鼻硬结病CT和MRI诊断

目的探讨鼻硬结病的CT和MRI表现，提高其诊断准确性。资料与方法回顾性分析10例经病理证实的鼻硬结病的影像学资料。结果起源于鼻腔7例，鼻窦3例。CT表现：鼻腔硬结病表现为实性软组织影2例，索条影5例，7例均见中下鼻甲破坏，4例鼻中隔破坏；7例均侵及邻近鼻窦，其中上颌窦内壁可见不同程度的骨质破坏，其余各窦壁骨质明显增生硬化，以上颌窦、蝶窦最显著；2例侵犯眼眶，侵犯翼腭窝及颅内各1例。鼻窦硬结病表现为窦腔充以不规则软组织肿块影，相应处窦壁骨质破坏，同时伴周围骨质硬化，3例均侵犯翼腭窝，2例侵犯眼眶及颅内。MRI表现：T1WI呈等信号(与脑实质比较)3例，稍高信号4例；T277I呈等信号2例，明显低信号5例，但信号不均匀；均可见不同程度强化；窦腔外周伴阻塞性炎症，T1WI呈等或稍低信号，T2WI呈明显高信号，有明显强化。结论CT可清楚显示骨质改变，是诊断鼻腔硬结病的主要影像方法；MRI能准确显示病变向邻近结构侵犯的范围，为临床分期、制定治疗方案提供依据。CT和MRI两种影像方法结合能较准确地对鼻窦硬结病作出诊断。

CT and MRI Diagnosis of Rhinoscleroma

Objective To investigate the CT and MRI findings of rhinoscleroma so as to improve the diagnostic accuracy.Materials and Methods CT and MRI appearances of 10 cases with rhinoscleroma confirmed by pathology were analyzed retrospectively.Results Among 10 cases, 7 originated in nasal cavity and 3 in sinus. On CT scans, the involved nasal cavaties filled with soft tissue in 2 cases and linear shadows in 5 cases. Rhinoscleroma arising from nasal cavity showed the destruction of middle and inferior turbinates in 7 cases and nasal septum in 4 cases. In all 7 cases, the lesions eroded the medial wall of maxillary sinuses, the rest sinus walls revealing bony sclerosis, especially in maxillary sinus and sphenoid sinus. The lesions invaded orbit in 2 cases, intracranial region and pterygopalatine fossa in 1 case respectively. Rhinoscleroma originated in sinuses showed the destruction of sinus walls associated with sclerosis of the remaining bone. The sinus cavities were filled with irregular soft tissue. On MR T_1WI, the lesions were isointensity compared to brain in 3 cases, and mildly hyperintensity in 4 cases. On T_2WI, the lesions showed isointensity in 2 cases, and markedly heterogeneous hypointensity in 5 cases. Postcontrast MR scans demonstrated varied enhancement in these cases. The affected sinuses were associated with obstructing inflammatory lesions, revealing isointensity or slight hypointensity on T_1WI, hyperintensity on T_2WI with enhancement on postcontrast MR imaging. Conclusion CT can depict bony changes clearly, which is the primary method for the diagnosis of rhinoscleroma arising from nasal cavity. MRI can demonstrate optimally the invading extranasal extent, providing information for clinical stage and therapeutic procedure for rhinoscleroma. Both CT and MRI can contribute to the diagnosis of rhinoscleroma arising from sinus.