【摘要】：目的：海綿竇（cavernous sinus，CS）結構小而復雜，病變種類繁多，均可壓迫或侵犯鄰近的顱神經和血管引起CS綜合征,即包括眼肌麻痹、球結膜水腫、眼球突出、Horner綜合征、三叉神經感覺缺失等。CS綜合征不同病因，治療方案也不同。通過影像學檢查一方面對潛在致死性病變如海綿竇血栓性靜脈炎（cavernous sinus thrombosis CST）的早發(fā)現(xiàn)早治療早治愈起到重要作用，同時通過病變的影像學表現(xiàn)，可大致判斷病變性質；另一方面觀察病變與鄰近結構的解剖關系，有助于選擇最佳外科手術入路，從而減少手術并發(fā)癥。本文回顧性分析經臨床及病理確診107例患者（130處病灶）的CS區(qū)病變影像表現(xiàn)，總結CS區(qū)疾病基本影像學表現(xiàn)，探討CS各腔隙及MC腔解剖結構改變對病變起源、性質的診斷價值。 方法：收集我院2011年5月~2012年12月107例CS區(qū)病變（130處病灶）患者，男50例，女57例，年齡20~79歲，平均49歲。原發(fā)性腫瘤11例（神經鞘瘤6例，腦膜瘤4例，節(jié)細胞膠質瘤1例），繼發(fā)或侵犯性腫瘤60例（侵襲性垂體瘤45例，脊索瘤6例，膽脂瘤3例，成熟性囊性畸胎瘤1例，鼻咽癌1例，腦轉移性腺樣囊性癌1例，乳癌轉移1例，肺癌轉移1例，內翻性乳頭狀瘤癌變1例），血管性病變28例（血管瘤12例，動脈瘤8例，硬腦膜海綿瘺3例，創(chuàng)傷性頸內動脈海綿竇瘺5例），血栓性靜脈炎8例。其中1例發(fā)育不良因例數(shù)太少，不在統(tǒng)計范圍內。其中CT檢查4例，CT血管造影（CTA）16例，MRI平掃檢查98例，MRI增強檢查88例, MRI平掃+增強82例，MRA檢查2例。海綿竇炎癥經臨床治療后證實，血管性病變經DSA證實，轉移瘤中1例乳腺癌轉移，1例肺癌轉移，其余均經病理檢查證實。 結果：CS區(qū)腫瘤性病變占66.4%，其中繼發(fā)性腫瘤占56.1%，，原發(fā)性腫瘤占10.3%;血管性病變占26.2%；炎性病變占7.5%。不同病變構成比有統(tǒng)計學差異（單變量的χ~2檢驗，χ~2=37.5，P0.05）；不同類別CS區(qū)病變性別、年齡組構成無統(tǒng)計學差異（χ~2分別為7.77、7.67，P0.05）；不同CS區(qū)病變側別構成有統(tǒng)計學差異（Fisher精確檢驗，P=0.010.05）。影像學征象：①所有病變側CS均增大伴異常密度/信號影，除了1例垂體微腺瘤外余病變側外側壁均膨隆。②ICA受累117處，占90%。③血管性病變MRI均見異常流空信號影。④98例MRI平掃檢查中，等信號為主病灶占72.5%，長T1長T2為主占27.6%。CS區(qū)不同疾病信號總體構成有統(tǒng)計學差異（Fisher精確檢驗P=00.05）：除血管性病變組以長T1、T2為主（P＜0.05），其他三組患者均以等T1、T2信號為主（P＜0.05）。⑤107例MRI增強或CTA，輕中度、明顯強化、無強化分別占50.5%，43.9%，5.6%。不同CS區(qū)病變強化方式具有統(tǒng)計學差異（Fisher精確檢驗P 0.01），并將四組疾病分別比較：繼發(fā)性腫瘤以輕中度強化比例最大，其他三類疾病均為明顯強化比例最大（P=00.05）。⑥M eckel腔受侵占46.2%，其中MC腔腦脊液信號消失占21.5%，部分殘存占15.4%，MC腔擴張伴信號異常占9.2%，其中6例神經鞘瘤MC腔均擴大伴信號異常。不同CS區(qū)病變引起MC改變總體有統(tǒng)計學差異（Fisher精確檢驗，P＜0.05）；MC腔受侵以原發(fā)腫瘤組（90.9%）最高，血管性病變組（51.6%）和血栓性靜脈炎組（50.0%）次之，繼發(fā)性腫瘤組陽性率（37.5%）最低（P＝0.006＜0.05）。⑦C S腔受侵發(fā)生率：內、外側腔最多，后上腔次之，前下腔最少；CS各腔病變構成：CS各腔病變以繼發(fā)性腫瘤常見，血管性病變次之，原發(fā)性腫瘤、血栓性靜脈炎少見；不同病變侵犯CS各腔隙構成：原發(fā)腫瘤易侵犯外側腔，前下腔、后上腔次之，內側腔少見；繼發(fā)性腫瘤易侵犯后上腔及內側腔，外側腔次之，前下腔更次之，其中侵襲性垂體瘤侵犯內側腔達100%；血管性病變，易侵犯外側腔，內側腔、前下腔次之，后上腔少見，其中動脈瘺累及全腔；血栓性靜脈炎易侵犯外側腔，前下腔次之，內側腔及后上腔少見（χ~2=24.9，P 0.05）。 結論：①CS區(qū)病變以繼發(fā)性腫瘤多見。②CS區(qū)病變性別、年齡組構成均無統(tǒng)計學差異。③CS區(qū)病變發(fā)病側別構成有統(tǒng)計學差異，以單側發(fā)病為多。④CS增大、外側壁膨隆、信號/密度改變、ICA包繞、狹窄或局部擴張?zhí)崾綜S病灶的存在。⑤異常流空信號可提示血管性病變。⑥CS區(qū)腫瘤性病變、血栓性靜脈炎以等信號為主，血管性病變信號復雜。⑦繼發(fā)性腫瘤以輕中度強化多見，血管性病變及血栓性靜脈炎以明顯強化為多見。⑧增強強化方式、CS各腔隙、MC腔結構改變，有助于判斷病變的起源、性質。
[Abstract]:Objective: The structure of cavernous sinus (CS) is small and complex, and there are many kinds of lesions, which can compress or invade adjacent cranial nerves and blood vessels to cause CS syndrome, including ophthalmoplegia, bulbar conjunctival edema, exophthalmos, Horner syndrome, trigeminal nerve sensory loss and so on. On the one hand, it plays an important role in the early detection, early treatment and early cure of potentially fatal lesions such as cavernous sinus thrombophlebitis (CST), on the other hand, it can roughly judge the nature of the lesion by the imaging manifestations of the lesions; on the other hand, it is helpful to choose the best surgery by observing the anatomical relationship between the lesions and adjacent structures. The imaging manifestations of CS lesions in 107 patients (130 lesions) diagnosed clinically and pathologically were retrospectively analyzed. The basic imaging manifestations of CS lesions were summarized. The diagnostic value of anatomical changes of CS lacunae and MC cavity on the origin and nature of lesions was discussed.
Methods: 107 cases of CS lesions (130 lesions) from May 2011 to December 2012 in our hospital were collected, including 50 males and 57 females, aged from 20 to 79 years, with an average of 49 years. There were 11 cases of primary tumors (6 cases of neurilemmoma, 4 cases of meningioma, 1 case of ganglioma), 60 cases of secondary or invasive tumors (45 cases of invasive pituitary adenoma, 6 cases of chordoma, 3 cases of cholesteatoma, 3 cases of mature cyst). There were 1 case of teratoma, 1 case of nasopharyngeal carcinoma, 1 case of brain metastatic adenoid cystic carcinoma, 1 case of breast cancer, 1 case of lung cancer, 1 case of inverted papilloma carcinogenesis, 28 cases of vascular lesions (12 cases of hemangioma, 8 cases of aneurysm, 3 cases of dural cavernous fistula, 5 cases of traumatic internal carotid cavernous fistula), 8 cases of thrombophlebitis. There were 4 cases of CT examination, 16 cases of CT angiography (CTA), 98 cases of MRI plain scan, 88 cases of MRI enhancement, 82 cases of MRI plain scan and enhancement, and 2 cases of MRI examination.
Results: Tumorous lesions in CS area accounted for 66.4%, of which secondary tumors accounted for 56.1%, primary tumors accounted for 10.3%; vascular lesions accounted for 26.2%; inflammatory lesions accounted for 7.5%. Signs of imaging: 1. All lesions were enlarged with abnormal density / signal shadows, except one case of pituitary microadenoma. 2. ICA was involved in 117 lesions, accounting for 90%. (4) In 98 cases of plain MRI, the main lesions were iso-signal (72.5%) and long T1 and long T2 (27.6%). There were significant differences in the overall composition of different diseases in CS area (Fisher's exact test P = 00.05). Except for long T1 and T2 in vascular lesions (P < 0.05), the other three groups were mainly iso-signal T1 and T2 (P < 0.05). Mild to moderate, obvious enhancement, no enhancement accounted for 50.5%, 43.9%, 5.6% respectively. Different CS lesion enhancement methods were statistically different (Fisher exact test P 0.01), and the four groups of diseases were compared: secondary tumors with the largest proportion of mild to moderate enhancement, the other three types of diseases were the largest proportion of obvious enhancement (P = 00.05). _Meeckel cavity invasion accounted for 46.2%. Among them, 21.5% of MC lumen and cerebrospinal fluid signal disappeared, 15.4% of MC lumen remained, 9.2% of MC lumen dilated with signal abnormality, 6 cases of neurilemmoma were enlarged with signal abnormality. 1.6% and thrombophlebitis group (50.0%) followed by the secondary tumor group (37.5%) the lowest positive rate (P = 0.006 < 0.05). _CS lumen invasion rate: the most in the internal and lateral lumen, followed by the superior lumen, anterior and inferior lumen at least; CS lumen lesions: secondary tumors, vascular lesions followed by primary tumors, thrombophlebitis. Inflammation is rare; different lesions invade the lacuna of CS: the primary tumor is easy to invade the lateral cavity, anterior inferior cavity, posterior superior cavity, medial cavity is rare; secondary tumor is easy to invade the posterior superior cavity and medial cavity, lateral cavity is next, anterior inferior cavity is next, in which invasive pituitary tumor invades the medial cavity up to 100%; vascular lesions, easy to invade the lateral cavity, medial cavity. Anterior inferior cavity followed by posterior superior cavity, in which arterial fistula involved the whole cavity, thrombophlebitis was easy to invade the lateral cavity, anterior inferior cavity was next, medial cavity and posterior superior cavity were rare (_~2=24.9, P 0.05).
Conclusion: Secondary tumors were common in CS area. There was no significant difference in sex and age group in CS area. The lesions in CS area were more common in unilateral lesions. _Tumorous lesions in CS area, thrombophlebitis mainly iso-signal, and vascular lesions have complex signal. _Secondary tumors with mild to moderate enhancement, vascular lesions and thrombophlebitis with obvious enhancement are common. _Enhancement enhancement, CS lacunae, MC cavity structure changes, help to judge the lesions. The origin and nature of.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.1;R445.2

【參考文獻】

相關期刊論文 前10條

1 張體江;朱克文;呂粟;黃曉琦;關晶;駱科進;先正元;龔啟勇;;海綿竇病變的影像學表現(xiàn)及臨床意義[J];華西醫(yī)學;2008年03期

2 袁夢雪;盧紫聿;朱星紅;;海綿竇的結構特征與海綿竇血栓形成[J];局解手術學雜志;2010年05期

3 唐作華;錢雯;宋濟昌;馮曉源;;磁共振成像對侵襲性垂體瘤的診斷價值[J];中國臨床醫(yī)學;2010年03期

4 徐文堅,張云亭,吳恩惠;海綿竇病變的CT和MRI研究(附102例分析)[J];醫(yī)學影像學雜志;2002年01期

5 羅偉;韓德清;陳玉光;孫亦明;盛英武;劉宇超;鄭維;;CTA、DSA在顱內動脈瘤診治中價值的對比研究[J];中國臨床神經外科雜志;2010年05期

6 張占偉;羅剛;喻堅柏;余文運;勞一;;經靜脈入路栓塞治療海綿竇區(qū)硬腦膜動靜脈瘺(附8例報告)[J];中國臨床神經外科雜志;2010年10期

7 曾一;朱紅伍;;海綿竇顯微外科解剖學概述[J];中國社區(qū)醫(yī)師(醫(yī)學專業(yè)半月刊);2009年16期

8 王恩敏;潘力;王濱江;張南;董亞非;吳瀚峰;;海綿竇海綿狀血管瘤的MRI表現(xiàn)及伽瑪?shù)吨委?附14例報告)[J];中華神經外科雜志;2006年05期

9 林佳平,黃正松,吳新建,劉金龍,陳曉雷;海綿竇外側壁腫瘤的診斷和顯微手術治療[J];中華顯微外科雜志;2002年04期

10 菅鳳增,沙成,王興文,楊玉明,袁慶國,劉樹山;經顱海綿竇手術的顯微外科解剖及臨床應用[J];中國臨床解剖學雜志;2001年01期

本文編號：2222431