28例中耳副神经节瘤影像学分析

Imaging Features of 28 Cases of Middle Ear Paragangliomas

目的分析和评价中耳副神经节瘤的临床和影像学表现。方法回顾性分析28例经手术病理证实的中耳副神经节瘤的临床及影像学表现。其中20例行高分辨率CT(HRCT)检查,5例行CT增强扫描,27例行MRI检查,22例行DSA检查。结果 28例患者中,男16例,女12例,发病年龄14~73岁,平均37.8岁。临床主要表现为搏动性耳鸣和听力下降。影像学上,CT骨窗显示颈静脉孔及其周围骨质侵蚀性破坏,边缘毛糙(95%)。增强CT和MRI可见软组织肿块,增强后呈明显强化(100%)。MRI平扫T;WI和T;WI可见典型的"盐-胡椒征"(85.2%)。肿瘤平均表观扩散系数(ADC)值为0.97×10^(-3)mm^(2)/s(n=18)。时间信号强度曲线(TIC)呈"速升流出"型(94.4%)。氢质子磁共振波谱成像(;H-MRS)可见胆碱峰(77.8%)。DSA表现为富血供肿瘤染色(100%),最常见的供血动脉为咽升动脉(54.5%),其次为枕动脉(45.5%)。结论 HRCT及MRI应作为中耳副神经节瘤常规影像学检查,特别是MRI功能成像对鉴别诊断很有帮助。DSA对栓塞和手术治疗有很大帮助。

Objective To analyze the clinical manifestations and radiographic features of middle ear paragangliomas. Methods The clinical and imaging findings of 28 patients with histopathology-proven middle ear paragangliomas were retrospectively analyzed.20 patients underwent HRCT,5 patients with enhanced CT,27 patients with MRI,22 patients with DSA. Results Among the 28 patients, 16 were male and 12 were female. Patient age ranged from 14 years old to 73 years old with a mean of 37.8 years old.The main clinical manifestations were pulsatile tinnitus and subjective hearing loss.Radiologically, CT bone window showed an aggressive bone erosion with indistinct margins of the wall of the jugular foramen and surrounding bones(95%).All lesions were solid masses with obvious enhancement on contrast-enhanced CT and MRI(100%).MRI showed a typical “salt and pepper” sign in soft mass on T;WI and T;WI(85.2%). The mean ADC value was 0.97×10;mm;/s(n=18). The TIC showed a rapid rise and outflow curve(94.4%). The choline peak was seen on;H-MRS(77.8%).DSA showed highly vascular tumor(100%) and the most common supplying vessel wasthe ascending pharyngeal artery(54.5%),followed by occipital artery(45.5%). Conclusion HRCT and MRI should be taken as routine preoperative examination of middle ear paraganglioma. Functional MRI was especially very helpful for differential diagnosis. DSA was helpful for embolization and surgical treatment.