72岁女性，进行性水平及垂直方向复视，进展迅速， 伴有右侧前额、鼻部疼痛。
Question :No.1
Which of the following are present on these images? (Check all that apply.) 正确选项：A.C.D 此组图像的可见下列那种表现？（选择全部正确选项）
• 注释： • Thecontrast-enhanced T1-weighted images show diffuse loss of normal aeration ofthe sphenoid sinus with intrinsic T1 hyperintense signal and peripheral mucosalenhancement. There is some associated left sphenoid sinus expansion, consistentwith early mucocele-like changes. • 对比增强T1WI示蝶窦内气体弥漫缺失，周围粘膜强化，T1像呈高信号，相应左侧 蝶窦膨胀，与黏液囊肿早期改变相符。 • There is noevidence of internal carotid artery occlusion in these images. • 此组图像未见颈内动脉闭塞。
这世界，你最珍贵~
2017.01.11
晴
小房子.
01
简要病史
Question
02
目
录
CONTENTS
03
图片说明 Diagnosis
04
05
Case Point
Discussion
06
复视 ！！
??
→诊断
→总结要点
【简要病史】 • A 72-year-old woman presents with rapidly progressive horizontal and vertical diplopia as well as pain in the right forehead and right nasal region
• Question :No.2 • Brain MR images demonstrate which of the following? (Check all that apply) 正确选项：A.D 颅脑 MR图像的表现包括下列那种？（选择全部正确选项） A.Sphenoid sinus opacification 蝶窦浑浊 B.Internal carotid artery occlusion颈内动脉闭塞 C.Normal pattern of sphenoid sinus mucosal enhancement 蝶窦粘膜正常强化 D.Unilateral cavernous sinus expansion单侧海绵的膨胀
• 注释： • At thesuperolateral margins of the bilateral sphenoid sinuses, there is loss ofmucosal enhancement pattern, and nodular soft-tissue thickening is present. • 双侧蝶窦侧上方未见粘膜强化，并见结节样软组织增厚。 • Asymmetricexpansion of the right cavernous sinus with soft-tissue attenuation and outwardconvexity of the lateral wall of the right cavernous sinus are seen. • 右侧海绵窦膨胀并见软组织信号，向右侧海绵窦侧壁外侵犯，与左侧不同。
• This axialcontrast-enhanced CT of the brain in bone window shows cortical disruption ofthe lateral wall of the right sphenoid sinus (arrow) with a permeative patternof bone destruction. • 此骨窗轴位增强颅脑CT示右侧 蝶窦外侧壁骨皮质中断（箭）， 呈穿凿样骨质坏。
A. Orbital apex involvement 眶尖部侵犯
B. Osseous
C. Mastoid air
sclerosis 骨质硬化
cell destruction 乳突气房破坏 蝶窦皮质破坏
D. Sphenoid sinuscortical disruption
• 注释： • The lesioninvolves the lateral wall of the sphenoid sinus extending into the rightorbital apex, as demonstrated by loss of normal fat attenuation in thislocation. • 此病变累及蝶窦外侧壁，侵入右侧眶尖，表现为此处正常脂肪消失。 • The walls of thebilateral sphenoid sinuses are thickened and sclerotic, as is the intersphenoidalseptum. The sphenoid sinus is opacified. • 双侧蝶窦壁及间隔增厚、硬化，蝶窦浑浊。
• 注释： • There is noevidence of a destructive process involving the mastoid air cells on theprovided images. • 所示图像并无证据表明乳突气房破坏。 • Focal corticaldisruption of the lateral wall of the right sphenoid sinus is present. • 可见右侧蝶窦外侧壁局部骨皮质破坏。