Tolosa-Hunt綜合癥又稱痛性眼肌麻痹綜合癥(painfulophthalmoplegiasyndrome)T2-weightedimagerevealslowsignalintensitymassintheleftCS(arrows).Thisisanonspecificfinding.ImagingsupportsthediagnosisofTolosaHuntsyndrome,buttheclassicclinicalpresentationandbiopsyresultsarenecessarytomakethediagnosisconfidentlyT2加權(quán)像顯示左側(cè)海綿竇低信號(hào)腫物(箭頭).為非特異性發(fā)現(xiàn).影像支持Tolosa-Hunt綜合癥,但需要有典型的臨床表現(xiàn)和活檢才能確立診斷.海綿竇血栓AandB,Cavernoussinusthrombosissecondarytosphenoidandethmoidsinusitis.A,T2-weightedaxialimageshowslateralbulgingoftheduralwalloftheleftCS(arrow).TheCScontentsarerelativelylowinsignalintensity,consistentwiththrombosis.TheleftICAispatent,asthereissignalvoidwithinthelumen,consistentwithflowingblood(arrowhead).Notethehigh-signalintensitybenignsecretionswithinthesphenoidandethmoidparanasalsinuses.B,T1-weightedaxialimagefollowinggadolinium-basedcontrastagentshowsbulgingoftheleftCSandthin,nonnodularmeningealenhancement(whitearrows),probablyduetoinflammationinthedura.Duralenhancementisoftenseenassociatedwithextraaxialinfection.AlsonotethatthelumenoftheleftICA(blackarrows)ismorenarrowthanontheright,suggestingspasmfromtheperiarterialinflammatoryprocess.圖AB為海綿竇血栓繼發(fā)于蝶篩竇炎癥.圖AT2橫斷像顯示左海綿竇壁向外膨脹(箭).海綿竇內(nèi)相對(duì)低信號(hào),符合血栓.左ICA通暢,可見腔內(nèi)流空,符合血液流動(dòng)(箭頭).注意蝶篩竇內(nèi)高信號(hào)的分泌物.圖B強(qiáng)化橫斷T1顯示左海綿竇壁向外膨脹,薄的,無分葉腦膜強(qiáng)化(白箭),可能為硬膜炎癥所致.硬膜強(qiáng)化多伴有腦外感染.注意左ICA(黑箭)比右側(cè)窄,提示動(dòng)脈周圍炎癥所致的動(dòng)脈痙攣.(縮略圖，點(diǎn)擊圖片鏈接看原圖)海綿竇動(dòng)脈動(dòng)脈瘤AC,RightcavernousICAaneurysm.A,SagittalT1-weightedimageshowsalesionwithheterogeneoussignalextendingintothesphenoidsinus.B,OntheT2-weightedaxialimage,thelesionarisesfromthemedialaspectoftherightcavernousICA(longarrow)andhasmixedsignalintensity.Theblackregions,orsignalvoid,areduetoflowingbloodinthepatentportionoftheaneurysm,whereastheareaofhighersignalintensity(shortarrow)suggestseitherdisturbedslowfloworclot.C,Aftergadolinium,noticetheheterogeneousenhancementwithintheaneurysm.Thebandofvaryinghighandlowsignalintensityparalleltotheaneurysm(arrowheads)isaphaseartifact,whichiscommonlyseenonMRnearmovingorflowingblood.Aphaseartifactcanbeusedtoconfirmthatthelesionisananeurysm.海綿竇動(dòng)靜脈漏AandB,Indirectcarotidcavernousfistula(left).Onthispostgadolinium-enhancedT1-weightedaxialimagenoticetheflowvoidsintheleftcavernoussinus(arrow),discretefromthenormalcavernousICA.Theextraocularmusclesontheleftareswollenandedematous.Catheterangiogram,lateralview,leftICAinjection.Thereisshuntingintothecavernoussinuswithretrogradedrainagethroughthedilatedsuperiorophthalmicvein.垂體瘤侵犯Cavernoussinusinvasionbypituitaryadenoma.OnthisT1-weightedcoronalimageobtainedaftergadoliniumadministration,notethenormalCSvenoussulcusbeneaththecavernousportionoftheICAontheleft(largearrow).Thisspaceisreplacedbytumorontheright,suggestingCSinvasion.TheotherfindingsofCSinvasionincludewideningoftherightCSandlateraldisplacementofthelateralwall(arrowheads).Smallbilateralarrows,cranialnerves(probablyIIIand/orIV)inthesuperolateralwallsoftheCS.腦膜瘤AandB,Cavernousandparacavernousmeningioma.A,TheenhancingmeningiomaontheT1-weightedpostgadoliniumcontraststudyinvolvestherightCS,therightparacavernousregion,andspillsintotheprepontinecistern.B,OnthecoronalT1-weightedsequence,notethespiculatedenhancementpattern.Nervesheathtumorsgenerallyhaveamorehomogeneouspatternofenhancement.Alsonotetheduraltail(arrow),anonspecificfinding,butonethatsupportsthediagnosisofmeningioma.淋巴瘤Lymphomaoftheleftcavernoussinus.T1-weightedimage,withoutgadoliniumcontrast,showssubtlewideningoftheleftCS,slightmedialdisplacementandnarrowingoftheleftcavernousICA,andlateraldisplacementofthelateralCSwall(whitearrow).TherightMeckel'scaveisahypointensestructure(blackarrow)posterolateraltotheCS.Notethecisternalportionoftheleftfifthcranialnerve(arrowhead),seencoursingthroughCSF.淋巴瘤Lymphomaoftheleftcavernoussinus.Inanotherpatient,thepostgadoliniumT1-weightedaxialimagerevealsmarkedcompressionoftheleftcavernousICAwithnear-completelossofflowvoidwithinthevessel.ThereisenhancementwithintheCSmass,butitenhanceslessthanthenormalrightCS.Notethesecondlymphomamassintherightorbit(arrow).淋巴瘤AandB,Lymphomaofthecavernoussinus.A,OnthisT2-weightedaxialimage,notethemarkedlylow-signalintensitymassinthesphenoidsinus,pituitaryfossa,andleftcavernoussinus.B,Aftergadoliniumadministration,thereisrobustenhancementwithintheosseousandCScomponentsoftheinvasivenonnodallymphoma.鼻咽癌侵犯Perineuralspreadofadenoidcysticcarcinoma,originatinginthenasopharynx.Thislesionissubtle,withthin,nonnodularduralenhancement(straightarrows)andasymmetricwideningoftherightCS,seenonthisaxialT1-weightedgadolinium-enhancedimageattheleveloftheskullbaseandCS.Notethefineenhancementofthecisternalportionofthefifthcranialnerve(curvedarrow),consistentwithtumor.痛性眼肌麻痹綜合征(Tolosa-Huntsyndrome,THS)，是一種較少見的神經(jīng)內(nèi)科及眼科疾病。本病的發(fā)病率較低。THS首先由Tolosa于1954年報(bào)道1例，臨床表現(xiàn)為劇烈眼眶周圍疼痛，同側(cè)眼球運(yùn)動(dòng)神經(jīng)(第