颞下间隙病变的CT影像诊断及鉴别诊断

CT Diagnosis and Differential Diagnosis of Lesions in Infratemporal Fossa

目的:探讨螺旋CT对颞下间隙病变应用诊断价值。方法:回顾性分析113例ITF病变,应用螺旋CT及全景片、华氏位对ITF病变进行影像学诊断研究,并与病理诊断及临床特征进行对照分析。结果:本组113例ITF病变经临床、X线、病理组织学证实分为肿瘤及炎症两大类,肿瘤97例(97/113),炎症16例(16/113)。肿瘤中原发恶性肿瘤19例(19/97),原发良性肿瘤9例(9/97),继发性肿瘤为邻近部位肿瘤侵犯ITF69例(69/97),其中包括恶性61例(61/69),良性8例(8/69)。ITF恶性肿瘤CT征象大多为:窝内肿块,咽旁间隙受压移位,邻近骨质破坏,CT增强瘤体呈不均匀强化,ITF炎症CT征象:窝内弥漫性密度增高,脂肪带消失,骨质破坏少见。结论:临床上ITF肿瘤与炎症均为开口受限、面部肿胀,影像学上又都表现为窝内占位效应,常导致误诊,仅靠临床诊断非常困难,螺旋CT影像学的应用为ITF病变的诊断提供了重要指导意见,为ITF病变的治疗计划制定及预后评估提供了重要信息。其诊疗阳性率与全景片华氏位比较有显著差异性(P<0.05)。

Objective：To study the diagnosis and differential diagnosis of infratemporal fossa（ITF） lesions with spiral computed tomography（CT） . Methods：We retrospective analysed 113 cases of lesions ITF. Spiral CT,panoramic and waters imaging were used to diagnose the ITFfrom pathological and clinical characteristics. Results：The ITF lesions in our study included two types of lesions：tumor and inflammation. Of all the cases,97 were tumors（97/113） ,16 were inflammation（16/113） . Of the tumors,19 were primary malignant tumors（19/97） ,9 were primary benign tumors（9/97） ,69 were affected by the adjacent tumors（69/97） . Of the 69 cases,61 were malignant（61/69） ,8 were benign（8/69） . The signs of ITF tumors in CT images：mass in the ITF,parapharyngeal space displacement,destruction of adjacent bone,uneven enhancement;the signs of inflammation：diffuse hyperdense of the ITF,the disappearance of the fat space,but rare bone absorption. Conclusion：Tumors and inflammations in ITF have similar clinic presentations：mouth-opening limitation and facial swelling,and both of them were presented a mass in the ITF in plain films. It＇s difficult to discriminate them in clinic practice,and the CT images supply plenty of information about the lesions so that the accuracy of the diagnosis is high and there are significant differences between the CT images and the plain radiographs（P0.05） .