鼻咽纖維血管瘤的影像表現(xiàn)和臨床培訓(xùn)課件

1、Page 1患者：男，26歲主訴：右鼻出血2天圖1 CT平掃圖2 CT增強(qiáng)Page 1患者：男，26歲圖1 CT平掃圖2 CT增強(qiáng)影像圖像Page 2圖3 增強(qiáng)矢狀位圖4 骨窗影像圖像Page 2圖3 增強(qiáng)矢狀位圖4 骨窗影像圖像Page 3圖5 MRI T1WI圖6 MRI T2WI影像圖像Page 3圖5 MRI T1WI圖6 MRI 影像圖像Page 4圖7 MRI T1WI增強(qiáng)圖8 MRI T1WI增強(qiáng)圖9 MRI T1WI增強(qiáng)影像圖像Page 4圖7 MRI T1WI增強(qiáng)圖8 MR影像圖像Page 5圖10 DSA冠狀位圖11 DSA矢狀位影像圖像Page 5圖10 DSA冠狀位圖1

2、1 DSA矢Page 6患者：男，26歲主訴：右鼻出血2天現(xiàn)病史：患者輸2天前無(wú)明顯誘因出現(xiàn)右鼻出血，為鮮血，呈滴狀，先從左前鼻孔出，后亦從口中、右鼻流出，數(shù)分鐘后停止，反復(fù)出現(xiàn)多次，總量約為100ml，無(wú)鼻塞，流涕，嗅覺(jué)正常。無(wú)頭痛、發(fā)熱、咳嗽、打鼾，無(wú)耳鳴、而鼻塞感，無(wú)聽(tīng)力下降。于當(dāng)?shù)蒯t(yī)院治療，予以鼻腔填塞，癥狀好轉(zhuǎn)。在中山陳星海醫(yī)院，予以電子喉鏡檢查“右鼻腔腫物，性質(zhì)待查”。既往史：否認(rèn)肝炎、結(jié)核、瘧疾病史，否認(rèn)高血壓、心臟病史，否認(rèn)糖尿病、腦血管疾病史，否認(rèn)手術(shù)、外傷、輸血史，否認(rèn)食物、藥物等過(guò)敏史，否認(rèn)吸煙、飲酒史，否認(rèn)毒物接觸史。Page 6患者：男，26歲Abstract Nas

3、opharyngeal angiofibroma (NA) is a rare,vascular tumor affecting dolescent males. Due to aggressive local growth, skull base location and risk of profound hemorrhage, NA is a challenge for surgeons.Angiofibromas tumor showed intensive contrast enhancement on CT and magnetic resonance imaging (MRI) s

4、cans, and abundant vascularity on angiography.Page 7Abstract Nasopharyngeal anBackground(NA) is a rare vascular tumor, which represents 0.05 % of all head and neck tumors. At the same time, it is the most common benign neoplasm of the nasopharynx . NA occurs predominantly in adolescent males. Althou

5、gh histologically benign it shows locally aggressive growth with bone destruction and spread through natural foramina and fissures. Page 8Background(NA) is a rare vasIt originates from the posterolateral wall of the nasopharynx and from this site usually extends to the nasopharynx, nasal cavity, par

6、anasal sinuses, sphenoid-palatine foramen and infratemporal fossa. In 1020 % of the cases tumor invades the cranial cavity 。Page 9It originates from the posteroNasal tumor underwent CT, which demonstrated homogenous mass, with contrast enhancement ranging from strong to intermediate (Fig. 1).In one

7、case, signs of bony destruction with tumor invasion to the ethmoid sinus were visible. The patient with the tumor of the infratemporal fossa underwent CT, (MRI) and carotid arteriography with preoperative embolization. The lesion showed intensive contrast。Page 10Nasal tumor underwent CT, whicPage 11

8、Fig. 1 Computed tomography, coronal plane, shows homogenoustumor mass in the right nasal cavityFig. 2 Magnetic resonance, saggital T1-weighted image after contrastadministration. Page 11Fig. 1 Computed tomograPage 12Histologic section of the tumor (H&E stain) shows fibrous stroma with ectatic, thin-

9、walled vascular channelsEnhancement on CT and MRI as well as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. Page 12Histologic section of tEnhancement on CT and MRI as well

10、as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. Page 13Enhancement on CT and MRI as wHistopathological appearance typical for NA consists of numerous wide, irregular vess

11、els with a single layer of endothelial cells, embedded in fibrous stroma. The abundant vascular component is responsible for excessive bleeding during surgery or following biopsies. It also contributes to certain characteristic radiological features of NAs, including strong contrast enhancement on C

12、T and MR images, signal-void areas representing tumor vessels visible on MR images, as well as intensive vascular blush demonstrated on angiography . Page 14 DiscussionHistopathological appearance tSelective angiography is a useful diagnostic method to demonstrate tumor vascular composition and conf

13、irms the diagnosis. It also allows tumor embolization, which reduces intraoperative bleeding. Due to a risk of profound hemorrhage, in a presence of characteristic clinical symptoms and classic radiological findings, preoperative biopsy is not recommended in the management of NAs.Page 15Selective angiography is a use鑒別診斷要點(diǎn)Page 161.鼻咽纖維血管瘤：常見(jiàn)于男性青少年，有多次鼻出血病史，影像檢查見(jiàn)鼻咽部軟組織腫塊，多伴有壓迫性骨質(zhì)吸收破壞；增強(qiáng)掃描病灶明顯強(qiáng)