颞骨郎格尔汉斯细胞组织细胞增生症的CT及MRI表现

CT and MRI preliminary study of Langerhans' cell histiocytosis in temporal bone

目的 探讨颞骨郎格尔汉斯细胞组织细胞增生症的CT及MR影像学特点。方法 回顾性分析 10例经病理证实的颞骨郎格尔汉斯细胞组织细胞增生症 ,10例均经过CT检查 ,其中 5例作过MRI检查。结果 5例仅见颞骨病变 ,其余 5例同时累及其他脏器。CT发现 10例都累及外耳道和乳突 ,8例并累及岩部和鳞部 ,7例累及中耳 ,听小骨及内耳骨迷路破坏各 2例。CT显示 10例颞骨病变区均呈大块溶骨性破坏 ,轮廓不整 ,8例边缘清楚无硬化 ,伴大的软组织肿块 ,有明显强化 ;MRI发现 5例都累及外耳道和乳突 ,4例并累及岩部及鳞部 ,3例累及中耳 ,1例内耳膜迷路破坏 ,MRI显示5例颞骨病变在T1WI呈等或低信号 ,T2 WI呈高信号 ,其中 3例呈明显强化。结论 CT可清晰显示颞骨郎格尔汉斯细胞组织细胞增生症的骨质改变 ,具有重要诊断价值 ;MRI能清楚显示病变范围 ,帮助选择最佳治疗方案 ;2种影像检查方法结合对颞骨郎格尔汉斯细胞组织细胞增生症的诊断、治疗和随访具有重要意义。

Objective To study the CT and MRI features of Langerhans′ cell histiocytosis affecting the temporal bone. Methods Ten cases of Langerhans′ cell histiocytosis of the temporal bone proved by clinical materials and pathology were retrospectively analyzed. CT was performed in all the 10 cases. MRI was also performed in 5 cases. Results Temporal bone involvement presented as an isolated manifestation in 5 cases and was associated with lesions of other organs in the remaining 5 cases. External auditory canal and mastoid process were involved in 10 cases, squamous and petrous parts in 8 cases, and middle ear in 7 cases on CT scans. Destruction of ossicles and bony labyrinth were detected in 2 cases, respectively. CT showed massive lytic destruction in the affected region, associated with large soft tissue masses. The lesions had irregular border and well defined margin without osteosclerosis in 8 cases. On MR imaging, external auditory canal and mastoid process were involved in 5 cases, squamous and petrous parts in 4 cases, middle ear in 3 cases, and membranous labyrinth in 1 case. The lesions were isointense or hypointense compared to brain on T 1WI and hyperintense on T 2WI in 5 cases. Postcontrast CT and MR imaging scans demonstrated marked enhancement. Conclusion CT may clearly depict the bony lesions of the temporal bone in Langerhans′ cell histiocytosis, and enhance the diagnostic accuracy to a great degree. MRI may effectively define the extent in the temporal bone, especially the intracranial invasion, and aid the selection of the optimal treatment procedure. Together with the two imaging modalities, the diagnosis, treatment, and follow up would be greatly improved in patients with the temporal bone Langerhans′ cell histiocytosis.