海绵窦海绵状血管瘤影像学特点及误诊分析

Imaging Features and Misdiagnosed Analysis of Cavernous Hemangioma of Cavernous Sinus

目的探讨海绵窦海绵状血管瘤(cavernous hemangioma of cavernous sinus,CHCS)临床、影像学特点及误诊原因、防范措施。方法对经病理学检查证实的CHCS 5例(2例误诊)的临床及影像学资料进行回顾性分析,并复习相关文献。结果 5例均为女性,年龄34~56岁。2例术前误诊为脑膜瘤。误诊时间分别为2和4周。影像学检查5例均为单发病灶,3例病灶位于左侧海绵窦,2例病灶位于右侧海绵窦;4例病灶横跨蝶鞍内外生长。2例行CT平扫,病灶呈稍高密度。5例均行MRI检查,病灶T1WI图像上呈稍低信号,T2WI图像上呈高信号或明显高信号,增强扫描均呈明显均匀强化。5例中4例行病灶部分切除术后辅助放射治疗,1例病灶经外科手术完整切除;均经术后病理检查证实为CHCS。5例术后均预后良好,随访2年均未复发。结论 CHCS有一些特征性影像学表现,对该病临床及影像学特征有明确认识并改良影像学扫描模式对降低该病误诊率有一定价值。

Objective To analyze imaging features, misdiagnosed causes and prevention methods of cavernous bemangioma of cavernous sinus （CHCS）. Methods Clinical and imaging data of 5 CHCS patients （ including 2 misdiagnosed patients） was retrospectively analyzed, and relevant literature was also reviewed. Results All patients were female, and the age was 34-56 years old, of whom 2 patients were misdiagnosed as having meningloma before operation, and the misdiagnosed time were 2 and 4 weeks respectively. Imaging examination showed that the 5 patients were solitary lesions, in which 3 lesions were located in the left cavernous sinus and 2 in the right cavernous sinus; 4 lesions were grew across the internal and external sella tureiea. Plain CT images for 2 patients showed that lesions were slightly high intensity. Magnetic resonance imaging （MRI） examination for 5 patients showed that low or slightly low signal on T1WI images, high signal and significantly high signal on T2WI images and obviously homogeneous enhanced on all enhanced MRI images. Among the 5 patients, 4 patients underwent partial excision and postoperative radiotherapy, and the rest patient underwent complete excision, and CHCS was confirmed by postoperatively pathological results. The prognosis was good in the 5 patients, and no recurrence was found dur- ing 2 years of follow-up. Conclusion CHCS has some special characteristics in imaging, and therefore clinicians should improve the understanding of imaging features and change scan model in order to decrease misdiagnosis rate.