鼻咽腔和鼻咽壁异常影像的鉴别诊断

The differential diagnosis of abnormal image in the nasopharyngeal cavity and wall

目的 提高对鼻咽腔和鼻咽壁异常影像鉴别的认识。方法 搜集鼻咽腔和鼻咽壁异常影像患者 6 5例 ,经手术病理证实者 2 0例 ,经病理活检证实 4 5例。全部病例做了CT和 (或 )MR检查 ,详细分析其影像学表现。结果 鼻腔后鼻孔息肉和内翻乳头状瘤突向鼻咽腔者 19例 ,与鼻咽壁之间有小气泡影、呈间断性接触表现者 18例 ,前者肿块边缘规则 ,后者不规则。鼻咽炎、腺样体肥大 11例 ,均位于顶后壁 ,前缘平直或内凹 ,CT增强和MR检查均见黏膜线连续 ;1例右侧口咽炎延至鼻咽右侧壁 ,无清楚的边缘 ,占位效应轻微。鼻咽癌 33例和非霍奇金淋巴瘤 1例 ,肿块前缘弧形前凸 ,多数伴有咽隐窝变浅或消失和腭帆提肌肿大。结论 鼻腔后鼻孔良性肿块突向鼻咽腔 ,呈间断性接触表现 ;鼻咽良性病变多位于顶后壁 ,其前缘平直或凹陷 ,黏膜线影连续 ;鼻咽腔恶性肿块前缘多呈弧形前凸 ,鼻咽癌多有腭帆提肌受累。

Objective To improve the differential diagnostic accuracy of abnormal image in the nasopharyngeal cavity and wall.Methods Sixty-five cases with abnormal image in the nasopharyngeal cavity and wall were collected.Twenty cases were proven by operation and pathology.Forty-five cases were proven by biopsy and pathology. All the patients were examined by using CT and (or) MRI. Their imaging features were analyzed in details.Results In 19 cases, polyp and inverted papilloma in the nasal cavity and choanal projected into the nasopharyngeal cavity. Small air bubbles or contact between the lesion and the nasopharyngeal wall were detected in 18 of them. The edge of the polyp was regular, while the margin of the inverted papilloma was irregular. In 11 cases, nasopharyngitis or adenoidal hypertrophy located in the posterosuperior wall. The anterior borders were almost straight or curve toward inside, and the contrast enhanced CT and MRI scans showed that the mucous membrane lines were continuous. Oropharyngitis in the right side spread to the right wall of the nasopharynx without clear borderline and the space occupying effect was little in 1 case. There were 33 cases of nasopharyngeal carcinoma (NPC) and 1 case of non-Hodgkin′s lymphoma (NHL), and the anterior borders of the masses were evaginated like a curve, and most of them were accompanied with shallowing or disappearing of pharyngeal recess and tumefaction of the levator muscle of palatine velum.Conclusion According to the imaging features, most of the abnormalities in the nasopharyngeal cavity and wall can be diagnosed correctly.