CAJ | 학술논문

目的：探讨咽旁间隙多形性腺瘤与神经源性肿瘤的MRI表现，提高对两者的鉴别诊断水平。材料与方法回顾性分析经手术病理证实的10例咽旁间隙多形性腺瘤及18例神经源性肿瘤的MRI表现。结果除1例有双侧迷走神经副神经节瘤外，其余均为单发。10例多形性腺瘤均位于茎突前间隙，使同侧茎突及其肌群、腭帆张肌、二腹肌及颈内动、静脉受压向后移位。17例神经源性肿瘤(1例颈静脉球瘤除外)均位于茎突后间隙，肿块与腮腺深叶分界清楚，同侧咽旁脂肪组织、茎突及其肌群、腭帆张肌、二腹肌及颈内动脉受压向前移位。其中4例神经鞘瘤、3例迷走神经副神经节瘤和1例神经纤维瘤使同侧颈内动、静脉明显分离；3例颈动脉体瘤使颈内、外动脉明显分离。另外，4例多形性腺瘤(40%)在MRI上可见局灶性低信号，即“靶征”。7例副神经节瘤(88%)可呈典型的“盐和胡椒征”。结论通过MRI仔细观察咽旁间隙邻近结构的移位情况，判断肿瘤发生的精确位置并结合肿瘤的特征性信号，从而有助于提高对两者的鉴别诊断水平。
목적：탐토인방간극다형성선류여신경원성종류적MRI표현，제고대량자적감별진단수평。재료여방법회고성분석경수술병리증실적10례인방간극다형성선류급18례신경원성종류적MRI표현。결과제1례유쌍측미주신경부신경절류외，기여균위단발。10례다형성선류균위우경돌전간극，사동측경돌급기기군、악범장기、이복기급경내동、정맥수압향후이위。17례신경원성종류(1례경정맥구류제외)균위우경돌후간극，종괴여시선심협분계청초，동측인방지방조직、경돌급기기군、악범장기、이복기급경내동맥수압향전이위。기중4례신경초류、3례미주신경부신경절류화1례신경섬유류사동측경내동、정맥명현분리；3례경동맥체류사경내、외동맥명현분리。령외，4례다형성선류(40%)재MRI상가견국조성저신호，즉“파정”。7례부신경절류(88%)가정전형적“염화호초정”。결론통과MRI자세관찰인방간극린근결구적이위정황，판단종류발생적정학위치병결합종류적특정성신호，종이유조우제고대량자적감별진단수평。
Objective To analyze the MRI appearance of pleomorphic adenomas and neurogenic tumors in the parapharyngeal space (PPS), and to improve the differential diagnosis between them. Materials and Methods Ten cases of pleomorphic adenomas and 18 cases of neurogenic tumors in the PPS were collected in the study. The lesion,s position, the displacement with the surrounding structures, number, shape, border, uniformity, characteristic signal, enhancement degree and capsule were analyzed retrospectively. All of them were scanned with MRI and then confirmed pathologically. Results The rest were single lesions except 1 vagal glomus tumor had two lesions on both sides of the neck. 10 pleomorphic adenomas were located in the prestyloid compartment and the prestyloid PPS fat;the styloid process and its muscles;tensor veli palatine, digastric muscle and the carotid sheath were compressed and displaced posteriorly. On the contrary, 18 neurogenic tumors which were located in the retrostyloid compartment made these structures anterior displacement. Moreover, 4 schwannomas, 3 vagal glomus tumors and 1 neurofibroma made the ICA (internal carotid artery) and the IJV (internal jugular vein) separation. 3 carotid body tumors made the ICA and the ECA (external carotid artery) separation. There were clear boundaries and visible fat space between neurogenic tumors and deep-lobe of parotid gland. Diagnostic features, such as“patchy or actiniform”low signal intensity areas in some (4/10) pleomorphic adenomas, and“salt-and-pepper”appearance in most (7/8) paragangliomas, were found on MRI. Conclusion Through the MRI careful observation the displacement with the surrounding structures in the PPS, judge the precise location of the tumor and combined with characteristic signal of the tumor, which helps to improve the differential diagnosis level.