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目的:总结青少年鼻咽纤维血管瘤的临床及影像学特点。方法:47例青少年鼻咽纤维血管瘤患者平均年龄16.5岁。治疗前有完整的CT、MRI和DSA影像学资料。利用CT、MRI评价肿块的位置、范围并进行Fisch分期。DSA主要评价肿块的供血动脉、血流速度、是否存在颅内外异常交通。结果:本组病例中,原发病例39例,复发8例。均有鼻塞症状,41例有鼻腔反复出血史,其中伴面中部隆起11例、眼球突出7例、视力下降或复视5例、听力障碍或耳鸣4例、头晕、头痛2例。CT扫描可见鼻咽部软组织肿块,增强CT扫描可见肿块明显强化,CT可以很好显示颅底颞骨的破坏。在MRI的T1WI上,JNA呈低或等信号,T2WI上信号增高,注射Gd-DTPA后T1加权增强扫描可见“椒盐征”。血管造影可见肿瘤的供血动脉主要来自颈外动脉分支,如上颌动脉的蝶腭支和腭降支以及面动脉和咽升动脉等。随着肿瘤的生长,颈内动脉岩段分支、海绵窦支以及筛支也参与供血。结论:结合临床症状和影像学特征,青少年鼻咽纤维血管瘤可以明确诊断,需注意与面深间隙的恶性肿瘤相鉴别。
Objective: To summarize the clinical features and imaging features of nasopharyngeal fibroadenoma in adolescents. Methods: The average age of 47 adolescent patients with nasopharyngeal fibrosioma was 16.5 years. Before treatment there is a complete CT, MRI and DSA imaging data. The location and extent of the mass were evaluated by CT and MRI and Fisch staging was performed. DSA main evaluation of the mass of the donor artery, blood flow velocity, whether there is abnormal intracranial traffic. Results: The group of patients, 39 cases of primary, recurrent in 8 cases. There were nasal congestion symptoms in 41 cases with history of repeated nasal bleeding. Among them, there were 11 cases with central bulge, 7 cases with prominent eyes, 5 cases with decreased vision or diplopia, 4 cases with hearing impairment or tinnitus, 2 cases with dizziness and headache. CT scan visible nasopharyngeal soft tissue mass, enhanced CT scan visible mass was significantly enhanced, CT can be very good display skull base temporal bone destruction. On MRI T1WI, JNA showed low or equal signal, T2WI signal increased, after injection of Gd-DTPA T1 weighted enhanced scan visible “salt and pepper sign.” Angiography showed that the main artery of the tumor from the external carotid artery branches, such as the maxillary artery sphenopalatine branch and palatal descending branch, and facial artery and pharyngeal ascending artery. As the tumor grows, the branch of the internal carotid artery, the cavernous sinus branch, and the sieve branch also participate in the blood supply. Conclusion: Combined with clinical symptoms and imaging features, juvenile nasopharyngeal fibro-hemangioma can be clearly diagnosed, and should pay attention to differentiate with the deep-space clearance of malignant tumors.