【摘要】 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更多还原

【Abstract】 Objective To study CT diangnosis and differential diagnosis of malignant diseases in middle ear. Methods High-resolution CT findings and clinical manifestations of 10 patients with various malignant diseases in middle ear (squamous cell carcinoma 5 cases,non-Hodgkin’s lymphoma 4 cases,malignant granuloma 1 case)and 19 patients with various benign diseases in middle ear proved by surgeon and pathology were analyzed,and the main points of CT diagnosis of malignant diseases in middle ear were summarized.Results The main points of CT diagnosis of malignant diseases in middle ear included: (1) The lesion appeared mostly single irregular soft-mass ,without the appearance of “multicentric-focus-lesion” which was common in benign diseases ; (2) The bone structure in the area of lesion was destructed completely. The lesion might invade the bone structures outside the middle ear .The edge of the bone destructive region was indistinct and irregular, without the benign CT feature of “edge bone sclerosis”. (3) The walls of the sigmoid sinus and the mastoid process might be usually and extensively destructed , and accompanied with swelling of the soft tissues around the mastoid process, but the structure of craniocerebral had seldom invaded . Conclusion Based on above main points,most of malignant diseases in middle ear can be diagnosed by CT.The history of sanguinolent-purulent ear discharge was important for diagnosis in the atypical cases.更多还原