鼻腔及鼻咽肌上皮瘤影像特征分析

Analysis of imaging features of nasal and nasopharyngeal myoepithelioma

目的:探讨鼻腔及鼻咽肌上皮瘤(ME)的影像特征。方法:回顾性分析本院15例经病理证实的鼻腔及鼻咽ME患者的临床及影像资料,其中良性5例,恶性10例。本组病例中15例均行CT平扫,其中5例行CT增强扫描,8例行MRI平扫加增强扫描。结果:15例鼻腔及鼻咽ME位于鼻咽4例,鼻腔11例;CT上,表现为团块状软组织密度影;10例恶性病灶中,5例合并片状低密度区,7例合并周围结构侵犯,9例合并周围骨质破坏;5例良性病灶中,3例合并片状低密度区,1例合并钙化,1例合并周围结构蔓延及邻近骨质压迫吸收;增强扫描5例病灶呈轻度至中度不均匀强化,其中4例合并囊状未强化区,3例合并结节状突出强化区。MRI上,T1WI呈低或混杂低信号,T2WI呈高或混杂高信号;增强扫描8例病灶实质部分均呈明显强化,其中6例病灶呈不均匀强化,内部合并囊状未强化区;2例呈均匀强化。结论:鼻腔及鼻咽ME影像学特征不典型,当瘤体周围合并骨质破坏时,应考虑恶性;确诊仍需依靠病理检查及免疫组化分析。

Objective:To investigate the imaging features of myoepithelioma(ME)in nasal cavity and nasopharynx.Methods:The clinical and imaging data of 15 patients with nasal and nasopharyngeal ME confirmed by pathology in our hospital were analyzed retrospectively,including 5 cases of benign and 10 cases of malignant.In this group,15 cases underwent plain CT scan,among which 5 cases underwent enhanced CT scan and 8 cases underwent plain and enhanced MRI scan.Results:Four cases of malignant nasal cavity and nasopharyngeal ME were located in nasopharynx,and 11 cases in nasal cavity.On CT,it showed mass with soft tissue density.Among 10 cases of malignant lesions,5 cases were complicated with flaky low density area,7 cases with surrounding structure invasion,and 9 cases with surrounding bone destruction.Among 5 cases of benign lesions,3 cases were complicated with flaky low density area,1 case with calcification,1 case with surrounding structure spreading and adjacent bone compression absorption.In contrast-enhanced scan,5 cases showed mild to moderate uneven enhancement,among which 4 cases were complicated with cystic unreinforced areas and 3 cases with nodular protruding enhanced areas.On MRI,T1WI showed low or mixed low signal,and T2WI showed high or mixed high signal.The parenchymal parts of 8 lesions were obviously enhanced by enhanced scan,among which 6 lesions showed uneven enhancement and internal cystic unreinforced area.2 cases were uniformly enhanced.Conclusion:The ME imaging features of nasal cavity and nasopharynx are not typical.When there is bone destruction around the tumor,malignant should be considered,and the diagnosis still depends on pathological examination and immunohistochemical analysis.