Sakai Masafumi, Hiyama Takashi, Kuno Hirofumi, Kobayashi Tatsushi, Nakajima Takahito
Department of Radiology, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Jpn J Radiol. 2025 Feb;43(2):152-163. doi: 10.1007/s11604-024-01662-9. Epub 2024 Sep 20.
The skull base and orbit have complicated anatomical structures where various tumors can occur. The tumor may present with neurological symptoms; however, its diagnosis is clinically difficult owing to accessibility issues. Therefore, diagnostic imaging is crucial in assessing tumors in the skull base and orbit and guiding subsequent management. Notably, some tumors have a predilection for a specific site of origin, and identifying the site of origin on imaging can help narrow the differential diagnosis. At the skull base, chordomas typically occur in the clivus, chondrosarcomas in the paramedian areas, paragangliomas in the jugular foramen, neurogenic tumors, and perineural spread in the neural foramen. Among orbital tumors, cavernous hemangiomas usually occur in the intraconal space, and pleomorphic adenomas and adenoid cystic carcinomas occur in the lacrimal glands. Some skull base and orbital tumors exhibit distinctive imaging features. Chordomas and chondrosarcomas of the skull base show high signal intensities on T2-weighted images, with chondrosarcomas often displaying cartilaginous calcifications. Paragangliomas are characterized by their hypervascular nature. In the orbit, cavernous hemangiomas and pleomorphic adenomas present unique dynamic patterns. Immunoglobulin G4-related disease forms lesions along the nerves. Identifying the tumor origin and its imaging characteristics can help narrow the differential diagnosis of skull base and orbital tumors.
颅底和眼眶具有复杂的解剖结构，可发生各种肿瘤。肿瘤可能表现出神经症状；然而，由于可及性问题，其临床诊断具有挑战性。因此，诊断性影像学对于评估颅底和眼眶肿瘤以及指导后续治疗至关重要。值得注意的是，一些肿瘤倾向于特定的起源部位，在影像学上识别起源部位有助于缩小鉴别诊断范围。在颅底，脊索瘤通常发生在斜坡，软骨肉瘤发生在中线旁区域，颈静脉孔区副神经节瘤、神经源性肿瘤以及神经孔内的神经周围扩散。在眼眶肿瘤中，海绵状血管瘤通常发生在肌锥内间隙，多形性腺瘤和腺样囊性癌发生在泪腺。一些颅底和眼眶肿瘤表现出独特的影像学特征。颅底脊索瘤和软骨肉瘤在T2加权图像上显示高信号强度，软骨肉瘤常显示软骨钙化。副神经节瘤的特点是血运丰富。在眼眶，海绵状血管瘤和多形性腺瘤呈现独特的动态模式。免疫球蛋白G4相关疾病沿神经形成病变。识别肿瘤起源及其影像学特征有助于缩小颅底和眼眶肿瘤的鉴别诊断范围。
