颈部囊实性病变的CT诊断

CT diagnosis of cystosolid lesions concerning neck soft tissue

目的:探讨颈部软组织囊实性病变的CT诊断。方法:回顾性分析35例经手术和病理证实的头颈部软组织囊实性病变CT表现。结果:病变CT表现分为3种:①单房单囊6例,增强后囊液及囊壁不强化;②多房多囊8例,以囊性成分为主,增强后囊液不强化,囊壁呈不规则厚壁环形强化,无壁结节;③多房多囊21例,其中以实性和坏死成分为主,增强后实质部分呈明显不均匀强化12例。合并斑点或斑块状钙化者9例。病灶周边模糊不清,与肌间组织分界不清12例。MSCT血管成像显示肿瘤血供丰富15例,包埋颈部大血管,5例将动、静脉血管分开。术后病理证实恶性肿瘤17例,其中恶性颈静脉球瘤4例,恶性纤维组织瘤3例,肉瘤样癌1例,恶性肉芽肿2例,转移性肿瘤7例,占82%(14/17)。良性肿瘤12例,其中舌骨下囊肿以及腮裂囊肿4例,神经鞘瘤5例,颈动脉体瘤3例。炎性病变6例其中淋巴结结核4例,炎性肉芽肿2例。结论:恶性肿瘤呈多房囊实性占位,增强后肿块呈不均匀强化,肿瘤血供丰富,边缘呈分叶状,包绕血管,伴有周围淋巴结转移。良性病变良性肿瘤及炎症肿块病灶呈弥漫性分布,占位效应不明显,呈单房或多房囊性占位,增强后不强化或厚壁环形强化,部分良、恶性肿瘤的发生部位有其特定性。

Objective：To investigate the CT diagnosis of head and neck soft cystosolid lesions.Methods：Retrospective analysis of CT representation of 35 cases of soft tissue cystosolid lesions confirmed by operation and pathology.Results：Pathological changes indicated by CT can be divided into three types.① single cyst with no enhancement（6 cases）;② mutiple ocular with cyst,and no enhancement in cyst fluid and wall（8 cases）;③ mutiple ocular and multiple cyst with solid and intralesion necrosis,and inhomogenous enhancement in the lesions（12 cases） and 9 with calcification.12 ill-definite margin around lesion and intermuscle,15 involve rich blood supply lesions with encased vascular,5 divide the artery and the vein.Among the postoperative pathology confirmed 14 cases of the 17（82%） malignant tumor which all belong to the third type,there are 4 malignant glomus jugular tumor,3 malignant histocytoma,1 sarcoacancer,2 malignant granuloma,and 7 metastases.As for the 12 cases of benign tumor,there are 4 infrahyoid cyst which belongs to the first type,5 neurinoma and 3 carotid body tumor which belong to the second type and are accompanied by signs of artery and vein division.Besides,there are 6 cases of inflammatory lesions,with 4 lymphatic tuberclosis and 2 inflammatory granuloma which also belong to the second type.Conclusion：Malignant tumor appear in the form of multilocular cystosolid mass,indicating irregularly and inhomogenous enhancement,with rich blood supply,lobulated margin,encased vessels,and lymphoid metastases.Benign lesions and inflammatory lesions,appearing single or mutilocular,display diffuse distribution,with no mass effect,no enhancement or thick-wall-ring enhancement.Some tumors,either benign or malignant,appear only in certain parts.