摘要
目的探讨鼻窦神经内分泌癌的CT和MRI的特征性表现。方法回顾性分析经病理证实的10例鼻窦神经内分泌癌的影像资料及临床资料，男5例、女5例；年龄27-57岁，平均（48±9）岁。患者均行MR平扫及增强检查，9例同时行CT检查。结果病变主体位于筛窦6例次、蝶窦5例次、上颌窦2例次，位于蝶窦者病变对称。典型类癌1例、不典型类癌1例、神经内分泌癌8例（其中大细胞型3例、小细胞型5例）。6例直径〉3cm，呈不规则分叶状；4例直径〈3cm，呈椭圆形。CT表现：1例呈等密度；4例肿瘤内见斑点、线条状高密度影，呈等高密度；4例有线环状或葡萄状低密度影。1例典型类癌呈骨质硬化、压迫吸收表现，余8例呈虫蚀状骨质破坏。MRI：10例均表现为T1WI等信号；T2W14例为等信号，6例以等信号为主，混杂少量线条、斑片、葡萄状高信号。增强扫描7例呈轻中度不均匀强化，3例明显强化。2例MRI动态增强时间-信号强度曲线为平台型。肿瘤广泛累及邻近结构，鼻腔受累9例次，侵犯眼眶7例次，翼腭窝4例次，筛窦、蝶骨和颞下窝各3例次，枕骨斜坡、海绵窦、颈内动脉管和视神经管各2例次，前颅窝底、颈静脉孔、岩尖、脑膜、颞窝、鼻咽腔及咽旁间隙各1例次。结论鼻窦神经内分泌癌的CT骨质改变依病理学分型不同有所差别，MRI可准确显示肿瘤累及范围，两者联合应用可对其诊断及治疗提供更全面的信息。
Objective To investigate the CT and MRI characteristic features of neuroendocrine carcinoma in paranasal sinuses. Methods CT and MRI findings of 10 patients with proved neuroendocrine carcinoma by pathology were retrospectively reviewed. All patients underwent plain and enhanced MRI scanning, and 9 patients also underwent CT scanning. Results There were 5 males and 5 females with mean age of （48±9） years old, ranging from 27 to 57 years. The treatment time after symptoms onset ranged from 1 to 4 months, with the median of 2 months. Clinical symptoms were headache and vision loss, hyposmia and yellow nasal discharge, and exophthalmos. The lesions were located in the ethmoidal sinus （ n = 6） , maxillary sinus （ n = 2）, and bilateral sphenoid sinus （ n = 5 ）. The lesions were symmetrical in the sphenoid sinus. Pathology type included typical carcinoid tumor （ n = 1 ）, atypical carcinoid （ n = 1 ）, and neuroendocrine carcinoma not otherwise specified （n = 8 ）. Immunohistochemical staining showed that neurospecific enolase, synaptophysin, cytokeratin and P53 were all positive. On CT images, lesions showed isointensity （n = 1 ）, iso- to hypointense （ n = 4 ）, and iso- to hyperintense （ n = 4） with hypointense or hyperintense spots. Bone changes included bony absorption and sclerosis （ n = 1 ） with a clear margin in typical carcinoid tumor, and moth-eaten bone destruction in other 8 cases （n = 8 ）. The lesions were isointenseon T1-weighted images, and isointense （ n = 4） or mixed iso- to hyperintense on T2-weighted images （ n = 6）. Lesions showed mild to medium heterogeneous enhancement （ n = 7 ） or marked enhancement （ n = 3 ） on gadolinium-enhanced images. Time-signal intensity curve （TIC） showed plateau type in 2 cases. The aggressive nature of the tumors was demonstrated by invasion of adjacent structures, involvement of nasal cavity （ n = 9 ）, orbits （ n = 7 ）, pterygopalatine fossa （ n = 4 ）, ethmoidalsinus and sphenoid （ n = 3 ）, clivus ossis occipitalis （n = 2）, cavernous sinus and internal carotid canal（ n = 2）, optic canal（ n = 2） ,jugular fossa （ n = 1 ）, anterior fossa （ n = 1 ）, apex partis petrosae ossis temporalis （ n = 1 ）, meninges （ n = 1 ）, temporal fossa and infratemporal fossa （ n = 1 ）, pharyngonasal cavity and parapharyngeal space （ n = 1 ） . Conclusions There are different CT features in different pathological types of neuroendocrine carcinoma of the paranasal sinuses, and MRI can demonstrate the invasive extent accurately. CT combined MRI can provide more comprehensive information in the diagnosis and therapy.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2012年第7期615-618,共4页
Chinese Journal of Radiology
关键词
鼻窦
癌
神经内分泌
体层摄影术
X线计算机
磁共振成像
Paranasal sinuses
Carcinoma, neuroendocrine
Tomography, X-ray computed
Magnetic resonance imaging
