鼻咽癌伴眶内侵犯的CT诊断(附12例分析)

CT characteristics of nasopharyngeal carcinoma with intraorbital involvement

目的 :探讨NPC眶内侵犯的CT特点。材料和方法 :收集经病理确诊的110例NPC患者中伴眶内侵犯的CT资料12例。采用西门子SOMATOMPLUS全身CT扫描机对鼻咽及眼眶进行轴位扫描 ,层厚及层距均为5mm。其中6例采用An giografin进行了增强扫描。结果 :①鼻咽癌患者110例 ,其中伴眶内侵犯12例 ,其发生率为10 9 % ;②眶内侵犯部位 :眶尖8例(其中4例包绕视神经 ,1例视神经增粗) ,占66 7 % ;眶内肌锥外3例 ,占25% ;外直肌单独受侵1例 ,占8 3% ;③侵犯途径 :向上侵犯海绵窦 ,经眶上裂或视神经管入眶 ,占73 3%(11/15部位) ,向前上侵犯翼腭窝 ,经眶下裂入眶 ,占13 3%(2/15部位) ;向前外上扩展至翼腭窝、颞下窝 ,破坏外侧壁入眶 :占6 67 %(1/15部位) ;向前内上破坏筛窦纸板入眶 ,占6 67%(1/15部位)。④颅底骨质改变 :眶上裂增宽11例 ,眶下裂增宽2例 ,眶外侧壁骨质破坏1例 ,蝶骨体破坏3例 ,蝶骨大翼2例 ,岩尖、斜坡及筛骨纸板破坏各1例 ,破裂孔及卵圆孔破坏或吸收扩大各5例。结论 :CT可以精确显示NPC眶内侵犯的部位、程度、侵犯途径 ,对鼻咽癌的分期。

Objective:To study CT characteristics of nasopharyngeal carcinoma (NPC) with intraorbital involvement.Materials and Methods:12 cases of intraorbital involvement among 110 cases of NPC proved by pathology were reviewed respectively.CT scanning was performed in all patients with 5mm axial scans with 5mm spacing,and 6 cases were enhanced with angiografin.Result:①110 cases of primary lesions of NPC and 12 cases of them with intraorbital involvement;②the sites of intraorbital involvement:orbital apex,8 cases;intraorbital but out of the muscle cone,3 cases;involvement of extraocular muscle only,1 case with the lateral rectus muscle involvement;③directions of involvement:the main direction of NPC with intraorbital involvement was divided into four directions,which were superior extensions,anterosuperior extension,anterosuperolateral extension and anterosuperomedial extension;④destructions of skull base were often detected.Conclusion:CT can accurately provide the sites,extend,and the routes of NPC with intraorbital involvement,and is helpful in T staging of NPC,radiotherapy and prognosis.