动态CT增强扫描在眼眶海绵状血管瘤和神经鞘瘤鉴别诊断中的研究

Study of dynamic CT contrast enhanced scan in differential diagnosis between cavernous angioma and neurilemoma

目的探讨动态CT增强扫描鉴别诊断眶内海绵状血管瘤和神经鞘瘤的意义,指导临床手术方法的选择。方法回顾性分析我院26例经手术/病理检查证实的眶内海绵状血管瘤和神经鞘瘤患者(16例海绵状血管瘤、10例神经鞘瘤)的一般资料、动态CT增强扫描以及病理学检查结果并对比分析眶内海绵状血管瘤和神经鞘瘤的影像学表现及其组织学特点。结果海绵状血管瘤的时间与CT值密度曲线为快速上升在高峰持续较长时间,然后缓慢下降。神经鞘瘤的曲线呈速升速降型,海绵状血管瘤和神经鞘瘤肿瘤增强后1 min、5 min、10 min和最高CT值减去10 min的CT值有差别(P(0.05)(神经鞘瘤的CT值较低,即下降较多)。结论海绵状血管瘤和神经鞘瘤在动态增强CT扫描中的表现具有明显差异,运用动态增强CT扫描可作出诊断和鉴别诊断,这对于肿瘤的定性诊断和麻醉方式、手术方法的选择,都有极其重要的意义。

Objective To investigate the meaning of differential diagnosis between cavernous angioma and neurilemoma by dynamic CT contrast enhanced scan in order to direct the selection of operation method. Methods 26 cases of cavernous angioma （16 cases）and neurilemoma （10 cases）confirmed by operation and pathology were analyzed retrospectively, including the result of dynamic CT contrast enhanced scan and pathology, and contrast the imageological appearance and histological feature of cavernous angioma and neurilemoma. Results Density curve of time-CT value was rapid upstroke and continued for a long time at peak, and then began to breakdown slowly in cavernous angioma. Curve of neurilemoma seemed as speed ascend-drop type. The CT value of tumor had statistical significance at 1 st min,Sth min,10th min after enhanced scan between cavernous angioma and neurilemoma（P 〈 0.05）. In addition,The result of the CT value at peak substracting that at the lOth min had statistical significance contrasting others too （P 〈 0.05 ）. Conclusion There were much obvious difference in the representation of dynamic CT contrast enhanced scan between cavernous angioma and neurilemoma. Diagnosis and differential diagnosis could be identified by dynamic CT contrast enhanced scan, which is important for qualitative diagnosis of tumor and selection of narcosis and operation method.