谢谢各位的建议、意见及指正
clinicalPresentation
A48-year-oldwomanpresentswithhearingloss,voicechangingover2years,anddifficultywithchewingandswallowing.48岁，女性，听力下降，声音改变超过2年，咀嚼和吞咽困难。
(A)OnnoncontrastCT,anisodenseextra-axialmassisbarelydiscerned(whitearrow).(B)PostcontrastCTshowsadenselyenhancingbroaddural-basedmass(whitearrow)withaduraltailextendinginleftjugularforamen.(C)Bonewindowexhibitshyperostoticpermeativemargins(whitearrow)ofnarrowedjugularforamen.(D,E)Broaddural-basedextra-axialmassextendingintothejugularforamen(whitearrow)appearsisointensetobrainparenchymaonT1-andT2-weightedimages.Thereisanenlargedextra-axialspacesurroundingthemass(whitearrow)withhighT2signalfluidcollectioninleftmastoidspace(blackarrow)likelyduetoobstructionofeustachiantube.(F,G)Intenselyenhancingjugularfossamass(shortarrow)withoutflowvoidsinvadesleftsigmoidsinus(longarrow)
(A)在平扫CT上，轴外等密度肿块难以辨认(白色箭头)。(B)增强后CT示有宽硬脑膜基底的明显强化肿块(白色箭头)，脑膜尾部延伸至左颈静脉孔。(C)骨窗显示穿透性的骨质增生累及颈静脉孔边缘并致其狭窄(白色箭头)。(d，E)在T1和T2加权像上，以宽硬脑膜为基底的轴外肿块延伸至颈静脉孔(白色箭头)，与脑实质等信号，肿块周围见扩大的轴外间隙(白色箭头)，左侧乳突腔(黑色箭头)见高T2信号液体聚集，可能由于咽鼓管阻塞所致。(F，G)颈静脉窝肿块明显强化(短箭头)，无流空及侵及左乙状窦(长箭头)表现。
DifferentialDiagnosis
?Jugularforamenmeningioma:Anisodense,stronglyenhancingposteriorskullmassextendingintothejugularfossaisseenwithpermeative/hyperostoticbonychangesalongthemarginsonCT.Abroaddural-basedintenselyenhancingisoT1andT2signalmasswithduraltailextendingintothejugularfossawithouthighvelocityflowvoidsisseenonMRI.Prolongedtumorblushextendingwellintolatevenousphaseonangiography.
?Glomusjugulareparaganglioma:JugularfossamasswithoutextensionintothemiddleearcavitywithpermeativebonechangesalongthemarginsofthejugularfossaonCT,erosionofjugularspine,andpresenceofflowvoidsonMRI.Shortbutintensetumorblushisseenonangiography.
?Jugularforamenschwannoma:Well-circumscribedmasswithsmoothenlargementofthejugularforamenwithouthyperostotic/permeativebonymarginscanbeseenonCTwithtubularspreadalongthecourseofcranialnervesIXtoXI.
?Highridingordehiscentjugularbulb:Smoothenlargementofjugularforamen(dehiscent)withintactbonymarginsonCTwithoutevidenceforasofttissuemass.IncreasedsignalisnotseenonallMRsequences.
鉴别诊断
?颈静脉孔脑膜瘤：CT表现为等密度、明显强化的后颅窝肿块，延伸至颈静脉窝，沿颈静脉孔边缘可见穿透性/骨质增生改变。MRI上可见一宽硬脑膜基底、等T1及T2信号并明显强化团块，硬脑膜尾部延伸至颈静脉窝，无流空影。血管造影显示肿瘤染色延长至静脉晚期。
?颈静脉球副神经节瘤：颈静脉窝肿块未延伸至中耳腔，CT表现为沿颈静脉窝边缘有穿透性骨破坏改变，MRI表现为颈棘虫噬样骨质破坏和流空影。血管造影可见短暂但明显的肿瘤染色。
?颈静脉孔神经鞘瘤：CT上可见边界清楚的肿块，颈静脉孔平滑扩大，无骨质增生/穿透性改变的骨缘，沿第IX~XI脑神经走行呈管状扩散。
?高位或颈静脉球裸露：CT显示颈静脉孔平滑扩大(裂开)，骨缘完整，但没有软组织肿块影。并不是在所有MR序列上都能看到信号增强。
EssentialFacts
?ArisesfromarachnoidalcellsofthemeningesthatcanfollowcranialnervesIXtoXIintothejugularfossaandintothenasopharyngealcarotidspace.
?Thereis2:1female-to-malepredominance;
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