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目的:分析鞍旁海绵状血管瘤MR影像特点及误诊原因,提高对该疾病的诊断及鉴别诊断水平。方法:收集我院经手术病理证实的13例鞍旁海绵状血管瘤,术前均行MRI平扫及增强扫描,5例行3D-ASL检查,分析其影像学资料。结果:9例表现为横向哑铃状,鞍旁大,鞍内小,病灶主体位于颈内动脉外侧,颈内动脉海绵窦段被病灶包绕;1例鞍旁与鞍内病灶大小相似,1例病灶主体位于颈内动脉内侧,2例病灶完全位于颈内动脉外侧;7例垂体显示不清,6例垂体受推移;6例T2W I表现为类似脑脊液的极高信号;仅5例行3D-ASL检查,病灶均呈低灌注。误诊9例,其中4例误诊垂体腺瘤,5例误诊脑膜瘤。结论:横向哑铃状、病灶主体位于颈内动脉外侧及T2W I类似脑脊液的极高信号是鞍旁海绵状血管瘤的典型影像特征。对于不典型病变,借助3D-ASL可以减少误诊,充分掌握MRI影像特征及鉴别诊断的要点,对提高临床术前诊断水平具有重要价值。
OBJECTIVE: To analyze the characteristics of MR images and the causes of misdiagnosis of cavernous hemangiomas in the parasellar and to improve the diagnosis and differential diagnosis of the cavernous hemangiomas. Methods: Thirteen cases of parasellar cavernous hemangiomas confirmed by operation and pathology in our hospital were scanned by MRI and enhanced scan before operation, and 5 cases were examined by 3D-ASL to analyze the imaging data. Results: Nine cases showed lateral dumbbell shape, large parasellar and small internal saddle. The main lesion was located outside the internal carotid artery. The cavernous sinus segment of internal carotid artery was surrounded by the lesion. The focus of the lesion was located inside the internal carotid artery, and the two lesions were completely located outside the internal carotid artery. In 7 cases, the pituitary showed unclear, and 6 cases showed pituitary degeneration. In 6 cases, T2WI showed high signal similar to cerebrospinal fluid. ASL examination, lesions were low perfusion. 9 cases were misdiagnosed, 4 cases misdiagnosed as pituitary adenomas and 5 cases were misdiagnosed as meningiomas. CONCLUSIONS: The extremely high dumbbell-shaped and focal high-intensity signal of T2W I-like cerebrospinal fluid located outside the internal carotid artery is a typical imaging feature of the cavernous cavernous hemangioma. For atypical lesions, with 3D-ASL can reduce the misdiagnosis, fully grasp the MRI features and differential diagnosis of the main points, to improve the level of clinical preoperative diagnosis is of great value.