【作者】 张桐；

【导师】 宋跃；

【作者基本信息】 吉林大学 ， 临床医学， 2008， 硕士

【摘要】 目的：研究眼眶海绵状血管瘤(Orbital Cavernous Hemangioma)与眼眶神经鞘瘤(Orbital Neurilemmoma)影像学表现特点，探讨最适合鉴别区分二者的影像学检查方法。方法：总结经手术后、组织病理学证实的眼眶海绵状血管瘤25例与眼眶神经鞘瘤24例的B型超声(brightness mode，B超)、彩色多普勒血流成像(color Doppler fiow imaging，CDFI)、计算机体层摄影(computedtomography CT)、磁共振成像(Magnetic resonance imaging，MRI)的表现，归纳各种检查方法所表现出来的影像学特点，对两种肿瘤进行鉴别诊断，以病理学诊断为标准，影像学诊断与之一致的为定性诊断符合；以手术定位为标准，影像学诊断与之一致的为定位诊断符合。诊断符合率比较采用Fisher’Exact test方法检验。总结出最适合鉴别这两种肿瘤的影像学检查方法。结果：眼眶海绵状血管瘤的B超、CDFI、CT、MRI的定位诊断符合率分别为45％、47％、88％、100％，B超与CT(P=0．003<0．01)、B超与MRI(P=0．004<0．01)、CDFI与CT(P=0．009<0．01)、CDFI与MRI(P=0．008<0．01)对比之间的差异具有非常显著性意义，而B超与CDFI、CT与MRI之间对比无统计学意义，说明MRI、CT的在定位诊断上的正确率高于B超与CDFI。眼眶海绵状血管瘤的B超、CDFI、CT、MRI的定性诊断符合率分别为80％、87％、40％(增强扫描后93％)、70％(增强扫描后100％)，B超与CT平扫(P=0．014<0．05)对比之间的差异具有显著性意义，CDFI与CT平扫(P=0．007<0．01)对比之间的差异具有非常显著性意义，说明B超、CDFI检查定性诊断符合率明显高于CT平扫检查，而MRI平扫与B超(P=0．657>0．05)、MRI平扫与CDFI(P=0．358>0．05)的检查对比，无统计学意义，说明超声检查的定性诊断率与MRI平扫的定性诊断率基本相同，而当CT增强扫描后：B超与增强CT(P=0．365>0．05)、CDFI与增强CT(P=1．000>0．05)的统计学对比，无统计学意义，说明当CT增强扫描后，可大幅度提高定性诊断符合率，当MRI增强扫描后，B超与增强MRI(P=0．295>0．05)，CDFI与增强MRI(P=0．526>0．05)仍无统计学意义，虽然MRI增强扫描前后与B超、CDFI检查均无统计学意义，但是MRI增强扫描后检查的8例患者，定性检查全部准确，符合率为100％，较增强前符合率(70％)明显提高，因此说明CT或者MRI行增强扫描是提高定性诊断符合率必不可少的一种检查手段。眼眶神经鞘瘤的B超、CDFI、CT、MRI的定位诊断符合率分别为42％、47％、92％、100％，B超与MRI(P=0．000<0．01)、B超与CT(P=0．001<0．01)、CDFI与MRI(P=0．001<0．01)、CDFI与CT(P=0．003<0．01)对比之间的差异具有非常显著性意义，而B超与CDFI、CT与MRI之间对比无统计学意义，说明MRI、CT的在定位诊断上的正确率高于B超与CDFI。眼眶神经鞘瘤的B超、CDFI、CT、MRI的定性诊断符合率分别为46％、53％、46％(增强扫描后47％)、88％(增强扫描后91％)。B超与MRI增强扫描(P=0．023<0．05)、CDFI与MRI(P=0．049<0．05)、CT增强扫描与MRI增强扫描(P=0．036<0．05)对比之间的差异具有显著性意义；CT平扫与MRI平扫(P=0．008<0．01)、B超与MRI(P=0．008<0．01)对比之间的差异具有非常显著性意义。CDFI与MRI增强扫描(P=0．084>0．05)，无统计学意义，但是定性诊断符合率CDFI为53％，MRI增强扫描为91％，增强MRI明显高于CDFI检查。说明无论MRI增强与否定性诊断率均高于其它检查方法，MRI(平扫+增强)检查，定性诊断符合率最高。两种肿瘤的定位诊断上，MRI检查最准确，定位诊断符合率略高于CT，而B超及CDFI不及MRI和CT。定性诊断上，海绵状血管瘤的B超与CDFI检查符合率高于CT平扫和MRI平扫检查，但是当CT与MRI检查增强扫描后，定性诊断符合率略高于B超与CDFI检查，说明CT或MRI增强扫描是正确诊断海绵状血管瘤性质的必要手段，可很大程度提高定性诊断准确率。因此得出结论，CT(增强)或MRI(增强)联合超声检查(B超或CDFI)，可较为准确的诊断出海绵状血管瘤。神经鞘瘤的MRI平扫与增强扫描检查定性诊断符合率明显高于其它检查，而B超、CDFI、CT检查诊断符合率基本相同，所以得出结论MRI(增强)检查联合超声检查(B超或CDFI)，可较为准确的诊断出神经鞘瘤。结论：综合以上两种肿瘤的影像学最佳诊断方法，得出结论，在鉴别难度较大的海绵状血管瘤与神经鞘瘤的时候，选择(MRI增强扫描+超声检查)，可以最大程度提高这两种肿瘤在定位、定性诊断上的符合率，从而作出正确的鉴别诊断。更多还原

【Abstract】 Objective: Both orbital cavernous hemangioma and orbital neurilemmoma are common orbital tumors. They two have similarities on matter the confluence of the disease, age, gender, clinic sign or the formation, position of the tumor. However, they differ in the option of operation and treatment because the correct pre-operation diagnosis is the foundation for the right treatment. Imaging investigation is the best one for orbital cavernous hemangioma. Based on the different structures of the different tumor tissue, various image diagnosis investigations can reflect the respective clinic sign. Then, according to the features, the suitable investigation to differ the two kinds of tumors can be found.Methods: The paper sums up my faculty’s verification on the reflection of the twenty-five cases of orbital cavernous hemangioma and twenty-four cases orbital neurilemmoma via B - mode, CDFI, CT,MRI, also concludes all kinds of the imaging features reflected from various checks, afterwards, based on results distinguish, statistic analyses. Finally, the most suitable way for differentiate the image investigation on the two kind tumor is found.The statistic software SPSS 13.0 is used to process the stat.Results: The position diagnosis accordance ratio of B-mode, CDFI, CT, MRI for the orbital cavernous hemangioma are 45%、47%、88%、100%(table 1), B-mode and CT (P = 0.003<0.01), B-mode and MRI (P=0.004<0.01), CDFI and CT (P=0.009<0.01), CDFI and MRI (P=0.008<0.01), obvious differences exist, statistically meaningful. It reveals that the correct ratio of MRI and CT in position diagnosis is higher than B-mode and CDFI. The accordance ratio of qualitative diagnosis are 80%, 87%, 40%(contrast enhancement scan is 93%),70%(contrast enhancement scan is 100%). B-mode and plain CT scan (P=0.014<0.05), CDFI and plain CT scan (P=0.007< 0.01),obvious differences exist, statistically meaningful. It means that accordance ratio of B-mode and CDFI is higher than plain CT scan investigation, while there is on statistical difference plain MRI scan and B-mode (P=0.657>0.05) between plain MRI scan and CDFI (P=0.358> 0.05) . So, there is on obvious difference on determine diagnosis ratio between ultrasonic investigation and MRI investigation. With the contrast enhancement of CT scan, B-mode and the CT(CE) (P=0.365>0.05), CDFI and CT(CE) (P =1.000>0.05), it is meaningless statistically. Though, it is meaningless in this sense, the after-check on the eight patients MRI scanned, all determine investigation are correct, accordance ratio is 100%. Contrast enhanced than before (70%) was significantly improved, it is more obvious. So we can say contrast enhancement on CT and MRI is a necessary investigation means.Table 1 The Location and Qualitative for Diagnostic Accordance Rate of Varied Imaging Examination on Orbital Cavernous Hemangioma The position diagnosis accordance ratio of B-mode, CDFI, CT, MRI for the orbital neurilemmoma are 42%, 47%, 92%, 100%(table 2), B-mode and MRI(P=0.000<0.05), B-mode and CT (P=0.001<0.05), CDFI and MRI(P=0.001<0.05), CDFI and CT(P=0.003<0.05), obvious differences exist, statistically meaningful. It reveals that the correct ratio of MRI and CT in position diagnosis is higher than B-mode and CDFI. The accordance ratio of qualitative diagnosis are 46%, 53%, 46%(contrast enhancement scan is 47%), 88%(contrast enhancement scan is 91%). B-mode and MRI(P=0.008<0.01), B-mode and MRI (CE) (P=0.023<0.05) , CDFI and plain MRI scan (P = 0.049<0.05),plain CT scan and plain MRI scan(P=0.008<0.05), CT (CE) and MRI(CE) (P=0.036<0.05) , obvious differences exist, so it is statistically meaningful. CDFI and MRI (CE) (P = 0.084>0.05) are statistically meaningless. But accordance ration of position diagnosis of CDFI is 53%, MRI(CE) is 91%, MRI(CE) is much higher than CDFI investigation. It confirms that no matter MRI (CE) or not, its qualitative diagnosis accordance ratio is higher than any other investigation means. MRI(plain scan + contrast enhancement scan) investigation has the highest accordance ration.Table 2 The Location and Qualitative for Diagnostic Accordance Rate of Varied Imaging Examination on Orbital NeurilemmomaFor the position diagnosis of the two kinds of tumors, MRI is the most correct. The position diagnosis is higher than CT, while B-mode and CDFI are worse than MRI and CT. For the qualitative diagnosis, cavernous hemangioma’s B-mode and CDFI investigation accordance ratio is higher than CT scan and MRI scan investigation. However, CT (CE) and MRI (CE) investigation scan, qualitative diagnosis accordance ratio is slightly higher than B-mode and CDFI. It reflects that CT (CE) or MRI (CE) scan is a necessary method for final diagnosis cavernous hemangioma and can greatly improve the determine diagnosis. The conclusion is that CT(CE) or MRI(CE) combining ultrasonic investigation(B-mode or CDFI),can diagnosis the cavernous hemangioma better. Neurilemmoma’s MRI(plain scan + contrast enhancement scan) investigation accordance ratio is much higher than other kinds of investigation. B-mode , CDFI and CT investigation accordance ratio are mainly the same. So we can conclude MRI(CE) unites ultrasonography investigation(B-mode or CDFI) can diagnosis neurilemmoma correctly.Conclusion: by concluding the above two kinds of tumor’s imaging best diagnosis method, we can conclude when it is difficult to differ relatively big cavernous hemangioma and neurilemmoma by using (contrast enhancement MRI scan + ultrasonography) investigation can greatly improve the accordance ratio of these two kinds of tumors in position and determine diagnosis, then various diagnosis can be chosen.更多还原