眶壁转移瘤的CT和MRI诊断

CT and MRI diagnosis of metastases in the orbital walls

目的分析研究眶壁转移瘤的CT和MRI特点,提高诊断准确率。方法回顾性分析23例经手术病理证实的眶壁转移瘤的CT和MRI表现,成人组16例,儿童组7例。所有病例均行CT平扫与MR平扫和增强扫描。结果16例成年患者CT表现均为溶骨性骨质破坏和眼眶不规则肿块,9例骨质破坏区邻近的颅内可见扁平不规则肿块;16例MRI表现为骨质破坏区邻近的眼眶和颅内均可见略长T1、略长T2信号的不规则软组织影,增强后呈明显强化。7例儿童患者CT表现均为溶骨性骨质破坏和眼眶不规则肿块,其中2例可见垂直针状高密度影,3例骨质破坏区邻近的颅内可见扁平不规则软组织肿块;MRI显示7例骨质破坏区邻近的眼眶内和6例颅内可见略长T1、略长T2信号不规则的软组织影,其中1例为双侧,增强后呈明显强化;7例双侧眶骨、4例斜坡和双侧岩尖及1例双侧颞骨鳞部骨髓腔呈略长T1、略长T2信号影,增强后呈明显强化。结论眶壁转移瘤的CT和MRI表现有一些特点,有助于诊断和鉴别诊断。

Objective To evaluate CT and MR imaging findings and to refine the diagnostic accuracy of metastases in the orbital walls. Methods CT and MR imaging findings in 23 patients with metastases occurring in the orbital walls confirmed by surgery and pathology were investigated retrospectively. Twenty-three patients consisted of 16 adults and 7 children. Both CT and MR imaging including pest-contrast MR imaging scanning were performed in all 23 patients. Results In sixteen adult patients, an orbital mass with lyric bony destruction was observed on CT in all 16 patients, with an irregular intracranial mass adjacent to the lyric bony destruction in 9 patients. MR imaging demonstrated heterogeneous orbital and intracranial masses adjacent to the lyric bony destruction, which appeared mildly low signal intensity on T1 -weighted images and increased intensity on T2-weighted images and marked enhancement in all 16 cases. In seven children with metastatic lesions, CT showed an orbital mass with lytic bony erosion in 7 and an intracranial mass adjacent to the lytic bony erosion in 3 cases. Perpendicularly irradiating high-densities was seen on CT in two children. MR imaging demonstrated mildly long T1 and long T2 signal intensity masses in the orbital cavity in 7 patients and in the intracranial cavity in 6 patients with enhancement of masses after contrast administration. Extensive soft tissue masses showing long T1 and long T2 signal intensity and pest-contrast enhancement were seen within bony marrow of bilaterally orbital walls in 7 patients and bilateral petrous apices and clivus in 4 cases as well as bilateral squamous part of temperal bone in one patient. Conclusion CT and MR imaging can reveal characteristic findings of metastases in the orbital bones, which can contribute to diagnosis and differential diagnosis.