Barkovich A J, Vandermarck P, Edwards M S, Cogen P H
Department of Radiology, University of California, San Francisco 94143-0628.
AJNR Am J Neuroradiol. 1991 Jan-Feb;12(1):105-16.
The imaging studies of 16 children with pathologically proved nasal encephaloceles (eight), nasal dermal sinuses/nasal dermoids (seven), and nasal cerebral heterotopias, more commonly known as nasal gliomas (one), were retrospectively reviewed and compared with normal control subjects to define the normal anatomy and analyze deformities caused by these lesions. Nasal encephaloceles were always identified as complex masses of mixed soft tissue and CSF intensity that were contiguous with intracranial structures. The nasal glioma appeared as a mixed-intensity mass that, on the basis of the CT scan, appeared to be continuous with intracranial structures. Nasal dermal sinuses could only be identified as they coursed through the skin and subcutaneous soft tissue. They could not be identified when intraosseous. Moreover, on CT and, particularly, on MR, a number of potential diagnostic pitfalls were encountered. The most important of these was the normal fat deposition that occurs within bone during normal maturation and during aeration of the frontal sinuses and nasal bones. These fatty changes can easily be mistaken for fatty tumors if they are not recognized as normal anatomic changes. Interestingly, the classic plain film findings for congenital nasal masses were present only in the encephaloceles and nasal glioma; dermoids and dermal sinuses showed none of the classic plain film findings. In the six patients who had both CT and MR, the masses were easily identified and characterized by each imaging method. Congenital nasal masses are well characterized by both CT and MR. It is important to understand the normal changes in the anatomy of the nasofrontal region in the pediatric age group to avoid false-positive diagnoses in this region.
对16例经病理证实的鼻内脑膨出（8例）、鼻皮样窦/鼻皮样囊肿（7例）及鼻脑异位，即更常见的鼻胶质瘤（1例）患儿的影像学研究进行回顾性分析，并与正常对照者比较，以明确正常解剖结构并分析这些病变所致的畸形。鼻内脑膨出总是表现为与颅内结构相连的、由软组织和脑脊液密度混合而成的复杂肿块。鼻胶质瘤表现为混合密度肿块，根据CT扫描显示似乎与颅内结构相连。鼻皮样窦只有在其穿过皮肤和皮下软组织时才能被识别，在骨内时则无法识别。此外，在CT尤其是MR上，遇到了一些潜在的诊断陷阱。其中最重要的是在正常成熟过程以及额窦和鼻骨气化过程中骨内出现的正常脂肪沉积。如果这些脂肪变化未被识别为正常解剖变异，很容易被误诊为脂肪性肿瘤。有趣的是，先天性鼻腔肿块的典型平片表现仅见于脑膨出和鼻胶质瘤；皮样囊肿和皮样窦均无典型平片表现。在6例同时行CT和MR检查的患者中，两种成像方法都能轻松识别并明确肿块特征。先天性鼻腔肿块通过CT和MR都能很好地显示特征。了解儿童年龄组鼻额区域解剖结构的正常变化对于避免该区域的假阳性诊断很重要。
