雙語影像讀片

1、這世界，你最珍貴~,2017.01.11 晴 小房子.,目,錄,CONTENTS,簡要病史,圖片說明,Case Point,01,03,05,Question,Diagnosis,Discussion,02,04,06,,,復視 ??！,CT+MRI,??,→診斷→總結要點,A 72-year-old woman presents with rapidly progressive horizontal and vert

2、ical diplopia as well as pain in the right forehead and right nasal region,【簡要病史】,72歲女性，進行性水平及垂直方向復視，進展迅速，伴有右側前額、鼻部疼痛。,,,,,Question :No.1Which of the following are present on these images? (Check all that apply.)此組圖像的

3、可見下列那種表現(xiàn)？（選擇全部正確選項）A. Orbital apex involvement 眶尖部侵犯B. Osseous sclerosis 骨質(zhì)硬化C. Mastoid air cell destruction 乳突氣房破壞D. Sphenoid sinuscortical disruption 蝶竇皮質(zhì)破壞,正確選項：A.C.D,注釋：The lesioninvolv

4、es the lateral wall of the sphenoid sinus extending into the rightorbital apex, as demonstrated by loss of normal fat attenuation in thislocation.此病變累及蝶竇外側壁，侵入右側眶尖，表現(xiàn)為此處正常脂肪消失。The walls of thebilateral sphenoid sinuses

5、 are thickened and sclerotic, as is the intersphenoidalseptum. The sphenoid sinus is opacified.雙側蝶竇壁及間隔增厚、硬化，蝶竇渾濁。,注釋：There is noevidence of a destructive process involving the mastoid air cells on theprovided images.

6、所示圖像并無證據(jù)表明乳突氣房破壞。Focal corticaldisruption of the lateral wall of the right sphenoid sinus is present.可見右側蝶竇外側壁局部骨皮質(zhì)破壞。,,,,Question :No.2Brain MR images demonstrate which of the following? (Check all that apply)顱腦

7、MR圖像的表現(xiàn)包括下列那種？（選擇全部正確選項）A.Sphenoid sinus opacification 蝶竇渾濁B.Internal carotid artery occlusion頸內(nèi)動脈閉塞C.Normal pattern of sphenoid sinus mucosal enhancement 蝶竇粘膜正常強化D.Unilateral cavernous sinus expansion單側海綿的膨脹

8、,,正確選項：A.D,注釋：Thecontrast-enhanced T1-weighted images show diffuse loss of normal aeration ofthe sphenoid sinus with intrinsic T1 hyperintense signal and peripheral mucosalenhancement. There is some associated left sphe

9、noid sinus expansion, consistentwith early mucocele-like changes.對比增強T1WI示蝶竇內(nèi)氣體彌漫缺失，周圍粘膜強化，T1像呈高信號，相應左側蝶竇膨脹，與黏液囊腫早期改變相符。There is noevidence of internal carotid artery occlusion in these images.此組圖像未見頸內(nèi)動脈閉塞。,,注釋：At th

10、esuperolateral margins of the bilateral sphenoid sinuses, there is loss ofmucosal enhancement pattern, and nodular soft-tissue thickening is present.雙側蝶竇側上方未見粘膜強化，并見結節(jié)樣軟組織增厚。Asymmetricexpansion of the right cavernous s

11、inus with soft-tissue attenuation and outwardconvexity of the lateral wall of the right cavernous sinus are seen.右側海綿竇膨脹并見軟組織信號，向右側海綿竇側壁外侵犯，與左側不同。,,This axialcontrast-enhanced CT of the brain in bone window shows cortic

12、al disruption ofthe lateral wall of the right sphenoid sinus (arrow) with a permeative patternof bone destruction.此骨窗軸位增強顱腦CT示右側蝶竇外側壁骨皮質(zhì)中斷（箭），呈穿鑿樣骨質(zhì)破壞。,,This axialcontrast enhanced CT image depicts asymmetric soft-tissu

13、e attenuation withinthe right cavernous sinus and orbital apex (arrows).此軸位增強顱腦CT示右側海綿竇及眶尖軟組織密度影（箭），與左側不對稱。,,This T1 coronalpostcontrast MR image shows hyperintense mucosal enhancement of the sphenoidsinus with disrupti

14、on of the enhancement pattern superolaterally by a nodularmass (arrow) that is less intense than adjacent mucosal.此冠狀位增強T1 MR像示蝶竇粘膜強化呈高信號，側上方可見結節(jié)樣腫塊（箭），強化信號低于臨近粘膜。,,This T1 coronalpostcontrast image shows hyperintense m

15、ucosal enhancement of the sphenoidsinus. There is diffuse mass-like infiltration into the right cavernous sinuswith sinus expansion and convexity of the lateral wall (arrow).此冠狀位增強T1WI示蝶竇粘膜強化呈高信號，右側海綿竇膨脹，并見彌漫腫塊樣病變侵入海綿竇及

16、其外側壁（箭）。,,This nonenhancedT1 MR image in the coronal plane shows asymmetric T1 isointense signal andexpansion of the right cavernous sinus secondary to an intracavernous mass(arrow).此T1WI冠狀位平掃MR像示右側海綿竇腫塊（箭）呈等信號，致海綿竇膨脹，與

17、左側海綿竇不對稱。,,This T2 coronalimage demonstrates that the T2 signal of the right cavernous sinus lesion isisointense to gray matter. The mass encases the cavernous segment of the rightinternal carotid artery without apparent

18、 luminal narrowing (arrow).此T2WI示右側海綿竇病變與腦灰質(zhì)呈等信號，此腫塊包繞右側頸內(nèi)動脈海綿竇段，而管腔無明顯狹窄（箭）。,,This T2 axialimage shows hyperintense material occupying the sphenoid sinus and hypointenseirregular lesions along the lateral wall of the s

19、phenoid sinus, extending tothe posterior ethmoid cells (arrowhead). The lesion extends to the orbital apex(arrow). There is expansion of the ipsilateral cavernous sinus related to thelesion.此T2軸位像示蝶竇高信號病變，沿海綿竇外側壁見不規(guī)則低信號

20、病變，并侵入篩竇后部蜂房（箭頭）及眶尖（箭），病變導致同側海綿竇膨脹改變。,,DiagnosisBilateral non-Hodgkin lymphoma of the sphenoid sinus with extension into the right cavernous sinus and orbital apex雙側蝶竇非何杰金氏病淋巴瘤累及右側海綿竇及眶尖,,Case PointsLymphoma is an un

21、common cause of cavernous sinus syndrome and usually arises from metastatic deposits or direct infiltration.淋巴瘤并非海綿竇綜合征的常見原因，其常為轉移性或直接侵潤。MR findings of a T2-weighted iso- to-hypointense contrast-enhancing cavernous si

22、nus mass with diffusion restriction, permeative bone remodeling, and dural infiltration are findings in line with lymphoma.MR T2WI呈等-低信號，增強掃描海綿竇強化腫塊并擴散受限，骨質(zhì)呈穿鑿樣重構，硬膜浸潤等表現(xiàn)與淋巴瘤相符。,,,,Approximately 50% of patients with mal

23、ignant lymphoma clinically present with head and neck involvement, with the majority of cases showing nodal disease. Extranodal involvement of the head and neck is present in approximately 10% of cases and most commonly

24、occurs in tonsillar tissue, sinonasal cavities, and the thyroid. Sinonasal lymphoma is found most commonly in the nasal fossa and maxillary sinuses with rare frontal and sphenoid sinus involvement.,約50%惡性淋巴瘤患者臨床表現(xiàn)為頭部及頸部侵

25、犯，主要表現(xiàn)為淋巴結病變。頭頸部淋巴瘤約10%病例為淋巴結外侵犯，常發(fā)生于扁桃體，鼻前庭，甲狀腺。鼻腔、鼻竇淋巴瘤最常發(fā)生于鼻前庭、上頜竇，而額竇及蝶竇罕見。,,It may present as nodular or infiltrative enhancing mucosal masses, usually of iso- to-hypointense T2 signal compared to gray matter. Diffu

26、sion restriction may be identified. 常見表現(xiàn)為結節(jié)樣或侵潤性粘膜強化腫塊，T2像與灰質(zhì)比多呈等-低信號。因擴散受限可以診斷。,,There is often disruption of the expected thin T2-bright mucosal signal and a hyperintense enhancement pattern by MRI. CT often reveals

27、remodeling or erosion of the affected sinus wall.MRI上鼻竇的T2高信號及顯著強化的薄層粘膜常被破壞。CT可發(fā)現(xiàn)受累竇壁骨質(zhì)重建或侵蝕。,,CT or MR imaging typically reveals a homogenous enhancing cavernous sinus mass, which can mimic a meningioma. Evidence of d

28、irect extension from the paranasal sinuses, dural infiltration, or osseous permeation and remodeling may be helpful in differentiating this from other processes.CT或MR圖像典型表現(xiàn)為海綿竇均質(zhì)強化腫塊，與腦膜瘤相似。副鼻竇病變直接侵犯，硬腦膜侵潤，骨質(zhì)穿鑿樣改變及重建等表現(xiàn)