海绵窦区病变82例的影像学诊断

Imaing in the Diagnosis of the Cavernous Sinus Diseases: A Report of 82 Cases

目的探讨海绵窦病变的影像学表现,旨在提高海绵窦病变的诊断准确性。方法回顾性分析经临床、病理证实的82例海绵窦区病变的影像学表现。其中CT检查47例,CT血管造影(CTA)27例,MRI平扫及增强检查42例,数字减影血管造影(DSA)检查17例。结果1)血管性病变:海绵状血管瘤7例,动脉瘤20例,颈内动脉海绵窦瘘7例;2)炎症性病变:痛性眼肌麻痹综合征1例,副鼻窦炎症侵及海绵窦2例,硬膜外脓肿侵及双侧海绵窦1例;3)肿瘤性病变:脑膜瘤8例,三叉神经瘤3例,肺癌海绵窦转移2例,侵袭性垂体瘤累及海绵窦25例,垂体癌1例,鼻咽颅底恶性淋巴瘤1例,蝶窦腺样囊性癌侵及1例,脊索瘤侵及3例。结论海绵窦血管性病变以CTA诊断最为满意,可以行DSA检查同时给予介入治疗。海绵窦肿瘤和炎性病变,则以MRI多方位成像为最佳。

Objective To study imaging findings in the diagnosis of the cavernous sinus diseases and improve accuracy of diagnosis in the diseases. Methods lmaing findings of 82 patients with the cavernous sinus diseases proved by clinical and pathology were reviewed retrospectively. Among of them, 47 cases were performed with CT;27 cases were performed with CT angiography; 42 cases were performed with MR;17 cases were performed with DSA. Results （1） 34 cases of vascular diseases included 7 cases of cavemous hemangioma, 20 cases of aneurysma and 7 cases of carotid cavernous fistula; （2） 4 cases of inflammatory diseases included 1 case of Tolosa- Hunt syndrome, 2 cases of paranasal sinuses invasion to cavernous sinus and 1 case of Epidttral Abscess invasion to bilateral cavernous sinus; （3） 44 cases of tumorous lesions included 8 cases of meningioma, 3 cases of trigeminal nerve tumor, 25 cases of invasive pituitary adenomas located at cavernous sinus and 1 case of adenomas. Conclusion CTA can improve the diagnositic accuracy of cavernous sinus vascular diseases. Patients can be given intervenient treatment while being performed with DSA. MR/is one of the best methods for the diagnosis of cavernous sinus inflammatory diseases and tumnorous lesions.