鼻咽结核的MRI诊断与鉴别诊断

MRI diagnosis and differential diagnosis of nasopharyngeal tuberculosis

目的总结鼻咽结核的MRI影像学表现,提高该病的诊断及常见的鉴别诊断水平。方法回顾性分析15例经病理证实的鼻咽结核患者的磁共振图像,主要包括病变的分布、位置、范围、大小、内部结构、强化程度,颈部淋巴结肿大的情况等。结果 13例患者鼻咽结核呈息肉样肿块,2例呈弥漫性黏膜增厚,强化程度因病变所处的时期各不相同。所有鼻咽结核患者鼻咽顶部均有受累,鼻咽顶后壁受累12例,鼻咽后壁受累1例,咽隐窝受累6例,鼻咽各壁均受累1例。息肉样肿块的大小为5~20（平均10.4）mm,8例病灶中出现黑白相间条纹状信号影。未检测到相邻的肌肉侵犯或骨破坏,鼻咽部病变坏死6例。颈部淋巴结受累14例,咽后淋巴结受累14例。结论鼻咽病变出现坏死和黑白相间条纹状改变,未侵袭周围组织,伴颈部淋巴结肿大合并中央坏死与边缘环形强化可提示鼻咽结核的诊断。

Objective To summarize the magnetic resonance imaging（ MRI） features of nasopharyngeal tuberculosis,aiming to enhance the accuracy of MRI and differential diagnosis. Methods MRI data of 15 patients pathologically diagnosed with nasopharyngeal tuberculosis were retrospectively analyzed including the distribution,location,extent,size,internal structure of lesions,degree of enhancement and cervical lymphadenopathy. Results Thirteen patients with nasopharyngeal tuberculosis exhibited polypoid-like masses and two had diffuse mucosal thickening. The extent of enhancement varied according to the severity of lesions. The roof of the nasopharynx was involved in all cases. The tumors invaded into the posterior wall of the nasopharyngeal roof in 12 cases,the posterior wall of the nasopharynx in 1,the pharyngeal recess in 6 and all the nasopharyngeal walls in 1. The polypoid-like masses ranged from 5 to 20 mm in size with a mean diameter of 10. 4 mm.Signaling echo in black-and-white strip pattern was detected in 8 cases. No signs of adjacent muscular invasion or bone destruction were noted. Nasopharyngeal lesion necrosis was observed in 6 patients. Cervical lymph nodes involvement was found in fourteen patients,and retropharyngeal lymph nodes involvement was noted in fourteen patients. Conclusions Lesion necrosis and black-and-white strip pattern were detected in nasopharyngeal lesions without involvement with adjacent tissues. Cervical lymphadenopathy complicated with central necrosis and peripheral margin enhancement hints the diagnosis of nasopharyngeal tuberculosis.