MRI of the nasal cavity, the paranasal sinuses and orbits in Wegener's granulomatosis

The purpose of this study was to evaluate diagnostic MRI criteria in Wegener's granulomatosis of the nasal cavity, the paranasal sinuses and orbits. Between March 1991 and January 1996, 62 patients with biopsy-proven Wegener's granulomatosis were studied with T1- and T2-weighted spin-echo (SE) sequences. In 32 patients coronal postcontrast T1-weighted images were obtained. Mucosal thickening of the nasal cavity and paranasal sinuses was demonstrated as high-intensity lesions on T2-weighted SE sequences in 57 patients (92 %). Of this group, inflammatory granulomatous tissue was found on biopsy in 30 patients (48 %) in the nasal cavity and in 4 patients (6 %) in the paranasal sinuses. In 23 patients (37 %) biopsy revealed unspecific inflammatory changes without evidence of granulomatous tissue. In 14 patients (23 %) granulomas were depicted as low-signal intensity lesions on T1- and T2-weighted SE sequences in the paranasal sinuses and orbits. In 5 patients (8 %) osseous destruction was found. After gadolinium injection, 12 of 14 granulomas showed inhomogeneous signal enhancement. In two granulomas no enhancement was found. The MRI technique is helpful in the diagnosis of patients with Wegener's granulomatosis. In the initial inflammatory process of Wegener's granulomatosis, it is not possible to differentiate between mucosal inflammation and granulomatous tissue in MRI. In the later stage of granulomatous transformation, granulomas can be depicted as low-signal-intensity lesions. Therefore, Wegener's granulomatosis should be included in the differential diagnosis of patients with low-signal-intensity lesions on T1- and T2-weighted SE sequences of the nasal cavity, paranasal sinuses and orbits. Received 10 June 1996; Revision received 26 August 1996; Accepted 24 September 1996     

鼻腔及副鼻窦内翻性乳头状瘤的CT诊断

目的探讨CT对鼻腔及副鼻窦内翻性乳头状瘤的诊断价值.材料与方法回顾性分析23例经病理证实的鼻腔及副鼻窦内翻性乳头状瘤的CT征象,术后13例行CT随访.结果肿瘤呈不规则软组织肿块,以中鼻道为中心,同时侵犯同侧鼻腔及副鼻窦21例,单纯累及上颌窦2例;所致骨质改变以骨质破坏多见.术后肿瘤复发率高(85%),3例恶性变.结论CT能较好地显示鼻腔及副鼻窦内翻性乳头状瘤的病变部位、范围及术后有无肿瘤复发,有利于临床治疗方案的选择.     

鼻腔鼻窦肉芽肿性血管炎的 CT 和 MRI 表现

目的：探讨鼻腔、鼻窦肉芽肿性血管炎(GPA)的 CT 和 MRI 表现。方法回顾性分析8例经手术病理证实的鼻腔、鼻窦GPA 的 CT 和 MRI 征象。其中8例均行 CT 平扫,7例行 MRI 常规平扫,3例同时行 MRI 动态增强扫描,后处理得到时间-信号强度曲线(TIC)及半定量参数增强前信号强度(SIpre ),最大信号强度(SImax ),峰值信号强度(SIpeak ),峰值时间(Tpeak ),最大上升斜率(MSI)。结果 CT 表现：8例双侧中鼻甲、钩突、部分鼻中隔缺失,双侧上颌窦内侧壁骨质破坏、余上颌窦窦壁骨质增生硬化;6例上颌窦体积减小;6例筛骨迷路缺如;4例鼻骨扁平、鼻背塌陷;2例鼻咽软组织增厚,1例眼眶受累;8例鼻窦黏膜增厚。MRI 表现：7例平扫示病变区周围黏膜呈等、稍长 T1及稍短 T2信号;3例动态增强示病变周围黏膜明显不均匀强化,TIC 整体呈平缓型,于第1~4期有1段缓升。SIpre 平均为1030;SImax 平均为2500;SIpeak 平均为2353;Tpeak 平均为100 s;MSI 平均为1.28%。结论鼻腔、鼻窦GPA 具有典型的影像学征象,总结其 CT 和 MRI 表现,有助于本病诊断。     

Focal hyperostosis on CT of sinonasal inverted papilloma as a predictor of tumor origin

BACKGROUND AND PURPOSE: To evaluate the CT characteristics of focal hyperostosis in patients with sinonasal inverted papilloma and to correlate these characteristics with the detection of the origins of tumors. MATERIALS AND METHODS: Paranasal sinus and nasal cavity CT images of 76 patients were reviewed retrospectively to detect areas within which there was focal hyperostosis. We correlated the sites on the CT scans within which there was focal hyperostosis with the origin of the tumors described in the corresponding patient's medical records. We also evaluated the CT features of focal hyperostosis according to the origin of tumors. RESULT: Surgical evaluation of 55 lesions with focal hyperostosis in CT images revealed that 49 of these lesions coincided with the actual origin of tumor. The CT-based determination of the locations of the areas of focal hyperostosis corresponded to the actual tumor origin in 89.1% of cases. Especially in cases with focal hyperostosis within the frontal, maxillary, sphenoid, and posterior ethmoid sinuses, areas of focal hyperostosis corresponded to the origin of tumor without exception. In the evaluation of the CT features of focal hyperostosis, 2 patterns of localized bone thickening were noted. Plaquelike bone thickening was seen mainly when focal hyperostosis involved the lateral wall of the nasal cavity. On the other hand, cone-shaped bone thickening was seen only in the walls of the paranasal sinuses or the bony septum. CONCLUSIONS: A high correlation between the origin of the inverted papilloma and focal hyperostosis on CT might facilitate preoperative prediction of tumor origin by radiologists and rhinologists.     

CT findings in involvement of the paranasal sinuses by lepromatous leprosy.

The role of nasal infection in the transmission of leprosy has been extensively studied. Leprosy can affect the paranasal sinuses due to mucosal continuity and bacillaemia. This prospective study was performed on 25 untreated patients with lepromatous leprosy. 5 mm contiguous axial and coronal CT sections of paranasal sinuses, on soft tissue and bone windows, were obtained in all patients. Each sinus was examined for mucosal thickening, soft tissue densities and bony outlines. Representative biopsies were taken from ethmoid sinus to confirm the radiological diagnosis in 12 patients with multiple paranasal sinus involvement. Ethmoid aircells were involved in 20 patients (80%). Maxillary, frontal and sphenoid sinuses showed abnormalities in 12, four and three patients, respectively. The ethmoid biopsy showed involvement by lepromatous leprosy in seven of 12 patients (58.3%). Involvement of paranasal sinuses is common in lepromatous leprosy and is of considerable epidemiological significance.     

原发性鼻腔鼻窦恶性淋巴瘤的CT表现

目的:探讨鼻腔鼻窦恶性淋巴瘤的CT特点。材料和方法:回顾分析14例经病理证实鼻腔鼻窦淋巴瘤的CT表现。结果:鼻腔病灶12例,9例起源于鼻腔前部或鼻前庭,鼻窦腔病灶2例;病灶肿块表现4例,浸润表现3例,混合表现7例,多数(11/14)密度相对均匀;位于鼻窦腔者骨质破坏明显,2例均可见骨质缺损;位于鼻腔者骨质破坏不明显或较轻微,5例可见骨质吸收;病灶易累及邻近结构,6例鼻翼、鼻背部皮肤肿胀,皮下脂肪层消失,3例颊部软组织肿胀。结论:鼻腔鼻窦恶性淋巴瘤CT表现有一定特征性。     

鼻腔鼻窦淋巴瘤的CT和MRI诊断

目的 探讨鼻腔鼻窦淋巴瘤的CT和MRI表现，旨在提高其诊断准确性。资料与方法 回顾性分析46例经手术或活检证实的鼻腔鼻窦淋巴瘤患者的影像资料。结果 原发于鼻腔30例，鼻窦7例，鼻腔、鼻窦同时发病或累及邻近结构9例。CT表现：淋巴瘤位于鼻腔前部28例，后部2例，向前浸润鼻前庭、鼻翼、鼻背及邻近面部皮肤22例；病灶密度均匀8例，不均匀22例，增强后轻度强化7例，中度强化6例，鼻中隔、中下鼻甲浸润性破坏7例。鼻窦淋巴瘤表现为窦腔内充以软组织影，窦壁骨质浸润性改变5例，明显破坏2例，4例上颌窦周软组织浸润，增强后中度强化3例。弥漫型淋巴瘤表现为鼻腔中线区不同程度的骨质破坏，鼻腔及邻近鼻窦伴软组织肿块，6例并累及邻近面部软组织、眼眶、鼻咽部、口咽、颞下窝、翼腭窝，4例浸润颅底骨髓，2例破坏硬腭。MRI表现：T1WI低信号12例（与肌肉比较。以下同）。等信号8例；T2WI高信号11例，等信号9例；病变轻度强化6例，中度强化10例。4例沿翼腭窝神经周扩散。结论 多数鼻腔淋巴瘤及弥漫型鼻腔鼻窦淋巴瘤有特异影像学征象，可提示诊断；鼻窦淋巴瘤则缺乏特异影像学征象。CT是本病诊断的主要影像检查方法，MRI能更清楚显示病变的范围。帮助临床准确地分期。     

霉菌性鼻窦炎的CT诊断

目的探讨霉菌性鼻窦炎的CT表现特征并评价其诊断意义。方法12例经手术病理证实为霉菌性鼻窦炎患者均经鼻上颌部CT扫描,而后对所有患者的CT资料进行回顾性分析。结果CT扫描显示本组霉菌性鼻窦炎患者大多表现为一侧上颌窦混浊化,有的同时累及相邻其他鼻窦;鼻腔内见肿块状软组织密度影,密度不甚均匀,其内可见斑点状、结节状钙化;窦腔可见膨胀性增大,窦壁骨质吸收、破坏,亦可见窦壁骨质增厚,硬化。结论霉菌性鼻窦炎具有明显的CT特征,颇有助于该病的正确诊断。     

Complementary role of MR imaging of ethmomaxillary sinus disease depicted at CT in cystic fibrosis

Purpose: To assess whether MR imaging can improve characterization of ethmomaxillary opacification diagnosed at CT in patients with cystic fibrosis (CF) in order to select patients that may benefit from functional endoscopic sinus surgery (FESS).Material and Methods: Sixty-two CF patients (26 females and 36 males) aged 4-50 years (median 20 years) with ethmomaxillary sinus disease at CT underwent MR examination of the paranasal sinuses (coronal T1 and STIR sequences). FESS had been performed in 28 of the patients prior to this study. MR signal intensities were interpreted as mucosal thickening or infectious material, according to a previous study.Results: Three major maxillary sinus MR patterns could be distinguished: Air-filled, oval-shaped pus-filled, and streaky-shaped pus-filled sinus lumen. For air-filled maxillary sinuses with mucosal thickening, CT and MR imaging were diagnostically equivalent. Where CT showed homogeneous opacification of the maxillary sinuses, MR imaging differentiated between thickened mucosa and pus-filled areas. Patients who had undergone FESS most commonly had air-filled or streaky-shaped pus-filled maxillary sinus lumen. In non-operated patients oval-shaped pus-filled sinus lumen was most common and could occur without ethmoid disease.Conclusion: MR imaging of the paranasal sinuses can differentiate between infectious material and thickened mucosa and should be used to select CF patients with pus-filled areas that can be eradicated with FESS.     

Extramedullary plasmacytoma of the sinonasal cavities: CT evaluation

Computed tomography was performed in four patients with solitary extramedullary plasmacytoma of the nasal cavity and paranasal sinuses. Two tumors originated in the nasal cavity, one in the maxillary sinus, and one in the frontal sinus. Soft tissue mass(es) was seen in all patients. Bone destruction was apparent in only two patients. It seems possible to rule out carcinomas in such patients with no or subtle bony destruction. Computed tomography was also helpful for planning radiation therapy.     

Lymphoma of nasal and sinus cavities

Seven cases of non-Hodgkin lymphoma of the nasal cavities and paranasal sinuses are reported. All but one were primary lesions. Five of the 7 cases involved only the facial structures. Sites of involvement were the maxillary sinus (4 cases), the nasal fossae (2 cases), and one case in which lesions of both the ethmoid and sphenoid sinuses were associated with intracranial extension. CT studies showed sinus opacification and invasion of adjacent structures, but bone destruction was inconstant. Follow-up studies during treatment revealed rapid tumor regression with non specific images of mucosal hypertrophy.     

鼻窦真菌球的 CT 及磁共振成像表现

目的：探讨鼻窦真菌球的CT、磁共振成像（MRI）特征性表现及诊断价值。方法回顾性分析35例经手术、组织病理学证实的鼻窦真菌球的影像学资料,35例患者均做CT平扫,其中4例做MRI平扫加增强扫描。结果鼻窦真菌球的主要CT表现为：①病变为单侧性（100%）;②病变部位以上颌窦为主（80%）,部分突入同侧鼻腔;其次为蝶窦（14%）;③病变窦腔内不均匀软组织密度影充填,其内可见呈斑点状、云絮状或条带状高密度钙化影（89%）;④局限性骨质增生（74%）及破坏（9%）。 MRI表现为：病变中心T1WI呈等信号,T2WI呈低信号,周围增厚黏膜T1WI呈低信号,T2WI呈高信号,增强扫描病变中心不强化,周围增厚黏膜明显强化。结论病变内钙化影是本病特征性的CT征象,是诊断该病较为可靠的依据,CT检查是诊断本病的重要手段;MRI能显示病变内真菌球的范围,有助于诊断。     

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.Correspondence to: M. Mantoni     

Paranasal sinuses on MR images of the brain: significance of mucosal thickening

One hundred twenty-eight patients were examined prospectively to determine the significance of mucosal thickening seen in the paranasal sinuses during routine MR imaging of the brain. On the basis of responses to a questionnaire, each patient was categorized as symptomatic (n = 60) or asymptomatic (n = 68) for paranasal sinus disease. Patients were categorized further on the basis of the maximal mucosal thickening seen by MR in any paranasal sinus. A modified t test was used to compare the prevalence of various degrees of mucosal thickening between symptomatic and asymptomatic groups. Statistically significant differences between the groups were seen only in those patients with normal sinuses and in those with 4 mm or more of mucosal thickening. We conclude that mucosal thickening of up to 3 mm is common and lacks clinical significance in asymptomatic patients. An ancillary finding is that 1- to 2-mm areas of mucosal thickening in the ethmoidal sinuses occur in 63% of asymptomatic patients. This minimal mucosal thickening in the ethmoidal sinuses is thought to be a normal variant, possibly a function of the physiologic nasal cycle.     

真菌性鼻窦炎的CT与临床诊断

目的：探讨真菌性鼻窦炎的CT和临床特征以及新的分类。资料与方法：回顾性分析经手术、病理证实的34例真菌性鼻窦炎患者的CT表现。结果：CT征象：（1）所有受累鼻窦均显示窦腔内密度增高影；（2）上颌窦内可见团块状或线样钙化影25例（73．5％）；（3）窦腔高密度湿浊影中有气泡影8例；（4）上颌窦骨质吸收、破坏5例，窦壁骨质膨胀或变薄3例。结论：真菌性鼻窦炎有特征性的CT表现，如窦腔内可见团块状高密度影、线样钙化影或气泡影等。CT扫描结合鼻内镜检查是诊断本病的重要手段。     

鼻窦真菌病的CT诊断

探讨鼻窦真菌病的ＣＴ表现特征。材料和方法：回顾分析１０３例手术和病理证实的鼻窦真菌病的ＣＴ表现，其中累及上颌窦及蝶窦分别为９３和１０例。结果：病变未充满窦腔５６例（５４．４％），充满窦腔４７例（４５．６．％）。密度不均匀８７例（８４．４％），均匀１６例（１５．６％）。全窦腔受累者，基病变中心密度高于外周密度；病变涉及部分窦腔者显示为中央不规则的高密度软组织团块影伴窦壁黏膜增厚。９３例上颌窦真菌中，     

Prospective analysis of CT of the sinuses in acute asthma.

OBJECTIVE: Asthma and sinusitis are both inflammatory diseases of the respiratory epithelium, but to our knowledge no prospective analyses of CT of the sinuses in patients with acute asthma have been performed. The purpose of this study was to investigate the type and extent of abnormalities found on CT of the sinuses in patients with acute asthma. SUBJECTS AND METHODS: Sixty-five patients with acute asthma and 62 age-, race-, and sex-matched control subjects were enrolled in the emergency department. Limited coronal sinus CT was performed and scans were interpreted by a radiologist who was unaware of the patient's clinical condition. Scans were analyzed for the presence of mucosal thickening in the sinuses, ostiomeatal complexes, and nasal cavities. Scans were also assigned a CT score for total mucosal thickening. A CT score of 12 or more points indicated extensive disease. RESULTS: Mucosal thickening in the nasal passages (p < .001), ostiomeatal complexes (p < .05), and ethmoidal (p < .05) and sphenoidal sinuses (p < .05) was associated with acute asthma, but maxillary mucosal thickening was not (p = .44). CT scores differed significantly between asthmatic patients (7.7 +/- 0.8 points) and control subjects (4.1 +/- 0.4 points) (p < .001). Nineteen of the 65 asthmatic patients had extensive disease compared with two of the 62 control subjects (p < .001). Thirteen asthmatic patients with extensive disease underwent follow-up CT 5 months later, and 11 of the 13 patients showed improvement in CT score without having undergone specific therapy for sinusitis. CONCLUSION: Mucosal thickening in the nasal passages and sphenoidal, ethmoidal, and frontal sinuses is more common in patients with acute asthma than in control subjects. However, maxillary sinus mucosal thickening is no more common in asthmatic patients than in control subjects.     

The diagnostic reliability of the occipitomental radiograph of the paranasal sinuses. Correlation with magnetic resonance tomography]

100 conventional occipitomental radiographs of the paranasal sinuses were studied independently by five radiologists. Predictive values were determined, based on MRI as the gold standard. Sensitivity and specificity for detection of mucosal thickening in the sinuses were: maxillary sinus: 0.73/0.76, frontal sinus: 0.20/0.85, ethmoid sinus: 0.38/0.87, sphenoid sinus: 0.14/0.96. In the maxillary sinus polypoid thickening was demonstrated with a significantly higher sensitivity than that of diffuse mucosal thickening (0.82 versus 0.65, Chi-square-test, p less than 0.01). Because of the low predictive values the occipitomental view is insufficient to assessing mucosal thickening in the paranasal sinuses, with the exception of polypoid mucosal thickening in the maxillary sinus.     

Pneumosinus dilatans and multiplex: report of three rare cases and review of the literature

Pneumosinus dilatans is a term used to describe a localized abnormal dilatation of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis or mucous membrane thickening. The involvement of all paranasal sinuses and mastoid air cells has been named pneumosinus dilatans multiplex. Although the involvement of one or more paranasal sinuses has been reported widely, all paranasal sinuses and the concomitant involvement of mastoid air cells has been reported in only one case. Herein, we present three unusual cases of pneumosinus dilatans (one is a second case of pneumosinus dilatans multiplex in English literature, another is the first reported case of a frontal pneumosinus dilatans case associated with frontoethmoidal meningocele, mental retardation and facial asymmetry and the third one is pneumosinus dilatans with a huge arachnoid cyst) along with the review of relevant literature.     

The role of the ostiomeatal unit anatomic variations in inflammatory disease of the maxillary sinuses

Objective: The purpose of the study was to determine the correlation between bony anatomic variations of the ostiomeatal unit (OMU) and chronic maxillary sinusitis. The study was based on the hypothesis that the mucosal contact caused by the variations represents the critical factor in increasing the risk of maxillary sinusitis. Materials and methods: Thin section high resolution computerised tomography (CT) examinations of the paranasal sinuses in 73 consecutive patients with 113 anatomic variations of the OMU were retrospectively reviewed. The following CT features were assessed: (1) Type of anatomic variations, (2) presence of a mucosal contact in the OMU and (3) presence of maxillary disease. Statistical evaluation was carried out using z²-test. Results: The following bony anatomic variations were found: Concha bullosa (67 cases), abnormalities of the uncinate process (18 cases), Haller's cells (24 cases) and large ethmoidal bulla (four cases). Only 52 of the 113 anatomic variations were associated with ipsilateral maxillary disease (mucosal thickening, mucous retention cysts, polyps, retained secretions). Of 113 variations, 44 caused a mucosal contact, 35 of these were associated with maxillary abnormalities, while in nine cases there were no pathologic changes. Of 69 variations, 17 did not cause mucosal contact (P < 0.05). Conclusion: Our data shows that, in the presence of anatomic bony variations, a contact between the mucosal surface of the OMU is valuable in predicting the likelihood of a maxillary inflammatory disease.