摘要
目的:探讨咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现差异,提高两者的鉴别诊断。方法:回顾性分析2001年7月至2019年1月间广州市第一人民医院收治的临床、影像学资料、病理资料均齐全的咽旁间隙神经鞘瘤和多形性腺瘤共31例。经手术病理证实的19例咽旁间隙神经鞘瘤和12例咽旁间隙多形性腺瘤患者的CT和MRI表现,重点观察肿瘤与腮腺和颈内动脉的解剖关系。结果:咽旁间隙神经鞘瘤和多形性腺瘤均表现为类圆形肿块,境界多较清楚。CT表现为软组织密度肿块,可伴有囊变,MRI多表现为长T1长T2信号,伴有囊变者信号不均匀,增强后呈不均匀强化。神经鞘瘤与腮腺深叶间境界均较清楚,多见于颈内动脉的前内方(13/19,68%),而多形性腺瘤均与腮腺深叶分界不清且位于颈内动脉前内方(12/12,100%)。结论:在影像学表现上,绝大多数咽旁间隙多形性腺瘤与腮腺深叶分界不清而神经鞘瘤则与腮腺深叶分界清晰,很大部分多形性腺瘤位于颈内动脉的前内方而神经鞘瘤与颈内动脉的关系可呈多样性。头颈外科医师临床工作中应首先通过仔细分析咽旁间隙肿瘤与腮腺深叶解剖关系,再查找其与颈内动脉解剖关系有助于术前诊断和手术径路的选择。
Objective:To investigate the difference in imaging manifestations of schwannoma and pleomorphic adenoma in the parapharyngeal space,and to improve the differential diagnosis of the two entities.Methods:A retrospective analysis was performed of 31 patients with parapharyngeal schwannoma or pleomorphic adenoma who were treated in Guangzhou First People’s Hospital between July 2001 and January 2019,and with complete clinical,imaging and pathological data.These patients comprising 19 with parapharyngeal schwannoma and 12 with parapharyngeal pleomorphic adenoma,as confirmed by surgical pathology.The CT and MRI findings of tumors were scrutinized,with focus on anatomical relationship among tumor,parotid gland and internal carotid artery.Results:Schwannoma and pleomorphic adenoma in the parapharyngeal space were both round masses with largely well-defined boundaries.The lesions presented with soft tissue density mass with or without cystic degeneration on CT scans;or on MRI,hypo-intense T1 and hyper-intense T2 signals,with heterogenous signals and enhancement of cystic degeneration.All schwannomas were well-demarcated from the deep lobe of parotid gland,and were mostly located anteromedially to the internal carotid artery(13/19,68%),while all the pleomorphic adenomas were ill-demarcated from the deep lobe of the parotid gland,and were located anteromedially to the internal carotid artery(12/12,100%).Conclusion:On imaging,most parapharyngeal pleomorphic adenomas are ill-demarcated,while all schwannomas are well-emarcated,from the deep lobe of parotid gland.The vast majority of parapharyngeal pleomorphic adenomas are located anteromedially to the internal carotid artery,but the spatial relationship between schwannomas and the internal carotid artery can vary.In clinical practice,head-and-neck surgeons should carefully scrutinize the anatomy of parapharyngeal tumor in relation to the deep lobe of parotid gland in the first place,and then in relation to the internal carotid artery.This whould help preoperative diagnosis a
作者
何龙
郭永梅
He Long;Guo Yongmei(Department of Otolaryngology Head and Neck Surgery,Second Affiliated Hospital of South China University of Technology,Guangzhou,510180,China;Department of Radiology,Guangzhou First People’s Hospital,Second Affiliated Hospital of South China University of Technology,Guangzhou,510180,China)
出处
《广州医科大学学报》
2020年第3期1-6,共6页
Academic Journal of Guangzhou Medical University
基金
广东省科学技术厅社会发展领域科技计划项目(20120318035)。
关键词
咽旁间隙
神经鞘瘤
多形性腺瘤
磁共振成像
Parapharyngeal space
schwannoma
pleomorphic adenoma
magnetic resonance imaging
