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目的探讨眼眶泪囊区不同恶性肿瘤的MRI表现与临床病理的关系。设计回顾性病例系列。研究对象北京同仁医院2005-2014年13例经病理证实为泪囊区恶性肿瘤患者的MRI表现及临床资料。方法所有患者均行眼眶MRI平扫及增强检查,其中10例行动态增强扫描,根据时间-信号强度曲线(TIC)分为三种类型(Ⅰ型稳定增强型,Ⅱ型平台型,Ⅲ型流出型)。11例手术切除,2例活检。主要指标MRI表现,强化程度,TIC类型及病变的累及范围。结果病变主体均位于泪囊窝内。病理结果显示淋巴瘤5例、恶性黑色素瘤2例,睑板腺癌、基底细胞癌、基底样鳞状细胞癌、腺样囊性癌、低分化腺癌、皮脂腺癌各1例。MRI表现:淋巴瘤T1WI、T2WI均呈等信号,增强扫描轻度均匀强化。恶性黑色素瘤T1WI呈高信号、T2WI呈低信号,增强扫描轻中度均匀强化。睑板腺癌及低分化腺癌T1WI、T2WI均呈等信号。另4例T1WI呈等信号,T2WI呈略长信号,增强扫描呈轻中度强化。TIC:Ⅰ型、Ⅱ型各2例,Ⅲ型6例。12例病变累及鼻泪管,9例累及邻近皮肤,7例累及眼睑,2例累及眼眶肌锥内间隙。结论泪囊恶性肿瘤因病理类型不同MRI表现不同,常累及邻近结构,MRI可准确显示肿瘤累及范围。TIC三型均有,以流出型为主。
Objective To investigate the MRI findings of different malignant tumors in the orbital dacryocyst area and their clinicopathological features. Design retrospective case series. Research object Beijing Tongren Hospital in 2005-2014 13 cases of pathologically confirmed MRI findings and clinical data of patients with malignant tumors of the dacryocyst area. Methods All patients underwent orbital MRI scan and enhanced examination. Among them, 10 patients underwent dynamic contrast-enhanced scan and were divided into three types according to the time-signal intensity curve (TIC): type I stable enhancement, type II platform, type III efflux type). Eleven cases were surgically removed and two biopsied. The main indicators of MRI performance, degree of enhancement, TIC type and extent of lesions involved. Results The main lesion were located in the dacryocystorhinus. Pathological results showed that 5 cases of lymphoma, 2 cases of malignant melanoma, meibomian gland carcinoma, basal cell carcinoma, basal-like squamous cell carcinoma, adenoid cystic carcinoma, poorly differentiated adenocarcinoma, sebaceous carcinoma in 1 case. MRI manifestations: Lymphoma T1WI, T2WI showed equal signal, enhanced mild mild enhancement. Malignant melanoma T1WI showed high signal, T2WI showed a low signal, enhanced scan mild to moderate enhancement. Meibomian gland cancer and poorly differentiated adenocarcinoma T1WI, T2WI showed equal signal. The other 4 T1WI showed equal signal, T2WI slightly longer signal, enhanced scan was mild to moderate enhancement. TIC: Ⅰ type, Ⅱ type in 2 cases, Ⅲ type in 6 cases. Twelve lesions involving the nasolacrimal duct, 9 involving the adjacent skin, 7 involving the eyelid, and 2 involving the orbital cone in the interphalangeal space. Conclusion Dacryocystadenocarcinoma has different MRI manifestations due to different pathological types, often involving adjacent structures. MRI can accurately show the extent of tumor involvement. TIC have three types, mainly out of type.