颈部搏动性肿块的影像学诊断

Imaging diagnosis of cervical pulsatile masses

目的 探讨颈部搏动性肿块的影象学诊断价值，并着重分析其血管造影征象。材料与方法 经病理和临床证实的颈部搏动性肿块患者３２例，其中颈动脉体瘤９例、动静脉瘘７例、颈动脉瘤５例、颈部假性动脉瘤３例、颈动脉迂曲症７例和巨大蔓状血管瘤１例。所有患者均行选择性颈动脉造影，２０例行血流超声检查、４例行ＣＴ检查、１例行ＭＲ检查。结果 ３２例患者中术前血管造影正确诊断３１例，其中２１例与病理结果相符，仅有１例假性动脉瘤误诊为真性动脉瘤；所有病变均显示其大小、起源和与周围大血管的关系。２例假性动脉瘤和５例颈动脉迂曲症彩超术前误诊为真性颈动脉瘤。结论 选择性颈动脉造影是一种安全可靠的低创伤性影像学检查方法，结合其他影像学技术如彩超、ＣＴ、ＭＲ等可准确做出定位和定性诊断。

Objective To explore the value of imaging diagnosis for cervical pulsatile masses and to analyze emphatically their characteristics on angiographic images. Methods Thirty - two patients with surgically and clinically proven cervical pulsatile masses which included 9 carotid body tumors, 7 arteriovenous fistula, 5 carotid artery tumors. 3 cervical pseudoaneurysms, 7 carotid artery flexuous signs. and 1 macro angioma arteriale racemosum initially underwent selective carotid arteriography, in addition, 20 patients underwent bloodflow Doppler sonography, 4 patients underwent computed tomography (CT), and 1 patient underwent magnetic resonance (MR) examination. Results Among the 32 patients with cervical pulsatile masses, the previous angiography correctly diagnosed 31 patients (96.8% ) in whom the angiographic findings in 21 patients were corresponding to that of the postoperative pathology, while only 1 patient with pseudoaneurysm was misdiagnosed as true aneurysm. At the same time. all the lesions revealed the size. origin. and relation between them and their surrounding big blood vessels. On preoperative color Doppler sonography, 2 pseudoaneurysms and 5 carotid flexuous signs were misdiagnosed as true aneurysms. Conclusion selective carotid angiography is a safe, reliable, and less - traumatic diagnostic method, if this method combine with other imaging techniques such as color Doppler sonography, CT or MR and then it can accurately does out the correct topical and qualitative diagnosis for cervical pulsatile masses.