双语影像读片.pptx

这世界，你最珍贵这世界，你最珍贵 2017.01.11 晴 小房子小房子.目录录CONTENTS简要病史图片说明Case Point010305QuestionDiagnosisDiscussion020406复视！CT+MRICT+MRICT+MRICT+MRI?诊断总结要点A 72-year-old woman A 72-year-old woman presents with rapidly progressive horizontal presents with rapidly progressive horizontal and vertical diplopia as well as pain in the and vertical diplopia as well as pain in the right forehead and right nasal regionright forehead and right nasal region【简要病史】【简要病史】72岁女性，进行性水平及垂直方向复视，进展迅速，伴有右侧前额、鼻部疼痛。Question:No.1Which of the following are present on these images?(Check all that apply.)此组图像的可见下列那种表现？（选择全部正确选项）A.Orbital apex involvement 眶尖部侵犯B.Osseous sclerosis 骨质硬化C.Mastoid air cell destruction 乳突气房破坏D.Sphenoid sinuscortical disruption 蝶窦皮质破坏正确选项：A.C.D注释：注释：The lesioninvolves the lateral wall of the sphenoid sinus extending into The lesioninvolves the lateral wall of the sphenoid sinus extending into the rightorbital apex,as demonstrated by loss of normal fat attenuation the rightorbital apex,as demonstrated by loss of normal fat attenuation in thislocation.in thislocation.此病变累及蝶窦外侧壁，侵入右侧眶尖，表现为此处正常脂肪消失。此病变累及蝶窦外侧壁，侵入右侧眶尖，表现为此处正常脂肪消失。The walls of thebilateral sphenoid sinuses are thickened and sclerotic,The walls of thebilateral sphenoid sinuses are thickened and sclerotic,as is the intersphenoidalseptum.The sphenoid sinus is opacified.as is the intersphenoidalseptum.The sphenoid sinus is opacified.双侧蝶窦壁及间隔增厚、硬化，蝶窦浑浊。双侧蝶窦壁及间隔增厚、硬化，蝶窦浑浊。注释：注释：There is noevidence of a destructive process involving the mastoid air There is noevidence of a destructive process involving the mastoid air cells on theprovided images.cells on theprovided images.所示图像并无证据表明乳突气房破坏。所示图像并无证据表明乳突气房破坏。Focal corticaldisruption of the lateral wall of the right sphenoid sinus Focal corticaldisruption of the lateral wall of the right sphenoid sinus is present.is present.可见右侧蝶窦外侧壁局部骨皮质破坏。可见右侧蝶窦外侧壁局部骨皮质破坏。Question:No.2Brain MR images demonstrate which of the following?(Check all that apply)颅脑 MR图像的表现包括下列那种？（选择全部正确选项）A.Sphenoid sinus opacification 蝶窦浑浊B.Internal carotid artery occlusion颈内动脉闭塞C.Normal pattern of sphenoid sinus mucosal enhancement 蝶窦粘膜正常强化D.Unilateral cavernous sinus expansion单侧海绵的膨胀正确选项：A.D注释：注释：Thecontrast-enhanced T1-weighted images show diffuse loss of normal Thecontrast-enhanced T1-weighted images show diffuse loss of normal aeration ofthe sphenoid sinus with intrinsic T1 hyperintense signal and aeration ofthe sphenoid sinus with intrinsic T1 hyperintense signal and peripheral mucosalenhancement.There is some associated left sphenoid peripheral mucosalenhancement.There is some associated left sphenoid sinus expansion,consistentwith early mucocele-like changes.sinus expansion,consistentwith early mucocele-like changes.对比增强对比增强T1WIT1WI示蝶窦内气体弥漫缺失，周围粘膜强化，示蝶窦内气体弥漫缺失，周围粘膜强化，T1T1像呈高信号，相应左侧蝶像呈高信号，相应左侧蝶窦膨胀，与黏液囊肿早期改变相符。窦膨胀，与黏液囊肿早期改变相符。There is noevidence of internal carotid artery occlusion in these images.There is noevidence of internal carotid artery occlusion in these images.此组图像未见颈内动脉闭塞。此组图像未见颈内动脉闭塞。注释：注释：At thesuperolateral margins of the bilateral sphenoid sinuses,there is At thesuperolateral margins of the bilateral sphenoid sinuses,there is loss ofmucosal enhancement pattern,and nodular soft-tissue thickening loss ofmucosal enhancement pattern,and nodular soft-tissue thickening is presentis present.双侧蝶窦侧上方未见粘膜强化，并见结节样软组织增厚。双侧蝶窦侧上方未见粘膜强化，并见结节样软组织增厚。Asymmetricexpansion of the right cavernous sinus with soft-tissue Asymmetricexpansion of the right cavernous sinus with soft-tissue attenuation and outwardconvexity of the lateral wall of the right attenuation and outwardconvexity of the lateral wall of the right cavernous sinus are seen.cavernous sinus are seen.右侧海绵窦膨胀并见软组织信号，向右侧海绵窦侧壁外侵犯，与左侧不同。右侧海绵窦膨胀并见软组织信号，向右侧海绵窦侧壁外侵犯，与左侧不同。This axialcontrast-enhanced This axialcontrast-enhanced CT of the brain in bone CT of the brain in bone window shows cortical window shows cortical disruption ofthe lateral disruption ofthe lateral wall of the right sphenoid wall of the right sphenoid sinus(arrow)with a sinus(arrow)with a permeative patternof bone permeative patternof bone destruction.destruction.此骨窗轴位增强颅脑CT示右侧蝶窦外侧壁骨皮质中断（箭），呈穿凿样骨质破坏。This axialcontrast enhanced This axialcontrast enhanced CT image depicts asymmetric CT image depicts asymmetric soft-tissue attenuation soft-tissue attenuation withinthe right cavernous withinthe right cavernous sinus and orbital apex sinus and orbital apex(arrows).(arrows).此轴位增强颅脑CT示右侧海绵窦及眶尖软组织密度影（箭），与左侧不对称。This T1 coronalpostcontrast MR This T1 coronalpostcontrast MR image shows hyperintense image shows hyperintense mucosal enhancement of the mucosal enhancement of the sphenoidsinus with disruption sphenoidsinus with disruption of the enhancement pattern of the enhancement pattern superolaterally by a superolaterally by a nodularmass(arrow)that is nodularmass(arrow)that is less intense than adjacent less intense than adjacent mucosal.mucosal.此冠状位增强T1 MR像示蝶窦粘膜强化呈高信号，侧上方可见结节样肿块（箭），强化信号低于临近粘膜。This T1 coronalpostcontrast This T1 coronalpostcontrast image shows hyperintense image shows hyperintense mucosal enhancement of the mucosal enhancement of the sphenoidsinus.There is sphenoidsinus.There is diffuse mass-like infiltration diffuse mass-like infiltration into the right cavernous into the right cavernous sinuswith sinus expansion and sinuswith sinus expansion and convexity of the lateral wall convexity of the lateral wall(arrow).(arrow)此冠状位增强T1WI示蝶窦粘膜强化呈高信号，右侧海绵窦膨胀，并见弥漫肿块样病变侵入海绵窦及其外侧壁（箭）。This nonenhancedT1 MR image in This nonenhancedT1 MR image in the coronal plane shows the coronal plane shows asymmetric T1 isointense signal asymmetric T1 isointense signal andexpansion of the right andexpansion of the right cavernous sinus secondary to an cavernous sinus secondary to an intracavernous mass(arrow).intracavernous mass(arrow).此T1WI冠状位平扫MR像示右侧海绵窦肿块（箭）呈等信号，致海绵窦膨胀，与左侧海绵窦不对称。This T2 coronalimage demonstrates This T2 coronalimage demonstrates that the T2 signal of the right that the T2 signal of the right cavernous sinus lesion isisointense cavernous sinus lesion isisointense to gray matter.The mass encases to gray matter.The mass encases the cavernous segment of the the cavernous segment of the rightinternal carotid artery rightinternal carotid artery without apparent luminal narrowing without apparent luminal narrowing(arrow).(arrow).此T2WI示右侧海绵窦病变与脑灰质呈等信号，此肿块包绕右侧颈内动脉海绵窦段，而管腔无明显狭窄（箭）。This T2 axialimage shows This T2 axialimage shows hyperintense material occupying hyperintense material occupying the sphenoid sinus and the sphenoid sinus and hypointenseirregular lesions along hypointenseirregular lesions along the lateral wall of the sphenoid the lateral wall of the sphenoid sinus,extending tothe posterior sinus,extending tothe posterior ethmoid cells(arrowhead).The ethmoid cells(arrowhead).The lesion extends to the orbital lesion extends to the orbital apex(arrow).There is expansion of apex(arrow).There is expansion of the ipsilateral cavernous sinus the ipsilateral cavernous sinus related to thelesion.related to thelesion.此T2轴位像示蝶窦高信号病变，沿海绵窦外侧壁见不规则低信号病变，并侵入筛窦后部蜂房（箭头）及眶尖（箭），病变导致同侧海绵窦膨胀改变。DiagnosisBilateral non-Hodgkin lymphoma of the sphenoid sinus with extension into the right cavernous sinus and orbital apex双侧蝶窦非何杰金氏病淋巴瘤累及右侧海绵窦及眶尖Case PointsCase PointsLymphoma is an uncommon cause of cavernous sinus syndrome and Lymphoma is an uncommon cause of cavernous sinus syndrome and usually arises from metastatic deposits or direct infiltration.usually arises from metastatic deposits or direct infiltration.淋巴瘤并非海绵窦综合征的常见原因，其常为转移性或直接侵润。MR findings of a T2-weighted iso-to-hypointense contrast-MR findings of a T2-weighted iso-to-hypointense contrast-enhancing cavernous sinus mass with diffusion restriction,enhancing cavernous sinus mass with diffusion restriction,permeative bone remodeling,and dural infiltration are findings permeative bone remodeling,and dural infiltration are findings in line with lymphoma.in line with lymphoma.MR T2WI呈等-低信号，增强扫描海绵窦强化肿块并扩散受限，骨质呈穿凿样重构，硬膜浸润等表现与淋巴瘤相符。Approximately 50%of patients with Approximately 50%of patients with malignant lymphoma clinically present with malignant lymphoma clinically present with head and neck involvement,with the head and neck involvement,with the majority of cases showing nodal disease.majority of cases showing nodal disease.Extranodal involvement of the head and Extranodal involvement of the head and neck is present in approximately 10of neck is present in approximately 10%of cases and most commonly occurs in cases and most commonly occurs in tonsillar tissue,sinonasal cavities,and tonsillar tissue,sinonasal cavities,and the thyroid.Sinonasal lymphoma is found the thyroid.Sinonasal lymphoma is found most commonly in the nasal fossa and most commonly in the nasal fossa and maxillary sinuses with rare frontal and maxillary sinuses with rare frontal and sphenoid sinus involvement.sphenoid sinus involvement.约50%恶性淋巴瘤患者临床表现为头部及颈部侵犯，主要表现为淋巴结病变。头颈部淋巴瘤约10%病例为淋巴结外侵犯，常发生于扁桃体，鼻前庭，甲状腺。鼻腔、鼻窦淋巴瘤最常发生于鼻前庭、上颌窦，而额窦及蝶窦罕见。It may present as nodular or infiltrative It may present as nodular or infiltrative enhancing mucosal masses,usually of iso-to-enhancing mucosal masses,usually of iso-to-hypointense T2 signal compared to gray hypointense T2 signal compared to gray matter.Diffusion restriction may be matter.Diffusion restriction may be identified.identified.常见表现为结节样或侵润性粘膜强化肿块，T2像与灰质比多呈等-低信号。因扩散受限可以诊断。There is often disruption of the expected There is often disruption of the expected thin T2-bright mucosal signal and a thin T2-bright mucosal signal and a hyperintense enhancement pattern by MRI.CT hyperintense enhancement pattern by MRI.CT often reveals remodeling or erosion of the often reveals remodeling or erosion of the affected sinus wall.affected sinus wall.MRI上鼻窦的T2高信号及显著强化的薄层粘膜常被破坏。CT可发现受累窦壁骨质重建或侵蚀。CT or MR imaging typically reveals a homogenous CT or MR imaging typically reveals a homogenous enhancing cavernous sinus mass,which can mimic a enhancing cavernous sinus mass,which can mimic a meningioma.Evidence of direct extension from the meningioma.Evidence of direct extension from the paranasal sinuses,dural infiltration,or osseous paranasal sinuses,dural infiltration,or osseous permeation and remodeling may be helpful in permeation and remodeling may be helpful in differentiating this from other processes.differentiating this from other processes.CT或MR图像典型表现为海绵窦均质强化肿块，与脑膜瘤相似。副鼻窦病变直接侵犯，硬脑膜侵润，骨质穿凿样改变及重建等表现有助于此病与其它疾病鉴别。