鼻、眶及耳部腺样囊性癌CT和MRI表现

CT and MRI Features of Adenoid Cystic Carcinoma in the Sinonasal Cavity,Orbit and Temporal Bone

目的探讨鼻、眶、耳部腺样囊性癌CT和MRI表现及其临床应用价值。方法19例经组织学证实为腺样囊性癌的患者,回顾性分析所获得的16例CT和11例MRI表现。结果19例中起源于鼻腔6例、鼻窦4例、外耳道7例、泪腺2例,肿块呈不规则形8例、分叶状2例、椭圆形6例、圆形3例,大小为1cm～3cm者11例、>3cm者6例、<1cm者2例,边界不清14例、边界清楚5例。平扫CT显示密度欠均匀9例、密度均匀7例,肿瘤周围骨质以受压为主,局部呈"虫蚀状"破坏10例、溶骨性破坏4例;仅为骨质受压1例;无骨质改变1例。MRT2WI上肿瘤呈等、高混杂信号,T1WI呈低信号,增强T1WI为不均匀"筛状"强化。结论鼻、眶、耳部腺样囊性癌较典型的影像学表现为T2WI和增强T1WI上"筛状"改变、相邻骨质以受压膨胀为主、局部虫蚀样骨质破坏,CT显示骨质改变优于MRI,MRI显示"筛状"改变及病变范围更清楚。

Objective To investigate the clinical applications of CT and MRI features in diagnosing adenoid cystic carcinoma （ACC） in sinonasal, orbital and aural region. Methods CT scannings were done in 16 patients with ACC in sinonasal, orbital and aural region confirmed by pathology, and 11 patients underwent MRI. The CT and MRI features were arialyzed retrospectively. Results The lesions occurred in sinonasal cavity in 10 cases, external auditory canal in 7 cases and lacrimal gland in 2 cases. The masses displayed irregular shape in 8 cases, lobular shape in 2 cases, elliptical shape in 6 cases and round shape in 3 cases. The sizes of the lesions were from one to three centimeters in 11 cases, above three centimeter in 6 cases,and below one centimeter in 2 cases. ACC demonstrated well-defined margin in 14 cases and hazy margin in 5 cases. On CT scans, ACC revealed inhomogeneous density in 7 cases, homogeneous density in 7 cases.Bone compression with local destruction were founded in 14 cases, bone compression without destruction in 1 case, and no bone involvement in 1 case. MR T2WI demonstrated hypointense signal, MR T1WI showed homo- and hyper-intense signal and postcontrast MR imaging displayed heterogeneous contrast enhancement in 11 cases. Conclusion ACC in sinonasal, orbital and aural region should be considered in patients who have the typical CT and MRI features. Bone changes were detected by CT better than MRI, and MRI can demonstrate more accurately the invading extent of ACC.