眶颅沟通性病变的CT和MRI研究

目的 研究、探讨眶颅沟通性病变的沟通路径、CT和MRI表现及其影像学特征。方法 51例患者，男28例，女23例，年龄2－68岁，平均41岁，为手术病理和随访结果证实。51例均行 CT扫描，45例行MR扫描，CT和MR增强扫描各44例。结果 通过眶上裂或视神经管沟通的颅眶沟通笥病变31例，占60.8％。其中9例通过视神经管沟通，包括4例视神经和视交叉胶质瘤、3例视神经鞘脑膜瘤，以及2例视网膜母细胞瘤侵犯视神经和视交叉；通过眶上裂沟通者，包括5例脑膜瘤、4例神经源性肿瘤、2例Tolosa-Hunt综合征、3例炎性假瘤、1例眼眶和海绵窦皮样囊肿，以及7例鼻咽癌同时侵犯海绵窦和眼眶，通过眶骨穿支血管间隙沟通的病变或骨质破坏缺损区沟通的眶颅沟通性病变20例，占39.2％，包括5例眶骨扁平性脑膜瘤、10例眶壁转移瘤、1例眶壁软骨肉瘤侵犯筛窦、额窦和额叶、3例泪腺囊腺癌侵犯颅内和1例额底脑膜瘤侵犯眼眶。结论 CT和MRI，尤其是使用脂肪抑制技术和增强扫描的T1WI能明确显示眶颅沟通性病变的沟通路径和病变特征，为制订治疗方案和手术入路提供重要和直接的依据。

Investigation of CT and MRI findings of cranio-orbital communicating lesions

Objective To investigate CT and MRI findings of cranio orbital communicating lesions so as to find out communicating passages and their imaging features. Methods Fifty one cases of cranio orbital communicating lesions confirmed by pathology and follow up results were studied. CT was performed in all cases and MRI in 45 cases. Post contrast CT and MRI was completed in 44 cases. Results There were 31 cases (60 8%) with lesions communicating between the orbital cavity and the cranial cavity through optic canal or superior orbital fissure showing communicating soft tissue mass and enlargement of optic canal or superior orbital fissure. Four cases of optic gliomas involving optic nerve and optic chiasm, three cases with meningiomas of optic nerve sheath, and 2 cases with retinoblastoma involving optic nerve and optic chiasm showed cranio orbital communicating masses through the optic canal. Cranio orbital communicating mass with enlargement of superior orbital fissure was found in 22 patients including 5 meningiomas, 4 neurogenic tumors, 1 dermoid cyst, 3 inflammatory pseudotumors, 2 Tolosa Hunt syndromes and 7 metastases from nasopharyngeal carcinoma. In addition, 20 of 51 cases (39.2%) communicated through perforating blood vessels or bony defect resulted from tumor destruction. Of these lesions, there were 10 metastases showing bone destruction in orbital walls, 5 cases with en plaque meningiomas of sphenoid bone with marked hyperostosis and widespread dural involvement, 1 chondrosarcoma involving frontal lobe and orbit, 3 adenoid cystic carcinomas involving frontal lobe, and 1 malignant meningioma with bone destruction of the superior orbital wall. Conclusion CT and MRI could definitely demonstrate communicating passages of cranio orbital communicating lesions and their imaging changes, which could contribute to diagnosis and differential diagnosis and provide valuable information for determining treatment measures and surgical approach.