鼻咽纤维血管瘤的CT诊断

CT Diagnosis of Juvenile Angiofibroma

目的 :探讨鼻咽纤维血管瘤的CT表现及其分期诊断。材料和方法 :回顾性分析40例鼻咽纤维血管瘤的CT资料 ,对肿瘤大小、侵犯范围、密度、形态、边界和骨质等进行观察分析。结果 :按Chandler分期 :Ⅰ期9例 ,Ⅱ期9例 ,Ⅲ期13例 ,Ⅳ期9例。侵犯部位最多为蝶窦和眼眶(包括眶上下裂) ,均为18例 ;其次为翼腭窝和鼻腔 ,各为14例 ,颞下窝和颅内海绵窦侵犯各9例 ,少数病例肿瘤侵犯面颊部和上颌窦。Ⅰ和Ⅱ期肿瘤相对较小 ,类圆形 ,边界清楚光滑 ;Ⅲ和Ⅳ期肿瘤较大且不规则 ,沿颅底孔缝扩展 ,呈哑铃状或分叶状。平扫时肿瘤密度均匀 ,与周围分界不清 ,增强后扫描肿瘤增强极显著 ,边界清楚 ,其中3例肿瘤中有混杂的不规则囊样低密度区 ,1例呈“囊肿”状。所有病例颅底骨质均有不同程度受压和吸收破坏。结论 :增强后CT可对鼻咽纤维血管瘤作出明确诊断及分期 ,对临床诊断和治疗具有重要价值 ,应作为本病的首选检查方法。

Purpose:To analyze the CT manifestations and stage diagnosis of juvenile angiofibroma.Materials and Methods:40 cases of juvenile angiofibroma are retrospectively analyzed according to tumor size,location,density,shape,margin and surrounding bones.Results:According to Chandler at al classification,there were 9 cases of stage Ⅰ,9 cases of stage Ⅱ,13 cases of stage Ⅲ and 9 cases of stage Ⅳ.The most frequent invading sites were sphenoid sinus and orbit (also including inferior and superior orbital fissure),both of 18 cases.The next frequent invading sites were pterygopalatine fossa and nasal cavity,both of 14 cases.Invasion into infratemporal fossa and cavernous sinus happened in 9 cases.Cheek and maxillary sinuse were involved in a few of cases.Tumors of stagesⅠ and stagesⅡ were relatively small and round,with clear margins,while tumors of stageⅢ and stagesⅣ were larger and irregular,expanding along skull fissures,with dumbbell-like or nodal shapes.The tumors were homogeneous and could not be differentiated from surrounding tissues in plane scan,while in contrast CT images the tumors were grossly enhanced so that they could be clearly differentiated from surrounding structures.Three cases had low density in the center of tumors and one case had a total cyst-like change.All cases showed either slight or remarkable pressure and bone destruction over the base of skull.Conclusion: CT examination can provide accurate diagnosis and stage classification for juvenile angiofibroma and it has a high value in surgical management.It can be used as the first choice of examination for this disease.