左侧上颌骨海绵状血管瘤(Intraosseous cavernous hemangioma of the left maxillary bone )MRI病例图片影像诊断分析

鼻窦   2010-10-22

 【临床病史】:患者,49岁,男性出现鼻内肿块。49-year-old male with an intranasal mass.

影像图片】MRI图像


 左侧上颌骨海绵状血管瘤左侧上颌骨海绵状血管瘤

左侧上颌骨海绵状血管瘤左侧上颌骨海绵状血管瘤


影像改变】:Noncontrast orbital CT demonstrates a mass arising from the left maxillary bone with internal bony trabeculations in a “honeycomb,” “sunburst,” or “spokewheel” pattern typical for an intraosseous cavernous hemangioma (yellow arrow).

    平扫CT显示一起源于左侧上颌骨的肿块,内部有“蜂窝状”、“日光状”、或“轮辐状”的小梁形成,这是骨内海绵状血管瘤的典型特征。

This pattern of trabeculation on CT translates into a network of linear hypointense T1 and T2 signal with interspersed areas of enhancement on the T1 post gadolinium images characteristic of this entity

CT上的小梁状结构,在T1和T2序列上显示为低信号的线样的网格,增强扫描表现为扩散性的强化,这也是本病的特征性表现

影像诊断】:Intraosseous cavernous hemangioma of the left maxillary bone 左侧上颌骨海绵状血管瘤

诊断要点】:Intraosseous cavernous hemangiomas of the facial bones and skull are benign lesions that typically contain bony trabeculations and enhancement features in a "honeycomb," "sunburst," or "spokewheel" pattern. 颅盖骨及颅面骨的海绵状血管瘤是一种良性病变,表现为“蜂窝状”、“日光状”或“轮辐状”,有明显强化。

    These lesions may be monitored conservatively unless a patient develops symptoms such as visual disturbances from mass effect into the intraorbital compartement.本病可以适当随诊,除非病人出现症状,如由于对眶内结构的占位效应导致的视觉障碍

讨论】:Intraosseous cavernous hemangiomas are benign neoplasms which comprise only up to 1% of all osseous tumors and 7-10% of skull tumors. These are most frequently seen in the frontal and parietal bones with the orbital and maxillofacial bones infrequently involved. These tumors are slow growing and are generally asymptomatic unless they cause mass effect on sensitive structures such as within the intraorbital compartment. In symptomatic cases, en bloc resection is generally the treatment of choice. Preoperative angiography with potential embolization may be helpful as these tumors can bleed profusely.

    骨内海绵状血管瘤是一种良性的骨肿瘤,仅占所有骨肿瘤的1%、颅骨肿瘤的7-10%。最常见于额骨和顶骨,眶骨和上颌骨很少受累。这种肿瘤生长缓慢并且通常无症状,除非对邻近敏感结构产生推移,如对眶内结构。在有症状的病例中,整体切除是首选的治疗方式。术前血管造影术、可能的话再行栓塞术是非常有帮助的,因为这种肿瘤可以出现大出血。

    Clinical differential diagnosis includes fibrous dysplasia, osteoma, dermoid cyst, meningioma, eosinophilic granuloma, Lagerhan cell histiocytosis, and metastatic disease. On imaging, these tumors are well-defined and have characteristic internal trabeculations and enhancement features described as a "honeycomb," "sunburst," or "spokewheel" pattern. Malignant degeneration is rare.

    临床鉴别诊断包括骨纤、骨瘤、皮样囊肿、脑膜瘤、嗜酸性肉芽肿、朗格汉斯组织细胞增生症、以及转移瘤。在影像上,肿瘤边界清晰,有特征性的小梁结构,明显的强化,表现为“蜂窝状”、“日光状”或“轮辐状”。恶性变是相当罕见的。

(参考来源:,ACR Friday, November 27, 2009,作者:freemanpyw)
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