泪腺腺样囊性癌的CT诊断

CT diagnosis of adenoid cystic carcinoma of the lacrimal gland

目的:评价泪腺腺样囊性癌(ACC)的CT影像表现。方法:回顾性分析经手术和病理证实的23例泪腺腺样囊性癌,结合临床和病理,观察CT表现。结果:全部肿瘤均发生在泪腺眶部,扁椭圆形11例,不规则形8例,梭型4例;肿瘤边界清楚15例,边缘不规则8例,其中肿瘤沿肌锥外间隙向眶尖生长10例,肿瘤部分包附眼球1例;肿瘤部分与外直肌和或上直肌和上睑提肌分界不清14例,蔓延到眶上裂和海绵窦1例,颞窝和中颅窝受累2例。11例(包括平扫和增强4例中的平扫)行平扫,显示肿瘤均为较高密度,其中4例密度较均匀,7例病灶内部分见小囊状、斑点状低密度改变;16例(包括平扫和增强4例中的增强)增强扫描大多为中到高度强化,其中10例强化不均匀,5例强化较均匀,1例未见强化;瘤内钙化3例。眶骨受压凹陷变薄13例,其中伴眶上裂扩大1裂;骨质吸收破坏10例。结论:泪腺腺样囊性癌的CT影像表现具有一定的特征,能为诊断定性和临床治疗提供重要依据。

Objective：To assess the imaging features of adenoid cystic carcinoma（ACC） of the lacrimal gland on CT scan.Methods：This retrospectively study included 23 patients with ACC which was surgically resected and pathologically proven.The CT results of all patients were analyzed in combination with clinical manifestations and pathological findings.Results：On CT images,all tumors located in orbital lobe of the lacrimal gland with variable appearance,11 presenting flat to oval shape,8 irregular shape and 4 fusiform shape.There were 15 tumors with well-defined margin and 8 tumors with irregular edge.Ten tumors were found that grew to orbital apex through extraconal space,and one case encased the eye-globe.The tumors infiltrated to the lateral rectus muscle,superior rectus muscle and levator muscle of the upper lid in 14 cases;the tumor was spread to superior orbital fissure and cavernous sinus in 1 case;the tumors involved temporal fossa and middle cranial fossa in 2 cases.Tumors appeared as relatively dense mass in 11 cases on non-contrast CT images,4 as homogenous mass and 7 as heterogeneous mass.Sixteen tumors showed moderate to high enhancement after contrast injection,10 as heterogeneous mass and 5 as homogenous mass,only 1 tumor showed no enhancement.The intratumoral calcification was detected in 3 cases.The orbital bone was compressed in 13 cases,including dilation of superior orbital fissure in one case.Bone destruction was found in 10 cases.Conclusion： CT may show virtually pathognomonic features of ACC,and could be used to assist in clinical management.