慢性鼻炎鼻窦炎的CT表现及诊断(附46例分析)

目的 探讨慢性鼻炎及鼻窦炎的CT 表现和诊断价值。方法 收集46 例经临床证实为慢性鼻炎及鼻窦 炎病人的CT 影像资料,进行回顾分析。结果 中道阻塞是引发鼻部及鼻窦疾病的重要原因,其中慢性上颌窦炎,筛窦炎与中鼻道的阻塞有明显的相关关系。结论 CT 能清晰的显示鼻窦和中鼻道的解剖及变异,为术前诊断,确定治疗方案及预后估计提供了重要的解剖依据,是目前诊断鼻腔—鼻窦首选的影像学方法。     

全模型迭代重建联合256层iCT低剂量扫描评估慢性鼻窦炎

目的 观察以全模型迭代重建（IMR）联合256层iCT低剂量扫描评估慢性鼻窦炎的可行性。方法 对20例临床拟诊慢性鼻窦炎患者先后行标准剂量和低剂量鼻窦CT扫描。根据剂量指数（DRI）和重建算法分为SD-FBP组、LD-IMR-L1组、LD-IMR-L2组和LD-IMR-L3组，记录不同扫描方案下容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP），计算有效剂量（ED），测量图像客观噪声值，评价图像噪声、伪影及窦口鼻道复合体解剖结构和病变显示情况。结果 4组图像噪声值自低到高依次为SD-FBP组、LD-IMR-L3组、LD-IMR-L2组和LD-IMR-L1组。LD-IMR-L3组平均噪声与SD-FBP组差异无统计学意义（P>0.05）；LD-IMR-L2组及LD-IMR-L1组噪声均高于SD-FBP组（P均<0.001）。LD-IMR各组伪影及显示病变评分与SD-FBP组差异均无统计学意义（P均>0.05），均满足诊断需求；其显示解剖结构细节较SD-FBP组欠清晰，但评分均>3分，能满足诊断需求。LD-IMR组CTDIvol、DLP、ED较SD-FBP组分别减少89.20%、89.37%和89.36%。结论 降低ED条件下，IMR低剂量鼻窦CT扫描图像质量可满足显示窦口鼻道复合体解剖结构及诊断慢性鼻窦炎所需。     

腺样体肥大儿童分泌性中耳炎鼻窦炎的CT表现及其相关性

[目的]探讨腺样体肥大儿童伴分泌性中耳炎、鼻窦炎的CT表现及其相关性.[方法]对105例经临床手术病理证实为腺样体肥大且术前进行鼻咽部CT扫描(同时具有鼻窦炎或/和分泌性中耳炎)的临床影像学资料进行回顾性分析,根据腺样体肥大程度分为两组:中度肥大和重度肥大.分析两组间分泌性中耳炎和鼻窦炎发病率的差异性及影像学特征.[结果]中度肥大组CT表现为:上颌窦炎24例,筛窦炎17例,额窦炎3例,蝶窦炎例7例,鼻甲肥大30例,外耳道炎7例,鼓室炎23例,乳突窦炎23例;重度肥大组CT表现为:上颌窦炎46例,筛窦炎43例,额窦炎11例,蝶窦炎14例,鼻甲肥大44例,外耳道炎21例,鼓室炎44例,乳突窦炎44例.71%同时合并有鼻窦炎、分泌性中耳炎.[结论]腺样体肥大与分泌性中耳炎和鼻窦炎发病率呈正相关.重度肥大组分泌性中耳炎及鼻窦炎发病率明显高于中度肥大组,双侧发病率高于单侧.     

18F-FDG PET/CT诊断肾细胞癌

目的 探讨¹⁸F-FDG PET/CT诊断肾细胞癌（RCC）的价值。方法 回顾性分析32例确诊为RCC患者的病理及PET/CT影像资料，比较不同病理类型（透明细胞癌与非透明细胞癌）、Fuhrman分级（高级别与低级别透明细胞癌）和临床分期（有无远处转移）RCC的肿瘤直径和最大标准摄取值（SUV_max）差异。结果 32例患者共33个原发灶，PET/CT检出31个，2个假阴性，检出率为93.94%（31/33）。31个原发灶PET/CT表现为肾实质内混杂密度的软组织团块，其¹⁸F-FDG摄取可接近、高于或低于正常肾实质；2个原发灶PET/CT未见异常表现。8例伴静脉瘤栓，19例伴远处转移，瘤栓及转移灶的FDG摄取均高于受累器官本底。不同病理类型组和不同Fuhrman分级RCC的肿瘤最长径及SUV_max差异无统计学意义；不同临床分期RCC的肿瘤最长径差异无统计学意义，SUV_max差异有统计学意义（t=3.852，P=0.001）。结论 RCC原发灶的PET/CT表现多样，较小的低级别肾透明细胞癌可无明显异常表现而漏诊；¹⁸F-FDG PET/CT在RCC术前分期中具有重要价值。     

标准检查条件下非心脏病心脏标准摄取值与组织CT值的相关性

目的 探讨标准检查条件下非心脏病患者心脏¹⁸F-FDG PET显像标准摄取值(SUV)是否受组织CT值的影响。 方法 在我院接受PET/CT检查的患者中随机抽取88例,排除心脏疾病,设立高血压组、贫血组、肿瘤组、正常组4个组,每组22例,观察不同机体状态下心脏组织SUV和CT值,测量左心室侧壁肌、室间隔肌、左心室腔的SUV和CT值,分析各组左心室侧壁肌、室间隔肌、左心室腔CT值和SUV的组间差异,进一步分析各组内不同组织SUV与自身CT值的相关性。 结果 贫血组左心室侧壁肌、室间隔肌、左心室腔CT值低于高血压组、肿瘤组和正常组(P＜0.05),而各组间SUV差异无统计学意义(P>0.05);各组内左心室侧壁肌、室间隔肌、左心室腔SUV与其身CT值无相关性(P>0.05)。 结论 标准检查条件下非心脏病患者心脏组织¹⁸F-FDG PET显像SUV与组织CT值无相关性,SUV相对稳定。     

对比原发性肺腺样囊性癌与黏液表皮样癌CT表现

目的 对比原发性肺腺样囊性癌（ACC）与黏液表皮样癌（MEC）CT表现。方法 回顾性分析经病理证实的22例ACC（ACC组）与18例MEC（MEC组）患者胸部CT资料，比较其CT表现差异，并对增强动脉期及静脉期CT值绘制受试者工作特征（ROC）曲线，评估其鉴别MEC与ACC的效能。结果 ACC组与MEC组间病灶类型，增强扫描动、静脉期CT值及病灶强化程度差异均有统计学意义（P均<0.05）；病灶部位、有无阻塞性病变、囊变/坏死、钙化、淋巴结肿大、胸腔积液及远处转移组间差异均无统计学意义（P均>0.05），而中央型病变发生部位、纵向浸润范围及病变环周范围组间差异均有统计学意义（P均<0.05）。ROC曲线显示，动脉期和静脉期CT值鉴别ACC与MEC的曲线下面积（AUC）分别为0.78及0.75。结论 ACC和MEC的CT表现存在一定差异，结合临床有助于鉴别诊断。     

不同MYCN基因扩增状态腹部神经母细胞瘤CT表现

目的 观察不同MYCN基因扩增状态的腹部神经母细胞瘤（NB）CT表现。方法 纳入172例腹部NB患儿,根据MYCN基因拷贝数分为MYCN组（n=47）及未扩增组（n=125）。比较组间肿瘤分布部位、大小、形态、密度、边界、钙化、囊变及坏死等CT征象差异;比较组间肿瘤实质的平均CT值及其与同一层面背部肌肉平均CT值差值的差异。结果 组间肿瘤大小、分布部位、形态、钙化、囊变及坏死、跨越中线生长情况差异均有统计学意义（P均<0.05）,而静脉期强化方式差异无统计学意义（P>0.05）;组间肿瘤与血管关系及邻近脏器侵犯情况差异均有统计学意义（P均<0.05）;未扩增组静脉期肿瘤实质平均CT值及与同一层面背部肌肉平均CT值差值均显著高于MYCN组（P均<0.05）。结论 MYCN基因不同扩增状态的腹部NB肿瘤CT表现存在一定差异。     

不同免疫状态下侵袭性肺曲霉菌病的CT表现

目的 探讨不同免疫状态下侵袭性肺曲霉菌病CT表现的特征。方法 回顾性分析本院诊断为侵袭性肺曲霉菌病的免疫异常组(n=29)和免疫正常组(n=10)侵袭性肺曲霉菌病患者的CT表现。结果 免疫异常组和免疫正常组单发病灶[3.45%(1/29)、30.00%(3/10)]、实变影[82.76%(24/29)、40.00%(4/10)]、小叶间隔增厚[51.72%(15/29)、10.00%(1/10)]、胸腔积液[58.62%(17/29)、10.00%(1/10)]比较差异均有统计学意义(P均<0.05);磨玻璃影、结节、团块影、空洞、空洞分隔征、晕征、树芽征、支气管扩张、侵袭类型比较,差异均无统计学意义(P均>0.05)。结论 不同免疫状态下侵袭性肺曲霉菌病的CT表现有一定的差异。多发结节伴晕征、实变影、磨玻璃影、空洞及空洞分隔征等CT征象对提高侵袭性肺曲霉菌病的诊断具有重要意义。     

不同病理级别膀胱神经内分泌肿瘤CT表现

目的 观察不同病理级别膀胱神经内分泌肿瘤（NET）的CT表现。方法 回顾性分析经手术病理证实的17例膀胱NET患者的临床、病理及CT资料，参照2010年WHO消化道NET分级标准对其进行分级并分为低级别组（G1和G2级）和高级别组（G3级），比较组间临床及CT表现差异。结果 17例膀胱NET中，G1级6例，G2级2例，G3级9例；低级别组8例，高级别组9例；组间性别及年龄（t=-3.43，P=0.03、0.04），肿瘤最大径、囊变坏死、周围侵犯及转移差异均有统计学意义（P均<0.05）。低级别组动脉期肿瘤绝对强化程度[（58.62±12.45）HU]高于高级别组[（31.88±8.86）HU，t=5.15，P<0.01]。结论 不同病理级别膀胱NET的CT表现有一定特征性，结合临床有助于诊断。     

老年鼻中隔偏曲和窦口鼻道复合体解剖变异与慢性鼻窦炎关系的研究

目的探讨老年鼻中隔偏曲和窦口鼻道复合体（OMC）解剖变异与慢性鼻窦炎的关系。方法分析2005年1月—2013年1月在本院接受治疗的60例老年慢性鼻窦炎患者的临床资料并设为观察组;另选取非慢性鼻窦炎患者60例设为对照组。结果 25例额窦鼻窦炎患者中,高位偏曲显著高于低位偏曲（χ2=4.000,P=0.046）;观察组中鼻甲气化发生率显著高于对照组（χ2=15.810,P〈0.001）;观察组钩突偏曲发生率显著高于对照组（χ2=5.657,P=0.017）;观察组钩突肥大发生率显著高于对照组（χ2=4.630,P=0.031）;观察组鼻丘气房发生率显著高于对照组（χ2=5.192,P=0.023）。Logistic回归分析显示,高位鼻中隔偏曲、中鼻甲气化、钩突偏曲、钩突肥大及鼻丘气房是导致鼻部解剖变异者发生慢性鼻窦炎的独立风险因素。结论鼻中隔偏曲及OMC解剖变异在慢性鼻窦炎患者中有一定的发生率,但并非所有解剖变异患者均会致病。高位鼻中隔偏曲、中鼻甲气化、钩突偏曲、钩突肥大及鼻丘气房是导致鼻部解剖变异者发生慢性鼻窦炎的独立风险因素,可针对性地进行干预。     

鼻甲泡的CT评估

目的 总结CT对鼻甲泡的评估价值并探讨其临床意义。材料与方法 所谓鼻甲泡是指中鼻甲的气化。37例鼻窦炎者与24例正常人CT检查资料进行对照比较。结果 CT能清晰显示微小鼻甲泡,对鼻窦解剖结构及变异的显示满意。鼻窦炎组鼻甲泡的发生率为37．8％,对照组鼻甲泡的发生率为45．5％,两组间鼻甲泡的发生率无显著差异。检出3例鼻甲泡内息肉,3例鼻甲泡炎,1例鼻甲泡粘液囊肿。2例巨鼻甲泡致OMC阻塞,合并额窦、筛窦和上颌窦炎症。结论 CT是检出鼻甲泡的金标准。鼻甲泡是引发鼻窦炎的潜在因素,关键在于它的大小和部位。     

慢性上颌窦炎影响因素的CT分析

目的探讨窦口鼻道复合体病变及解剖变异与慢性上颌窦炎的关系.方法对CT诊断的52例单侧慢性上颌窦炎进行两侧对比分析.结果患侧与健侧筛泡截面分别为(77.75±33.51) mm2和(34±20.27) mm2(P<0.01).两侧分别有19个及10个大筛泡.患侧伴有32组筛窦炎,对侧21组.鼻息肉11例,单发于上颌窦炎侧9例,对侧仅1例,双侧1例.结论大筛泡、前中组筛窦炎症、鼻息肉与慢性上颌窦炎有关.     

Middle Turbinate Headache Syndrome

The middle turbinate and nasal septum are innervated by the anterior ethmoidal nerve, a branch of the ophthalmic division of the trigeminal nerve. As reported in the classical work of Wolff (1948), stimulation of these regions causes pain in the medial canthus of the supraorbital region. Periorbital pain due to middle turbinate compression against the septum or the lateral wall of the nose may be due to congestion of the nasal mucosa or to pneumatization of the middle turbinate (concha bullosa). The diagnosis is made by exclusion and requires a high index of suspicion, anterior rhinoscopy, computerized tomography (CT), and confirmation by the lidocaine test. We present five cases of middle turbinate headache syndrome, all with contha bullosa. Four were treated surgically by partial middle turbinectomy and septoplasty more than 1 year ago, with excellent results. One patient refused surgical treatment which was suggested after failure of medical treatment with antihistamines, decongestants, and a topical corticosteroid, and continues to be symptomatic. Despite the small number of cases studied, the authors conclude that the procedure used was effective for the resolution of headache.     

Sinus CT scan findings in "sinus headache" migraineurs

OBJECTIVE: To evaluate the sinus CT scan findings in "sinus headache" migraineurs, and to compare the findings to nonmigraine "sinus headache" patients. BACKGROUND: The majority of patients presenting with "sinus headache" satisfy the International Headache Society (IHS) criteria for migraine headache. Few studies have correlated the rhinologic complaints and computed tomography (CT) findings in these patients. METHODS: Thirty-five patients with "sinus headache" were evaluated prospectively and referred for CT of the paranasal sinuses. The CT scans were assessed for sinus abnormality (recorded as a Lund-Mackay [L-M] score) and were analyzed for concha bullosa and septal deviation. The findings in the migraine cohort were compared with the nonmigraine "sinus headache" patients. FINDINGS: Twenty-six patients (74.3%) satisfied the IHS criteria for migraine. The mean CT scan L-M score did not differ significantly between the migraine (2.07) and nonmigraine cohort (2.66). Five of the migraine group had substantial sinus disease radiographically (with L-M scores of 5 or above). Concha bullosa of at least 1 middle turbinate was more common in the nonmigraine cohort. An analysis of the sidedness of the headaches, sinus disease, concha bullosa, and/or septal deviation is presented. CONCLUSIONS: The majority of "sinus headache" patients satisfy the IHS criteria for migraine. Surprisingly, these patients often have radiographic sinus disease. This raises the possibility of selection bias in otolaryngology patients, inaccurate diagnosis, or radiographic sinus disease and migraine as comorbid conditions. Positive migraine histories apparently do not obviate the need for a thorough ENT workup, possibly including CT scanning.     

Utilization of Prophylactic Antibiotics After Nasal Packing for Epistaxis

BackgroundThere have been few investigations examining the benefits, consequences, and patterns of use for prophylactic antibiotics for nasal packing in the emergency department setting. Given the frequency of epistaxis in the emergency department, it is an ideal setting to study the efficacy and utilization patterns of prophylactic antibiotics in nasal packing.ObjectiveOur aim was to assess both rates of utilization and evidence of benefit for prophylactic antibiotics in patients with nasal packing for epistaxis.MethodsA single-institution retrospective review of 275 cases of anterior nasal packing in an urban emergency department between September 2013 and April 2017 was performed. Chi-square statistical analysis was used to evaluate results.ResultsAmong 275 cases studied, there were no instances of toxic shock syndrome. Roughly 73% of patients with nonabsorbable packing received prophylactic antibiotics. Only one (1.1%) case of sinusitis was noted among the nonabsorbable packing with prophylaxis group, with no such complication in the nonprophylaxis group. In contrast, 95% of patients with absorbable nasal packing were not given prophylactic antibiotics. Analysis of all cases given prophylactic antibiotics vs. no prophylaxis, regardless of packing type, revealed no statistically significant difference in the development of acute sinusitis (1% vs. 0.56%; p = 0.6793).ConclusionsThere was no observed advantage or disadvantage to using prophylactic antibiotics in anterior nasal packing in the emergency department, regardless of whether patients received absorbable or nonabsorbable packing. However, patients who receive nonabsorbable nasal packing were more likely to receive antibiotic prophylaxis.     

鼻内镜下可吸收鼻窦药物支架手术对慢性鼻窦炎伴鼻息肉患者鼻腔菌群及预后的影响

目的 分析鼻内镜下可吸收鼻窦药物支架手术对慢性鼻窦炎伴鼻息肉患者鼻腔菌群及预后的影响。方法 选择2018年11月－2021年3月于该院耳鼻喉科就诊的80例慢性鼻窦炎伴鼻息肉患者纳入研究,依据随机数表法随机分为实验组和对照组,每组40例,对照组患者行鼻内镜Messerklinger微创手术,实验组患者在鼻内镜Messerklinger微创手术结束前将可吸收鼻窦药物支架置入。比较两组患者住院时间、鼻黏膜恢复时间及鼻腔恢复通气时间,以及不同治疗方式对于鼻腔黏膜菌群的影响,依据术后3周全部患者的临床表现进行疗效对比。结果 实验组住院时间、鼻黏膜恢复时间及鼻腔恢复通气时间均明显少于对照组（P < 0.05）。实验组术后鼻腔内弯曲杆菌属、肠球菌属阳性率明显低于对照组（P < 0.05）;实验组术后鼻腔内假单胞菌属、嗜血杆菌属、葡萄球菌属与对照组比较,差异无统计学意义（P > 0.05）。实验组术后治疗效果明显优于对照组（P < 0.05）。结论 鼻内镜下可吸收鼻窦药物支架手术治疗慢性鼻窦炎伴鼻息肉,可以明显促进鼻黏膜上皮化,降低术后患者鼻腔内弯曲菌属、肠球菌属阳性率,治疗效果显著,值得临床推广应用。     

Peroperative findings of the middle turbinate in 50 patients with chronic sinusitis who underwent total spheno-ethmoidectomy

This study describes the peroperative endoscopic findings about the size, shape and mucosal changes of the middle turbinate in patients with chronic sinusitis who underwent total spheno-ethmoidectomy. Results confirmed the middle turbinate to be a useful landmark in performing extensive sinus surgery. The most frequent change due to chronic inflammation seems to be polypous degeneration followed by hyperplastic mucosa. Anatomical variations, being paradoxically bent turbinate and concha bullosa, are not seen frequently.     

自发性气胸的胸膜窗MSCT及CT仿真内镜表现

目的 评价CE-MRA脊髓造影鉴别脊髓血管畸形（SCVM）和脊髓非血管畸形所致继发性血管纡曲的价值。方法 回顾性分析30例CE-MRA疑诊SCVM患者资料,根据DSA或手术结果分为SCVM组（16例）及脊髓非血管畸形组（14例）,对比分析2组CE-MRA脊髓纡曲血管的数量、长度、位置、纡曲程度及纡曲血管周围是否存在异常供血动脉差异。结果 与脊髓非血管畸形组比较,SCVM组脊髓纡曲血管数量更多,纡曲血管长度更长,血管纡曲程度评分更高。SCVM组仅2例（2/16,12.50%）血管纡曲局限于下胸椎段（T7~T12椎体）,而脊髓非血管畸形组11例（11/14,78.57%）局限于下胸椎段（T7~T12椎体）,2组间纡曲血管位置差异有统计学意义（P=0.020）。结论 CE-MRA脊髓血管造影可鉴别SCVM与脊髓非血管畸形引起的继发性血管纡曲。