部位,增强扫描无强化。淋巴管瘤显示分层液面现象为其特征,MRI可显示瘤内脂肪、出血和纤维分隔等不同成分,对鉴别诊断有一定价值。不同来源的肿瘤与颈内、外动脉或颈总动脉和颈内静脉的位置关系有解剖上的相关性,有利于准确的定位和鉴别诊断。结论:颈深部疾病影像检查应首选MRI。根据病变所在的解剖平面、强化扫描特点及其与颈部血管的关系,CT和MRI对大部分颈动脉鞘病变有定性诊断及鉴别价值。

Radiologic diagnosis of carotid space and the space-occupying lesions in it

Objective :To analyze the imaging features of carotid space(CS)and space-occupying lesions in it for investigating the differential diagnosis of masses in this area and selecting the proper imaging method in these cases. Methods:Carotid space of 3 normal people were explored,while that of 15 cases of CS lesions confirmed by histopathology were examined by CT (11 cases) and MRI (4 cases). Results:On the axial planes of the MR imaging,the shapes and relations of the deep cervical fascial spaces were clearly observed. The cases of myoschwannoma showed cystis degeneration and calcification and had characteristic light high signal in T2WI in MR. Carotid body tumor can be extremely enhanced. Branchial cleft cyst had the relatively fixed location and hadn't been enhanced. Lymphadenoma had the characteristic of laminated appearance and showed different component on MRI,such as fat,hemorrhage and fibrous septa which were benefit to the differential diagnosis. The relationship,which is important in differential diagnosis,between the great vessel and carotid spaces mass,was observed. Conclusions:MRI is superior to CT in diagnosis of the deep cervical diseases. According to the anatomic location and the pattern of enhancement and relationship with the great vessel in CS,most of lesions can be identified by CT and MRI.