鼻腔嗅神经母细胞瘤的CT分析

CT Analysis of Nasal Esthesioneuroblastoma

目的 :探讨CT在嗅神经母细胞瘤诊断、分期中的价值。材料和方法 :回顾性分析本院1992～2002年经手术病理证实的21例嗅神经母细胞瘤的CT资料。结果 :21例术前CT检查 ,按Kadish分期标准 :A期1例 ,B期6例 ,C期14例。5例平扫病灶为软组织密度 ,16例平扫 +增强病例 ,其中12例呈中等不均匀强化 ,4例呈明显不均匀强化。全组病例均有骨破坏 ,其中3例可见钙化灶 ,2例钙化或骨破坏碎骨片不能区分 ,2例可见骨质增生。病灶侵犯鼻腔21例 ,筛窦19例、蝶窦12例 ;上颌窦9例 ,额窦5例 ;眼眶侵犯8例 ,其中侵犯视神经管2例 ;颅内侵犯9例 ,其中侵犯前颅底脑外7例 ,海绵窦、额叶各2例 ,蝶鞍、鞍上池各1例 ;翼腭窝、口咽腔侵犯各4例 ;颞下窝、口咽部、鼻泪管、泪囊、面颊部软组织、鼻背部软组织侵犯各1例。有3例伴双侧颈部淋巴结转移。结论 :CT检查主要为显示肿瘤的侵犯范围 ,从而为临床制定治疗方案提供依据。冠状面扫描显示颅内、眼眶的侵犯更为清晰 。

Purpose:To assess the role of CT in the diagnosis and staging of esthesioneuroblastoma.Materials and Methods:CT images of21cases of nasal esthisioneuroblastoma provde by surgery and pathology from1992to2002were analyzed retrospectively.Results:On preoperative check up,according to Kadish staging,1case was in stage A,6in stage B,14in stage C.Unenhanced CT scans were performed in5of21cases,the tumors show soft tissue density;In the16cases on plain scan and endanced CT,the tumors were moderately and heterogeneously enhanced in12,markedly enhanced in4cases.All cases were alˉmost accompanied by bony erosion.The calcification was found inside of the tumor in3cases.It can not be differentiated from tumor calcification to bony fragments in tow cases.Two tumors were found hyˉperostosis.Tumor invasion involved nasal cavity(21cases);ethmoid sinus(19cases),sphenoid sinus(12cases),maxillary sinus(9cases),frontal sinus(5cases);orbital cavity(8cases),and2of them involved to optic canal;intracranial(9cases),and7of them involved anterior cranial fassa,2involved cavernous sinus and frontal lobe,sella turcica,suprasellar cistern(1case each);fossa pterygopalatine,nasopharyngeal cavity(4cases each);fossa infratemporalis,oropharyx,nasolacrimal duct,lacrimal saccus,soft tissue of cheek,nasal dorsal soft tissue(1case each).The bilateral cervical lymph node metastase in3cases.Conclusion:The aim of CT is to show the area of tumor involved,in order to provide the basis for clinic treatment planning.Coronal scan is an essential way of examination because in intracranial and intraorˉbital invasion of tumor could be shown more clearly.