颈动脉体瘤多排探测器CTA诊断

Multi-Detector Computed Tomography Angiography Diagnosis of Carotid Body Tumor

摘要: 背景：探讨颈动脉体瘤多排探测器CTA (MDCTA)表现特征与诊断意义。方法：观察26个颈动脉体瘤MDCTA的平扫、增强动脉期及静脉期三期扫描图，基于动脉期强化表现将瘤体分为显著强化的I区和轻微强化的II区。分别比较动、静脉期I区、II区间的强化程度，分别比较I区、II区动、静脉期间强化程度，比较动脉期I区和颈动脉间密度增加值及实际密度值，根据瘤体内部I区、II区的构成及分布进行CBT分型，比较CBT瘤体轴位最大径与纵向最大径，CT-病理对照比较I区、II区镜下表现。结果：MDCTA动、静脉期，I区的强化率均高于II区，差异有显著性(t = 7.95, P < 0.001; t = 4.07, P < 0.005)。I区动脉期强化率高于静脉期，差异有显著性(t = 10.38, P < 0.001)；II区动、静脉期强化率差异无显著性(t = 0.53, P > 0.5)。MDCTA动脉期I区的密度增加值及密度值均低于颈动脉，差异有显著性(t = 11.06, P < 0.001; t = 11.13, P < 0.001)。CBT分型：A型11个，B型10个，C型5个。26个瘤体纵向最大径(53.2 ± 16.8 cm)均大于轴位最大径(38.7 ± 10.3 cm)，差异有显著性(t = 8.43, P < 0.001)。组织学上，I区瘤细胞和血管丰富、纤维成分少；II区胶原纤维丰富、瘤细胞少。结论：MDCTA反映了颈动脉体瘤内部组织结构的异质性，在其诊断及鉴别诊断中有着重要意义。

Abstract: Background: To assess the multi-detector computed tomography angiography (MDCTA) features of carotid body tumor (CBT) and its diagnostic significance. Methods: The three-phase MDCTA images, pre-contrast, post-comtrast arterial phase and venous phase, of 26 cases of CBT were observed, and the tumoral mass was divided into 2 regions: Markedly enhancing region I and mildly enhancing region II based upon the enhancement pattern on the arterial phase of MDCTA. The enhancement degrees were compared between region I and region II in both arterial and venous phases, as well those compared between arterial and venous phases in both region I and region II. Both density in-crement and real density were compared between region I and carotid in the arterial phase of MDCTA. The MDCTA categorization of CBT was conducted based on the distribution of region I and region II in the tumoral mass. The maximal diameters were compared in the axial plane and in the longitudinal plane. CT-pathologic correlation was performed to identify the histopathology of both region I and region II. Results: The enhancing ratios of region I exceeded those of region II in both arterial and venous phases of MDCTA (t = 7.95, P < 0.001; t = 4.07, P < 0.005, respectively). The en-hancing ratios of region I were higher in arterial phase than that in venous phase (t = 10.38, P < 0.001). No significant difference was shown in region II between arterial and venous phases (t = 0.53, P > 0.5). The density increment in region I was lower than that of carotid in the arterial phase of MDCTA, as well as the real density (t = 11.06, P < 0.001; t = 11.13, P < 0.001, respectively). Eleven CBTs of type A, 10 of type B and 5 of type C were noted in the MDCTA categorixation of the 26 CBTs. The maximal diameters in the longitudinal plane (53.2 ± 16.8 cm) surpassed that in the axial plane (38.7 ± 10.3 cm) among the 26 CBTs (t = 8.43, P < 0.001). Histologically, region I was composed of abundance of tumoral cellular nests and blood vessels and rarity of fibers, while region II was com-posed abundance of collagens and rarity of tumoral cellular nests. Conclusion MDCTA reveals the heterogeneity of intra-tumoral texture and configuration of CBT, which possesses vital significance in the diagnosis and differential diagnosis of this tumor.