鼻腔、鼻窦病变的CT诊断

目的：为了提高理解,对50例单侧鼻腔和鼻窦病变的CT表现进行分析,总结各种常见的病理变化。方法收集50例耳鼻喉医院病理证实下的CT扫描单侧鼻腔鼻窦病变,分析这种病变的CT影像表现,并讨论总结诊断及鉴别诊断要点。结果鼻息肉15例;乳头状瘤8例;霉菌性鼻窦炎10例;鼻腔鼻窦癌2例;骨瘤5例;囊肿10例。结论单侧鼻腔鼻窦常见病变有不同图像,CT扫描的性能和特征有助于诊断和鉴别诊断。     

鼻腔鼻窦原发恶性黑色素瘤的影像学表现

目的：分析鼻腔鼻窦原发恶性黑色素瘤CT及 MR 表现,探讨其诊断要点。方法回顾性分析经活检或手术病理及免疫组化证实的16例鼻腔鼻窦恶性黑色素瘤的CT、MR特征及临床资料,均行 CT 平扫及增强,其中9例行 MR 平扫及增强。结果16例CT表现均为单侧发病;肿瘤位于鼻腔8例,鼻窦4例,同时累及鼻腔、鼻窦4例;形态欠规整,呈软组织密度,其内未见钙化和囊变;周围组织均受侵;增强后不均匀中-重度强化。9例 MR表现均为单侧发病;肿瘤位于鼻腔4例,鼻窦3例,同时受累鼻腔、鼻窦2例;形态欠规则,1例呈T1 WI高信号,T2 WI低信号,3例呈T1 WI等信号,T2 WI等/稍高信号,5例呈混杂信号。增强后不均匀轻-中度强化;周围组织均有侵犯。结论鼻腔鼻窦原发恶性黑色素瘤 CT表现缺乏特异性;典型恶性黑色素瘤有 MR 特征性表现,但罕见,以非色素及混合型常见。CT联合 MRI能准确显示肿瘤部位及与周围组织、邻近骨质的关系。     

中线恶性肉芽肿的影像学研究(附10例报告)

目的　探讨中线恶性肉芽肿鼻、鼻窦、咽及肺部病变的影像学特征及鉴别诊断。材料与方法　回顾分析 10例CT及X线表现。结果　所有病例均经组织学证实。 10例中有 4例鼻腔、鼻窦、咽部与肺部病变并存。肺部表现为空洞及结节病变。结论　中线恶性肉芽肿在鼻腔及鼻窦的病变具有明确的CT特征 ,即弥漫浸润病灶伴骨质破坏。咽部病变与早期鼻咽癌和炎症区别困难 ,需靠组织学诊断。肺部空洞与结节病变在鼻、咽部中线恶性肉芽肿组织学确诊后可以考虑肺部受侵的诊断     

鼻腔及鼻窦粘膜恶性黑色素瘤的CT评价

目的 探讨鼻腔及鼻窦恶性黑色素瘤的CT诊断价值。材料与方法 回顾性分析8例经病理证实的鼻腔及鼻窦恶性黑色素瘤的CT征象。结果 8例肿瘤均无钙化,注射碘对比剂后病灶有不同程度强化。CT冠状位及轴位扫描显示肿块位于单侧鼻、窦腔6例,双侧2例;病灶中心位于鼻腔前下4例,鼻腔上部及筛窦4例;肿瘤侵犯邻近结构,包括上颌窦4例,突破筛骨纸板到眶骨膜下间隙7例,向上破坏筛骨水平板和蝶平面,并浸润相应脑膜2例。结论 CT能很好地显示窦鼻腔恶性黑色素瘤的病变部位、周围骨质破坏和邻近重要结构的侵犯。尽管这些表现缺乏特征,对该肿瘤的定性诊断帮助不大,但CT对病变的全面评价是必要且较充分的。     

鼻腔及副鼻窦病变骨质改变的CT研究

目的探讨CT所见骨质改变对鼻腔和副鼻窦良、恶性病变的鉴别诊断价值.材料与方法经病理证实的鼻腔及副鼻窦良、恶性病变131例,在CT图像上盲法观察各种骨质改变的类型、范围和部位.结果良、恶性病变有骨质破坏者分别占65.2%和84.7%;66.7%,恶性病变的骨质破坏呈多发性,良性组以单发为主(73.3%);良、恶性病变突破窦壁的发生率分别是21.7%和52.9%;上颌窦内侧壁、筛窦间隔和鼻甲骨质破坏的发生率良、恶性组相似,其他骨壁骨质破坏恶性组多于良性组.骨膨胀的发生率两组相近,而良性组的骨质硬化多于恶性组,神经孔、裂扩大恶性组多于良性组.结论根据骨质破坏的不同类型、部位和范围,CT对鼻腔和副鼻窦良、恶性病变的鉴别诊断可提供较大的帮助.     

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.     

CT诊断鼻腔鼻窦肿块性病变的价值

目的探讨CT诊断鼻腔鼻窦肿块病变的价值。方法100例鼻腔鼻窦肿块,按病变累及部位分3种情况:A,肿块局限于鼻腔;B,肿块累及鼻窦和(或)鼻腔;C,肿块累及鼻腔、鼻窦以外的邻近结构。将鼻腔鼻窦肿块分良性病变组(60例)和恶性病变组(40例),对比分析肿块累及部位情况。结果肿瘤累及部位,良性肿块病变组:A,53例;B,1例;C,6例;恶性肿块性病变组:A,3例;B,9例;C,28例,2组差别显著(Ρ<0.05)。对于肿块骨质结构改变,良性肿块病变组:正常51例,骨质吸收2例,骨质破坏7例;恶性肿块病变组:正常1例,骨质破坏39例,无骨质吸收病例,2组差别显著(Ρ<0.05)。结论根据CT表现,多数可确定鼻腔鼻窦肿块的性质和起源部位。     

鼻腔及鼻窦原发性恶性黑色素瘤CT和MRI的诊断价值

目的探讨CT和MR诊断鼻腔及鼻窦原发性恶性黑色素瘤的影像特点。方法回顾性分析经病理证实的11例鼻腔及鼻窦原发恶性黑色素瘤的CT和MRI影像表现。本组11例病变短径均1.5cm,CT检查11例,11例均行CT平扫;MRI扫描9例,均行平扫+DWI+增强扫描。重点观察病灶的数目、位置、形态、对周围结构侵犯及影像学特征。结果11例中,CT、MRI能准确反映病灶的位置、形态及邻近结构的累及情况。CT表现为单侧5例,双侧6例;肿瘤形态不规则,呈软组织密度,其内未见钙化及囊变,11例均侵犯周围组织;11例均有周围骨质破坏;9例患者主要MRI表现为9例形态均不规则;单侧5例,双侧4例;表现为混杂信号,T_1WI以等、低信号为主,其内可见斑片状高信号;T_2WI 5例以等低信号为主,4例以稍高信号为主,DWI均呈高信号,增强扫描呈轻中度不均匀强化,邻近周围组织均有侵犯。结论鼻腔及鼻窦原发性恶性黑色素瘤CT表现无特异性;MRI表现具有一定特异性。CT和MRI能很好地显示肿瘤的部位、与周围组织关系及邻近骨质破坏情况,为临床分期及手术方案制定提供帮助。     

肾上腺少见肿瘤的CT、MRI评价

目的:探讨CT和MRI对肾上腺少见肿瘤的诊断及鉴别诊断价值。方法:对21例经手术和病理证实的肾上腺少见肿瘤的CT、MRI表现进行回顾性分析,包括囊肿8例、髓质脂肪瘤7例、神经节细胞瘤3例、神经纤维瘤、原发恶性淋巴瘤及恶性间皮瘤各1例。结果:14例(93%)肾上腺囊肿、髓质脂肪瘤有其特征性的CT、MRI表现而确诊,1例假性囊肿术前误诊为肿瘤;3例神经节细胞瘤中,1例为等密度肿块,轻度强化,1例大部囊变类似于假性囊肿,1例呈实性肿块,伴有囊变和钙化灶,明显不均匀强化;1例神经纤维瘤大部囊变;原发恶性淋巴瘤及恶性间皮瘤符合恶性肿瘤的影像学特征,但与常见的肾上腺恶性肿瘤鉴别困难。结论:CT、MRI对肾上腺少见肿瘤的诊断价值相似,后者有利于肿瘤的定位;大部分囊肿和髓质脂肪瘤可明确诊断,其它肾上腺少见肿瘤较难或不能与常见肿瘤鉴别,确诊仍需结合临床及组织学检查。     

鼻腔及鼻窦粒细胞肉瘤的影像诊断

目的 分析鼻腔及鼻窦粒细胞肉瘤的临床及影像特征,提高粒细胞肉瘤的影像诊断水平。方法 报道3例经病理确诊的鼻腔及鼻窦内粒细胞肉瘤的影像表现,并结合相关文献进行分析。结果 鼻腔及鼻窦粒细胞肉瘤CT上呈等密度,浸润性生长,常累及相邻结构,如咽腔、咽旁、眶内及颅内等,病变区骨质破坏吸收,无硬化改变;MRI上病变呈等T1、稍长T2信号,增强扫描呈中重度强化,周围环形强化程度较高。结论 鼻腔及鼻窦软组织肿瘤伴有邻近多个结构受累、骨质破坏,并有白血病病史的病人,要考虑到粒细胞肉瘤的可能性;白血病病史不明确,但影像表现典型,建议积极做相关检查;最终确诊仍需与病史、病理相结合。     

鼻腔、副鼻窦原发性肿瘤70例CT分析

本文回顾分析了70例经手术病理证实的鼻腔、副鼻窦原发性良恶性肿瘤的临床和CT表现。讨论了良恶性肿瘤的鉴别诊断,不典型的CT表现及CT的检查价值,认为CT检查可做为鼻腔、副鼻窦肿瘤的首选方法。     

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。     

Radiological changes associated with inverted papilloma of the nose and paranasal sinuses

Inverted papilloma is an uncommon benign tumour of the nose and paranasal sinuses which has a characteristic histological pattern, high recurrence rate after surgery and may undergo malignant change. The X-ray features are reviewed in 60 patients with histologically confirmed tumours. Plain X-ray appearances were negative or non-specific in nearly half the patients. The changes shown on hypocycloidal tomography and on CT scan are more specific. A mass in the middle meatus of the nasal cavity extending into the adjacent maxillary antrum is highly suggestive of the tumour. Other features not hitherto reported are the presence of calcified areas within the tumour mass demonstrated by CT, and sclerosis and deformity of the walls of the sinuses involved by tumour.     

Diagnosis of tumor in the nasal cavity and paranasal sinuses with [<Superscript>11</Superscript>C]choline PET: Comparative study with 2-[<Superscript>18</Superscript>F]fluoro-2-deoxy-<Emphasis Type="SmallCaps">d</Emphasis>-glucose (FDG) PET

[11C]choline (11C-choline) positron emission tomography (PET) was performed to evaluate its clinical utility in the diagnosis of tumors in the nasal cavity and paranasal sinuses. We studied 22 patients with suspicion of malignant tumors in the nasal cavity and paranasal sinuses. Tumor uptake of 11C-choline was measured with standardized uptake value (SUV) and correlated with the pathological diagnosis. 2-[18F]fluoro-2-deoxy-D-glucose (FDG) PET was performed in all patients for comparison. Both 11C-choline and FDG PET depicted squamous cell carcinoma showing an increased activity significantly higher than that of normal tissue, and these SUVs were significantly higher than those of benign lesions. FDG uptake in malignant tumors as a whole was variable. Although 11C-choline uptake in squamous cell carcinoma was lower than FDG uptake, 11C-choline uptake in malignant tumors was relatively uniform and statistical significance was found. PET with 11C-choline may be useful to diagnosis tumors in the nasal cavity and paranasal sinuses.     

能谱CT鉴别鼻腔鼻窦良恶性肿物的研究

目的探讨双源CT最佳单能量CT值及能谱曲线斜率对鼻腔鼻窦良恶性肿物的鉴别诊断价值。方法搜集60例经病理证实且直径≥1 cm的鼻腔鼻窦肿物,术前均行常规CT平扫及双能量CT双期增强扫描。根据病变的常规形态学表现判断良恶性。测量病灶实性部分的最佳CNR单能量CT值(CTose)及能谱曲线斜率(K),另测量双期融合图像病灶实性部分的CT值。根据病理结果分为良性组(34例)和恶性组(26例),评价常规形态学分析的诊断效能。比较良性组与恶性组病灶CTose值、K值、CT值,并绘制各参数的ROC曲线,比较曲线下面积(AUC),评估其诊断效能。结果常规形态学诊断的敏感性、特异性及准确性分别为61.5%、88.2%、76.7%。动脉期:良性组的CTose值、K值、CT值分别为61.91±25.62、0.92±0.69、56.56±16.67,恶性组分别为80.16±16.07、1.97±1.18、67.85±11.41;静脉期:良性组的各参数分别为68.25±26.60、1.26±0.78、62.57±19.98,恶性组分别为95.31±16.72、2.50±0.95、79.08±12.61;双期恶性组3参数均高于良性组(P值均<0.05)。动脉期病灶CTose值、K值、CT值的AUC分别为0.813、0.883、0.736,静脉期分别为0.841、0.885、0.777;其中静脉期病灶K值的AUC最大(0.885),以K=1.77为诊断阈值,其诊断敏感性、特异性及准确性分别为88.5%、88.2%、88.3%。结论双源CT的最佳单能量CT值及能谱曲线斜率可更准确地反映病变血供情况及组织差异,有助于鼻腔鼻窦良恶性肿物的鉴别诊断。     

Sinonasal computed tomography in patients with Wegener's granulomatosis

The goal of this study was to describe pathologies of sinonasal CT in patients with Wegener's granulomatosis. Between 1993 and 2004, sinonasal CT was performed in 28 patients (15 male, 13 female) with Wegener's granulomatosis. The following imaging findings were assessed on the CT scans: mucosal thickening, subtotal opacification, air-fluid level, bony destruction, sclerosing osteitis, bony thickening, orbital mass, and saddle nose deformity. Of the 28 patients, 61% showed mucosal thickening in the nasal cavity and 75% in the paranasal sinuses. A subtotal opacification of the paranasal sinuses was detected in 25%, and of the mastoid cells in 7% of patients. Fifty-seven percent of patients had bony destruction of the nasal cavity, and 54% of the paranasal sinuses. CT revealed sclerosing osteitis of the paranasal sinuses in 21%, and of the mastoid cells in 18% of patients. Bony thickening of the paranasal sinuses was detected in 18%, and of the mastoid cells in 14% of patients. With respect to all imaging findings, the maxillary sinuses were the most frequently affected paranasal sinuses. The authors conclude that the following sinonasal CT findings are observed in patients with Wegener's granulomatosis: (1) bony destruction, mainly of the nasal cavity, maxillary sinuses, and mastoid cells; (2) sclerosing osteitis, mainly of the maxillary sinuses and mastoid cells; (3) bony thickening, mainly of the maxillary sinuses and mastoid cells; and (4) mucosal thickening, mainly of the maxillary sinuses. These findings are, however, nonspecific and should be combined with other clinicopathologic and laboratory studies to confirm the diagnosis of Wegener's granulomatosis.     

Immunoglobulin G4-related sclerosing disease mimicking invasive tumor in the nasal cavity and paranasal sinuses

IgG4RSD affecting the nasal cavity and paranasal sinuses is extremely rare. A 71-year-old man presented with an invasive mass in the nasal cavity and paranasal sinuses that was confirmed by immunostaining to be IgG4RSD. The occurrence of this disease in the nasal cavity and paranasal sinuses can resemble a malignant tumor on diagnostic imaging.     

Radio-anatomy of the paranasal sinuses

The imaging anatomy of the paranasal sinuses presents some complexity. The paranasal sinuses develop within facial and cranial bones. They communicate with one another and with the nasal cavity. Knowledge of normal anatomy is mandatory for accurate diagnosis of sinonasal pathology. The most frequent anatomical variants should be identified to decrease surgical risks. CT is the main imaging modality for the evaluation of sinonasal pathology. Learning objectives: to review the normal sinonasal anatomy and its frequent anatomical variants at CT imaging.