颈动脉体瘤的影像学诊断

Imaging Diagnosis of Carotid Body Tumor

目的:探讨比较颈动脉体瘤的超声、CT、MRI、DSA的影像学表现,提高术前诊断水平。方法:回顾性分析手术病理证实的14例颈动脉体瘤的各种影像学表现及特征。结果:各种检查均可显示肿瘤部位、大小及形态,颈动脉体瘤的彩色多普勒特点为中等偏低实质回声,境界清楚,大于3.0cm的肿瘤可见管道结构,但肿瘤上缘观察欠清,14例行彩色多普勒超声其中9例可显示瘤内网状血管,有1例神经鞘瘤误诊为颈动脉体瘤,诊断符合率为93%(14/15)。14例均行CT平扫加增强,CT增强显示为富血管肿瘤,其中12例肿瘤均匀强化,2例呈明显不均匀强化,CT值150～180HU,颈内、外动脉密度与瘤体等同难以分辨,术前CT诊断符合率为100%(14/14)。11例患者行MRI及MRA检查,MRI平扫特点为瘤内见流空的血管影像,明确显示颈内、外动脉分离和紧贴或镶嵌在肿瘤后外缘及前外缘,MRA能良好显示肿瘤与颈总动脉及其分叉的关系,术前MRI诊断符合率为100%(11/11)。其中8例同时行DSA血管造影,除能明确诊断和显示供血动脉外,DSA能清晰显示其血供及与颈内、外动脉的关系,术前DSA诊断符合率为100%(8/8)。结论:彩色多普勒超声、CT和MRI对颈动脉体瘤均有很高的诊断价值,差异无显著性意义。

Objective： To compare the imaging manifestations of ultrasonography,CT, MRI and DSA for improving preoperative diagnosis of carotid body tumors （CBT）. Methods：Fourteen cases of CBT were confirmed by pathology,inclu ding 10 cases of unilateral ones and 4 cases of bilateral ones. The imaging manifestations of CBT were analyzed retrospectively. Results： Each imaging examination could display well the location, size and form of the tumor. The specific sonogram of CBT was isoechoic or hypoechoic solid lesion and small tubular areas could be seen in masses measured over 3cm in diameter,but the upper borderline of the tumor appeared indistinctive. Colour Doppler ultrasound showed web-like vessels inside the tumor in 9 cases,and 1 case was misdiagnosed as schwannoma. The rate of correct diagnosis was 93 % （14/15）. Fourteen cases were examined by helical CT enhancement, which reflected the hypervascular nature of CBT. In 12 cases the tumor could not be distinguished from the internal and the external carotid arteries because they were evenly enhanced and 2 cases were unevenly enhanced. The CT values were 150 - 180HU. The preoperatiove correct diagnosis rate was 100% （14/14）. Eleven cases were examined with MRI and MRA. MRI imaging of CBT featured flow void tumor vessels,and in ternal and external carotid arteries attached to or embedded respectively in the rear and the front of the external side of rnas ses,distinctively seperated. MRA showed clearly the distinction between CBT and common carotid arteries and their branches. The rate of correct diagnosis was 100% （11/11）. Eleven cases were examined with DSA. Angiography could confirm diagnosis and showed feeding vessels. The rate of correct diagnosis was 100% （8/8）. Conclusion： Ultrasound,CT and MRI are valuable and specific in diagnosis of CBT. There is no statistically significant difference in 4 kinds of imaging diagnostic methods.