颈部囊性病变的CT检查

CT Examination of Cervical Cystic Lesions

目的:分析颈部不同囊性病变的CT表现,进一步提高对颈部各种囊性病变的认识。方法:回顾性分析经手术、病理证实的颈部囊性病变42例,其中鳃裂囊肿19例,淋巴结囊性变8例,淋巴管瘤3例,甲状舌管囊肿2例,神经鞘瘤4例,甲状腺乳头状腺癌6例。全部病例均行层厚、层距为5～10mm的CT平扫;36例作增强扫描。结果:颈部囊性病变形态基本规则、光整,19例鳃裂囊肿大部分位于上颈部,且绝大部分与颈动脉鞘相毗邻;8例囊变淋巴结均与颈动脉鞘相邻;2例甲状舌管囊肿在颈前区与甲状软骨关系密切;4例囊变的神经鞘瘤多数位于椎前间隙的肌肉间隙内;6例甲状腺乳头状腺癌均为下颈部甲状腺区恶性囊性占位。伴感染的鳃裂囊肿、转移性淋巴结、甲状舌管囊肿、甲状腺乳头状腺癌可有囊壁强化改变,甲状腺乳头状腺癌更有较为特征性的囊内乳头样结节改变。囊性病灶增大后会对周围结构产生占位效应,部分恶性及伴有感染的良性病灶与周围组织界限不清。结论:颈部不同囊性病变所处的解剖位置有一定的分布特点,CT表现亦有除囊性外的各自特点,综合分析可提高颈部囊性病变诊断及鉴别诊断的准确性。

Objective:To analyze C T findings in patients with cystic lesions of the neck,improving the diagnosis o f various kinds of cystic cervical lesions.Methods:The CT findings of42patients with cystic lesions at the neck(proved by operation and pathology)were retrospec tively reviewed,including19branchial cleft cysts,8cystic lymph nodes,3lymphangio ma,2thyroglossal duct cysts,4cystic schwannoma,6papillary carcinoma of thyroid.O f these lesions,36were scanned in en-hancement.Results:The shape of these lesio ns were almost normal.Most branchial cleft cyst were at upper neck and near the carotid space;all the cystic lymph nodes were near the carotid space;thyroglossa l duct cysts were the cystic le-sion which near the thyroid cartilage;schwannom a more likely occurred at the prevertebral space;papillary carcinoma were the ma lignant tumors of the thyroid gland.Branchial cleft cyst with infection,metastat ic lymph nodes,thyroglossal duct cysts,papillary carcinoma of the thyroid had th e enhanced sign of the cystic wall,and papillary carcinoma of the thyroid have t he characteristic psammoma bodyies.Large lesions had the mass-effect.Some malig nant lesions and benign lesions with inflammation have ill-defined margin.Concl usion:The anatomical location of cervical cystic lesions and CT findings are ver y useful factors in correct diagnosis.