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目的探讨肿瘤所致周围性面瘫的CT、MRI表现,提高影像诊断水平。资料与方法回顾性分析41例因肿瘤所致周围性面瘫患者的CT、MRI表现,并与手术所见及病理结果对照。结果颞骨内面神经肿瘤25例,其中面神经鞘瘤13例,面神经纤维瘤8例,面神经血管瘤4例。面神经鞘瘤呈膨胀性生长,可形成较大肿块及骨质破坏;面神经纤维瘤沿面神经管长轴方向走行,面神经管扩大,面神经结节性或梭形增粗;面神经血管瘤以CT上钙化或典型的“蜂窝”状骨针样结构为特征。腮腺内面神经鞘瘤5例,表现为下颌后静脉后外侧,向茎乳孔区生长的软组织肿块,边界清楚,可见分叶,其中2例可见“靶征”。腮腺恶性肿瘤4例(腺样囊性癌3例,腺癌1例),T2WI上呈低信号,3例边界不清楚。内淋巴囊肿瘤2例,CT表现为以岩骨后缘中部为中心的“蜂窝”状或“虫蚀”状骨质破坏,MR T1WI上可见片状高信号区及血管流空信号。软骨瘤2例,软骨肉瘤3例,CT表现为颈静脉孔区骨质破坏和软组织肿块,可见较明显分叶征象,其中2例可见点片状钙化。MRI对于病变的检出及定性优于CT,差异有统计学意义(P<0.05)。结论面神经走行区的多种肿瘤均可导致周围性面瘫,以颞骨内面神经鞘瘤最常见。CT与MRI结合有助于对肿块的全面评价,为诊断和治疗提供依据。
Objective To investigate the CT and MRI findings of peripheral facial paralysis caused by tumor and to improve the diagnostic value of imaging. Materials and Methods Retrospective analysis of CT and MRI findings of 41 patients with peripheral facial paralysis caused by tumors was performed and compared with the results of surgery and pathology. Results 25 cases of temporal facial nerve tumors, including 13 cases of facial nerve sheath tumors, facial nerve fibroma in 8 cases, facial nerve hemangiomas in 4 cases. Facial nerve sheath tumor was swollen growth, the formation of larger lumps and bone destruction; facial nerve fiber tumors along the long axis of the facial nerve canal direction, facial nerve tube enlargement, facial nerve nodular or fusiform thickening; facial nerve hemangioma calcification with CT Or a typical “honeycomb” bone-like structure. Parotid gland nerve sheath tumors in 5 cases, the performance of the posterior mandibular vein posterior lateral, to the soft tissue area of the growth of soft tissue tumors, the border clear, visible lobes, of which 2 cases can be seen “target sign ”. 4 cases of parotid malignancy (adenoid cystic carcinoma in 3 cases, 1 case of adenocarcinoma), T2WI showed low signal, 3 cases of the border is not clear. Two cases of endolymphatic sac tumor showed CT-like “honeycomb” or “worm-eaten” bone destruction centering on the posterior edge of the petrous bone. The flaky high signal region and vascular flow-emptying were observed on MR T1WI signal. 2 cases of chondroma, 3 cases of chondrosarcoma, CT showed the destruction of the jugular foramen area and soft tissue mass, showing more obvious leaf sign, in which 2 cases can be seen flake calcification. MRI detection of lesions and qualitative better than CT, the difference was statistically significant (P <0.05). Conclusions Multiple tumors in the facial nerve can lead to peripheral facial paralysis and the most common neuroradiosis in the temporal bone. The combination of CT and MRI is helpful for the comprehensive evaluation of lumps and provides the basis for diagnosis and treatment.