颈神经鞘瘤MSCT诊断与鉴别诊断-附16例分析

The diagnosis value of MSCT for neck neurilemmoma(a report of 16 cases)

目的:探讨MSCT扫描对颈部神经鞘瘤的诊断与鉴别诊断。方法:分析16例经手术及病理证实的神经鞘瘤的CT表现与鉴别。结果:16例颈神经鞘瘤,颈动脉间隙14例,其中来源于迷走神经6例,颈交感神经干4例,颈丛神经1例,臂丛神经1例,不明确4例。平扫肿瘤密度低于邻近肌肉者13例。16例均有颈动静脉受压向前或前外侧移位。6例起源于迷走神经者颈动静脉受压分离移位。肿瘤沿神经干方向生长7例。14例增强扫描瘤体实性部分CT值增加21HU-31HU,坏死囊变部分无强化。7例有部分囊变,1例完全囊变壁有钙化。结论:MSCT平扫加增强扫描有助于颈神经鞘瘤的定位定性诊断,肿瘤的位置、形态、与邻近结构关系、生长方式、增强前后密度的变化是颈神经鞘瘤与颈动脉间隙肿块CT鉴别诊断的关键。

Objective：To study the diagnosis value of multi-slice spiral CT（MSCT） for neck neurilemmoma.Methods：To review 16 cases CT findings of neurilemmoma confirmed by surgery and pathology.Results：The neurilemmoma occurred from carotid space in 14 of 16 cases,vagus nerves in 6 cases,cervical sympathetic nerves in 4 cases,cervical plexus nerve in one and brachial plexus nerve in one case and unknown 4 cases.The density of tumors less than neighborhood muscle with plain scan in 13 cases.There were forword or forword outside displacement with carotid artery and jugular vein,separations of carotid artery and jugular vein were seen in all six tumor from vagus nerves,seven mass growed along with neural stem 14 patients received enhanced scaning.The CT value increased 21-31Hu at the solid partial and no raising at the aera of necrotic or cystic degeneration.Seven cases presented partial cystic degeneration and one entirty cystic wall with calcify.Conclusion：MSCT was helpful for diagnosis of neck meurilemmoma.The key of differentiation of neurilemmoma with other carotid space mass were neoplasms position,shape,the relationship with neighborhood structure,mode of growth,and the density changes after enhanced CT scaning.