咽旁间隙在头颈部肿瘤MRI诊断中的价值

目的探讨咽旁间隙移位方向及肿瘤MRI信号特点对病变定位、定性的价值。方法回顾性分析经病理确诊的累及咽旁间隙肿瘤76例,其中恶性肿瘤51例,良性肿瘤25例。结果扁桃体肿瘤和鼻咽癌使茎突前间隙外移,腮腺肿瘤使茎突前间隙向前内移位,或(和)颈动脉鞘区后移。颈动脉鞘区交感神经鞘瘤使颈内动、静脉向前外侧移位,迷走神经鞘瘤使颈内动、静脉明显分离,颈动脉体瘤使颈内、外动脉分叉角增大,颈静脉球瘤使血管向前外侧移位,转移淋巴结使颈内动、静脉向前内侧移位。25例良性肿瘤边界清楚,其中9例信号均匀;51例恶性肿瘤中,19例边界模糊,15例信号欠均匀。茎突前间隙脂肪消失或不连续6例均为恶性肿瘤,肿瘤边界较清但颈部淋巴结肿大符合淋巴结转移诊断标准2例及颈内动、静脉被肿瘤包绕3例,病理证实亦为恶性肿瘤。结论咽旁间隙移位方向及肿瘤MRI信号特点对头颈部肿瘤的定位、定性具有重要的价值。

Diagnostic Value of Parapharyngeal Space for Head and Neck Tumors on MR Imaging

Objective To explore the diagnostic value of the displace direction of parapharyngeal space(PPS)and MRI features of head and neck tumors for confirming the location and nature of the lesions.Methods 76 cases of head and neck tumors histopathologically proved involving PPS were reviewed retrospectively,including 51 malignant and 25 benign lesions.Results The prestyloid space displaced laterally in tonsil tumor and nasopharyngeal carcinoma(NPC)and the prestyloid space displaced anterior-medially or/and carotid space displaced posteriorly in parotid tumor.Of the tumors located in the carotid space,there were anterior and lateral displacement of the internal carotid artery(ICA)and internal jugular vein(IJV)in neurinomas of sympathetic nerve.The ICA and IJV were separated apart in neurinoma of vagus nerve.The angle of the ICA and external carotid artery enlarged was increased in carotid body tumors.There were anterior and lateral displacement of the ICA and IJV in jugular glomus tumors,anterior and medial displacement of the vessels in metastatic nodal lymph.The border was clear in 25 benign lesions,which the signal intensity was homogeneous in 9 cases.Of 51 malignant lesions,the outline of 19 cases was vague and the signal intensity of 15 cases was heterogeneous.The fat plane of prestyloid space disappeared completely or partly were all malignant in 6 cases.Though the tumor border was clear,the lymph nodes of neck met the standard of metastatic adenopathy in 2 cases and the ICA and IJV were surrounded by tumors in 3 cases were also malignant.Conclusion The displace direction of PPS and MRI features of the tumors are of important value for confirming the location and nature of head and neck lesions.