海绵窦海绵状血管瘤的CT和MRI诊断及临床应用价值

CT and MRI diagnosis of cavernous hemangioma in cavernous sinus and its clinical value

摘要:

目的：探讨海绵窦海绵状血管瘤（cavernous hemangioma in cavernous sinus，CHCS）CT、MRI表现特征和治疗方法，以提高其诊断、治疗水平。方法：回顾分析我院经手术和病理证实的CHCS 13例，全部病例均行头颅CT和MRI平扫及增强扫描。结果：病灶位于左侧7例，右侧6例，长径3.5～6.8 cm（平均4.6 cm）。11例呈“哑铃形”或“葫芦状”，2例呈圆形，13例病灶侧颈内动脉均受挤压或包绕，5例大脑中动脉受压，管腔无明显狭窄，未显示确切的供血动脉及引流静脉，周围均无水肿，4例伴蝶骨轻度骨质吸收侵蚀。CT平扫12例为均匀等或稍高密度，1例伴出血呈不均匀高密度，均无钙化及囊变。MRI平扫T1WI 6例呈脑灰质信号，6例稍低于脑灰质信号，1例呈不均匀高信号；T2WI呈类似于脑脊液的均匀极高信号12例，1例呈高低混杂信号。增强扫描CT呈均匀中度强化5例，显著强化8例。MRI增强13例均显著强化，其中6例增强早期强化不均匀，晚期强化均匀，强化程度更显著，呈延迟填充强化特征。病变9例DWI呈等信号，2例呈稍高信号，1例呈高低混杂信号，1例呈稍低信号。表观弥散系数（apparent diffusion coefficient，ADC）图上均呈明显高信号，ADC值（1.56±0.37）×10-3 mm2/s。结论：CHCS有一定CT、MRl表现特征，有助于术前诊断；CT及MRI能精确显示病灶与周围血管、神经的解剖关系，对于临床治疗具有重要指导价值。

Abstract:

Objective：To discuss on CT and MRI imaging features and treatment of cavernous hemangioma in cavernous sinus（CHCS） and to promote the diagnostic and treatment level. Methods：Totally 13 patients with surgically and pathologically verified CHCS were reviewed. All cases were examined by CT and MRI plain scan and contrast-enhanced scan． Results：Lesions located at the left side in seven cases and at the right side in six cases with the length of 3.5-6.8 cm（4.6 cm in average）. Eleven cases were ‘dumbbell-shaped’ or ‘gourd-like’ and 2 cases were in round shape. Ipsilateral internal carotid artery of 13 cases were wrapped or extruded and middle cerebral artery of five cases were pressed，without showing obvious lumen narrow，exact feeding arteries and draining veins. There was no edema around and four cases were in association with the sphenoid mild bone absorption erosion. CT scan of 12 cases showed evenly or slightly higher density，CT scan of one case showed hemorrhage and unevenly high density and no calcification and cystic degen－eration was observed. On T1WI of MRI scan，six cases exhibited cerebral gray matter signal，six cases exhibited slightly below cerebral gray matter signal and one case showed heterogeneous high signal. T2WI showed evenly high signal similar to cerebrospinal fluid in 12 cases and one case exhibited mixed-signal. Enhanced CT scan showed that five cases were evenly moderately enhanced and eight cases were significantly strengthened. Enhanced MRI of 13 patients showed that all patients were significantly strengthened and 6 cas－es were evenly enhanced at early stage and unevenly enhanced at late stage with more significant degree and similar delay filling en－hancement patterns. On DWI maps，nine cases showed equal signal，two cases with slightly higher signal，one case with mixed-signal and one case with slightly lower signal. Apparent diffusion coefficient（ADC） maps showed a significantly higher signal and ADC val－ue was （1.56±0.37）×10-3 mm2/s. Conclusions：CT and MRI findings of CHCS have some characteristic and are helpful for preoper－ative diagnosis. CT and MRI examination can show accurately the anatomical relationship of lesions，blood vessels and nerves and have important guiding value for clinical treatment.