脑池段和颞骨内面神经病变的影像学研究

Imaging study of cisternal and intratemporal segment of facial nerve disease

目的探讨面神经病变的影像学方法的选择以及影像学表现。方法回顾性分析所有颞骨HRCT、颅底MR平扫及增强检查显示面神经异常的病例49例,分析各种病变的影像学表现。结果49例病人中,8例面神经炎(面神经内耳道远段和迷路段明显强化),14例面神经肿瘤,其中神经鞘瘤和神经纤维瘤12例,多段面神经受累4例,乳突段5例,膝段3例,面神经膝段胆脂瘤2例。外伤性面神经损伤10例(HRCT示面神经管狭窄、断裂),血管性压迫8例(MR显示迂曲的血管压迫面神经)。结论面神经炎的病人首选MR增强检查。反复持续面瘫病人需行HRCT和MR平扫、增强检查。外伤病变首选HRCT,面肌痉挛病人首选梯度回波T1WI。影像学检查能够清晰显示面神经的各种病变。

Objective To study the choice of imaging modality and appearance in evaluating the facial nerve disease. Methods Forty-nine patients with abnormal appearance of HRCT or MRI were retrospectively analyzed. Results Among 49 patients, 8 cases suffered from facial neuritis （distal intracanular and labyrinthine segment were obviously enhanced）, 14 cases were confirmed tumor of the facial nerve by pathology,12 were schwannoma and fibroma （4 multiple segment involved, 5 for mastoid segment, 3 for genu segment）, 2 were primary choleasteoma of the genu segment. Ten cases were facial nerve posttraumatic injury （HRCT showing stenosis and fracture of the facial nerve canal）. Eight cases were vascular compression （RF-FAST T1WI showing the close relationship between the nerve and tortuous vessels）. Conclusion The first choice of neuritis is contrast MR. The patients with recurrent and persist facial palsy should perform HRCT and contrast MR scan. HRCT was first choose with traumatic patients and RF-FAST T1WI sequenced were performed in patients with facial spasm. The HRCT and MRI can clearly show the pathology of the facial nerve.