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目的:探讨鼻咽癌翼腭窝侵犯的MRI特征,分析肿瘤组织侵犯翼腭窝及经翼腭窝向周围组织侵犯的途径。方法:回顾性分析61例经病理证实的鼻咽癌伴翼腭窝侵犯患者MRI片,研究其鼻咽部病变、翼腭窝受累情况及其侵犯途径。结果:61例鼻咽癌翼腭窝侵犯中共有65侧病变。最常见翼腭窝受累的MRI表现是翼腭窝破坏、正常形态消失,翼腭窝内异常强化软组织肿块影(39侧),其次为翼腭窝正常或扩大(形态尚在)、翼腭窝正常脂肪信号影消失,被异常软组织影取代(19侧)以及翼腭窝扩大伴上颌神经的异常强化增粗(7侧)。61例翼腭窝受累病例中,有33例(54%)合并海绵窦侵犯,17例(28%)侵犯蝶窦,12例(20%)侵犯破裂孔,5例(8%)侵犯眶下裂、2例(3%)卵圆孔受累。7例(11%)出现上颌神经侵犯。结论:翼腭窝受累最易合并海绵窦、蝶窦和破裂孔侵犯。沿上颌神经侵犯是鼻咽癌侵犯翼腭窝的一条重要途径。MRI能有效、准确评价鼻咽癌侵犯翼腭窝及其向周围组织侵犯的情况,对临床治疗方案的选择及预后评估具有重要的价值。
Objective: To investigate the MRI features of nasopharyngeal carcinoma (PAG) infiltrated by the pterygocaval and palate fossa, and to analyze the invasion of the pterygopalatine fossa and the surrounding tissue by the pterygopalatine fossa. Methods: Retrospective analysis of 61 cases of pathologically confirmed nasopharyngeal carcinoma with pterygopalatine fossa in patients with MRI film, nasopharyngeal lesions, pterygopalatine fossa involvement and ways of infiltration. Results: There were 65 lesions in 61 cases of invasion of pterygopalatine fossa of nasopharyngeal carcinoma. The most common MRI findings of pterygopalatine fossa involvement were destruction of pterygopalatine fossa, loss of normal morphology, abnormal enhancement of soft tissue mass in the pterygopalatine fossa (39 sides), followed by normal or enlarged pterygopalatine fossa Normal fat signal disappeared, replaced by abnormal soft tissue shadow (19) and pterygopalatine fossa with maxillary nerve abnormal enhancement thickening (7 sides). Sixty-one cases of pterygopalatine fossa were infiltrated with cavernous sinus in 33 cases (54%), sphenoid sinus in 17 cases (28%), ruptured holes in 12 cases (20%) and infraorbital invasion in 5 cases (8%) Cleft, 2 cases (3%) foramen ovale involvement. Seven cases (11%) showed maxillary nerve invasion. Conclusion: Pterygopalatine fossa involvement is most likely to be associated with cavernous sinus, sphenoid sinus and rupture. Nasal nerve invasion along the maxillary nasopharyngeal carcinoma is an important way to infiltrate the pterygopalatine fossa. MRI can effectively and accurately evaluate the invasion of nasopharyngeal carcinoma to the pterygopalatine fossa and its surrounding tissues, which is of great value in the selection of clinical treatment options and prognosis.