嗅神经母细胞瘤的CT和MRI影像表现

Olfactory Neuroblastoma:CT,MRI Imaging Findings and Clinical Features

目的探讨嗅神经母细胞瘤(ONB)的CT和MRI影像表现及临床特点。方法收集经手术病理证实的7例嗅神经母细胞瘤患者的CT、MRI平扫+增强的影像及临床资料,分析肿瘤部位、形态、边界、大小、密度、信号、增强特点、骨质破坏、邻近结构的侵犯等情况。结果男性4例,女性3例;年龄27~52岁,平均(41.4±7.9)岁;病史8天~6个月。CT表现7例病灶均为形态不规则的软组织密度肿块,均伴有骨质破坏。MRI表现T1WI均呈等低信号,T2WI呈等高信号。内部囊变坏死多见,增强后肿瘤实性成分呈均匀或不均匀明显强化,囊变区无强化。肿瘤大小平均约3.7±1 cm。7例患者按Kadish分期标准:A期0例,B期0例,C期6例,D期1例。C期6例中,颅脑受侵犯6例,眼眶受侵犯3例,视神经受侵犯2例,上颌窦受侵犯2例。D期1例,伴有颈部淋巴结转移。结论嗅神经母细胞瘤好发于鼻腔顶部、筛板区,多跨越颅内外生长,CT对骨质破坏的显示有明显优势,MRI扫描尤其是增强扫描可准确显示嗅神经母细胞瘤的部位、大小、形态、信号、强化特点及邻近结构的侵犯,两者结合对定位、定性、分期及治疗方案的制定有重要价值。

Objective To explore the CT,MRI imaging findings and clinical features of olfactory neuroblastoma(ONB).Methods 7 cases of clinical analyzed CT,MRI materials confirmed by pathology were reviewed retrospectively.The location,shape,boundary,size,density,signal intensity,enhancement characteristics,bone destruction and invasion of adjacent structures were analyzed.Results There were 4 males and 3 females,aged from 27 to 52 years,with an average age of(41.4±7.9)years,with a history of 8 days to 6 months.All lesions were soft tissue masses with irregular shape.Bone destruction was seen in all patients.On MRI,T1WI showed isohypointensity and T2WI isohyperintensity.Internal cystic degeneration was common and especially around the tumors.After enhancement,solid components of the tumors showed homogeneous or in homogeneous enhancement,,with mo enhancement in the cystic degeneraion area.The average size of tumors were about 3.7±1 cm.According to Kadish staging criteria,there were 0 cases in stage A,0 cases in stage B,6 cases in stage C and 1 case in stage D.In stage C,there were 6 cases of craniocerebral involvement,3 cases of orbital involvement,2 cases of optic nerve involvement,2 cases of maxillary sinus involvement.Stage D:1 case with cervical lymph node metastasis.Conclusion Olfactory neuroblastoma usually occurs in the top of nasal cavity and ethmoid plate,and usually grows across intracranial and extracranial areas.CT has obvious advantages in demonstrating bone destruction.The location,size,morphology,signal intensity,enhancement characteristics and invasion of adjacent structures of olfactory neuroblastoma can be accurately displayed by MRI scan,especially enhancement scan.The combination of the two is of great value in the localization,characterization,staging and treatment of olfactory neuroblastoma.