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目的 探讨中耳恶性病变的CT诊断及鉴别诊断。方法 对手术病理证实的 10例中耳恶性占位性病变 (鳞癌 5例、NHL 4例、恶性肉芽肿 1例 )及 19例中耳良性占位性病变患者的临床资料和CT图像资料进行对比分析 ,着重总结恶性病变的CT诊断及鉴别诊断要点。结果 中耳恶性病变的CT诊断要点如下 :( 1)软组织密度肿物单发、形态可极不规则、但仍相连呈整体状 ,无良性病变常见的“多灶性”表现 ;( 2 )肿物区内的骨结构完全破坏消失 ,骨破坏区范围可远超出中耳乳突结构以外 ,骨破坏区边缘模糊、不规则 ,无边缘“骨质硬化带”表现 ;( 3 )肿物常广泛破坏乙状窦前壁或乳突外壁等 ,伴乳突周围软组织肿胀 ,但多无骨破坏区邻近颅内结构受侵表现。结论 根据上述CT诊断要点可对多数恶性病例做出正确诊断 ;对于CT征象不典型的病例 ,详细询问患者有否患耳流脓血史对恶性病变的诊断尤为重要
Objective To investigate the CT diagnosis and differential diagnosis of middle ear malignant lesions. Methods The clinical data and CT images of 10 cases of malignant middle ear malignant lesions (5 cases of squamous cell carcinoma, 4 cases of NHL, 1 case of malignant granuloma) and 19 cases of benign lesions of middle ear were confirmed by pathology. Comparative analysis, focusing on the summary of malignant CT diagnosis and differential diagnosis points. Results The main points of CT diagnosis of middle ear malignant lesions were as follows: (1) soft tissue density single tumor, the shape can be extremely irregular, but still connected to the whole like, non-benign lesions common “multifocal” performance; (2) swollen The bone structure completely destroyed and disappeared in the area, the range of bone destruction area can be far beyond the structure of the middle ear and mastoid process, the edge of the bone destruction area is fuzzy, irregular and borderless “bone sclerosis zone” performance; (3) Destruction of the anterior wall of the sigmoid sinus or mastoid wall, etc., accompanied by mastoid swelling of soft tissue around, but more no bone destruction adjacent to the performance of intracranial structures. Conclusion According to the above CT diagnosis of the most malignant cases can make the correct diagnosis; CT atypical cases, ask in detail whether patients suffering from ear flow of septic shock is particularly important for the diagnosis of malignant lesions