Recurring patterns of inflammatory sinonasal disease demonstrated on screening sinus CT.

PURPOSE: In order to define specific features on screening sinus CT (SSCT) that will aid the endoscopic surgeon in his approach to patients with inflammatory sinonasal disease, we sought to answer four questions: 1) what recurring patterns of inflammatory sinonasal disease are evident on SSCT; 2) what is the relative frequency of these recurring patterns; 3) how do these CT patterns correlate with the known sinus mucociliary drainage routes; and 4) what are the characteristic radiologic features of each pattern? METHODS: We reviewed the clinical and radiologic records of 500 consecutive patients who underwent SSCT as a prelude to possible functional endoscopic sinus surgery. RESULTS: Five recurring radiologic patterns of sinonasal inflammatory disease were identified: 1) infundibular (129/500 or 26%), 2) ostiomeatal unit (126/500 or 25%) 3) sphenoethmoidal recess (32/500 or 6%), 4) sinonasal polyposis (49/500 or 10%), and 5) sporadic (unclassifiable) (121/500 or 24%) patterns. Normal SSCT was seen in 133/500 patients (27%). CONCLUSION: Identification of specific patterns of sinonasal disease permits grouping of patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess patterns) surgical groups. Assignment of patients to radiologic patterns allows a tailored surgical approach.     

CT evaluation of nasolacrimal relapse of nasopharyngeal carcinoma

AIM: The aim of the current study was to elucidate the anatomy of the nasolacrimal apparatus using computed tomography (CT), and to investigate the CT findings suggestive of recurrent nasopharyngeal carcinoma (NPC) involving the nasolacrimal apparatus. MATERIALS AND METHODS: CT images of five patients with clinical or radiological findings suggestive of recurrent NPC who presented with nasolacrimal involvement were reviewed. Involvement of the lacrimal fossa, nasolacrimal canal (NLC), and adjacent anatomic structures including orbit and sinonasal cavities were noted. RESULTS: CT in all patients demonstrated findings of NLC invasion and ostiomeatal complex obliteration. Four of the five patients showed medial canthal mass or pre-septal thickening, ethmoid bulla opacification and inferior nasal meatal involvement. CONCLUSION: Knowledge of the anatomy of the nasolacrimal apparatus using CT is critical for evaluating images for tumour recurrence at this site. NLC invasion, a medial canthal mass and pre-septal thickening are important primary indicators for potential involvement of the nasolacrimal apparatus by recurrent NPC. Secondary signs suggesting this distinct form of relapse are obliteration of ostiomeatal channel, ethmoid bulla opacification and inferior nasal meatus involvement.     

慢性鼻炎鼻窦炎的CT表现及分型(附93例分析)

目的　探讨慢性鼻炎鼻窦炎CT表现及分型。方法　收集 93例经临床证实为慢性鼻炎鼻窦炎病人的CT影像资料。结果　慢性鼻炎鼻窦炎分为 6型 :(1 )漏斗型 ,占 1 7% ;(2 )鼻道窦口复合体型 ,占 2 8% ;(3)蝶筛隐窝型 ,占 6 % ;(4)鼻腔鼻窦息肉型 ,占 1 8% ;(5)特发型 ,占 1 4 % ;(6)混合型 ,占 1 6 %。结论　慢性鼻炎鼻窦炎的CT分型对指导鼻内镜手术治疗具有重要价值     

鼻及鼻咽孤立性髓外浆细胞瘤的CT和MRI表现

目的探讨鼻及鼻咽孤立性髓外浆细胞瘤的CT和MRI表现,并评价两种影像学检查方法的临床应用价值。资料与方法回顾性分析8例经组织学证实鼻及鼻咽孤立性髓外浆细胞瘤患者的影像学资料。结果发生于鼻咽3例,上颌窦2例,鼻腔1例,鼻腔、筛窦及蝶窦1例,鼻腔、额窦、筛窦、蝶窦及上颌窦1例;病变边界较清楚,呈椭圆形3例,分叶状5例;病变最大径20～92mm,平均49mm。CT表现:鼻部病变造成周围骨质变形、变薄、移位、吸收,其中3例伴局部破坏;鼻咽病变位于黏膜下,黏膜表面光滑,邻近骨质未受累。与脑实质比较,平扫7例呈等密度,1例呈不均匀高密度;增强后2例呈中度、较均匀强化,1例呈不均匀高度强化。MRI表现:T1WI、T2WI均呈等信号,其中7例T1WI信号较均匀,T2WI散在细条状略高信号,另1例可见片状短T1、长T2出血信号;增强后病变中度强化6例,显著强化2例,其中7例病变内可见强化更明显的细条状间隔,对应T2WI所示略高信号。3例动态增强扫描的时间-信号强度曲线均为速升缓降型。MRI均清楚显示病变的范围、伴发的炎症及术后的复发。结论鼻部病变所致骨质变形和吸收、鼻咽病变黏膜下生长、MRI平扫等信号和增强后所示间隔强化是鼻及...     

Another CT sign of sinonasal polyposis: truncation of the bony middle turbinate

In order to study the features of sinonasal polyposis (SNP) on CT, 100 consecutive coronasal sinus CT examinations done for chronic inflamamtory sinonasal disease were reviewed. The CT findings of the 27 fully documented SNPs were analyzed. All our SNPs were bilateral. There was a strong tendency for extensive involvement. Nasal polyps were seen in 22 of 27 (81%); bony trabecular deossification in 23 of 27 (85%); widening of infundibulum in 26 of 27(96%). We discovered a new sign truncation of the bony middle turbinate, where the bulbous part of bony middle turbinate was missing, in 51 of 26 (58 %) of SNP patients without a previous history of middle turbinectomy, 12 of 15(80%) were bilateral. The one SNP patient (1 of 27) with previous middle turbinectomy was not regarded to be real truncation. Truncation of the bony middle turbinate is a characteristic and easily recognizable ancillary sign, and is not seen in other patterns of sinusitis. Together with other features on coronal sinus CT, this adds diagnostic confidence in diagnosing sinonasal polyposis. Correspondence to: E. Y. Liang     

鼻腔和鼻旁窦腺样囊性癌的影像学表现

目的：分析鼻腔鼻旁窦腺样囊性癌的影像学表现，评价其临床价值。资料与方法：回顾分析临床病理证实的鼻腔鼻旁窦腺样囊性癌25例，CT检查23例，其中CT平扫5例，增强扫描3例，平扫加增强扫描15例；MR扫描3例，均为平扫加增强扫描。结果；肿瘤原发于鼻腔5例，上颌4例，筛窦2例，蝶窦1例，其余3例为鼻腔筛窦和鼻腔上颌窦肿块。肿瘤侵及范围包括鼻腔，上颌窦，筛窦，蝶窦，翼腭窝，颞下窝，眼眶，硬腭，眶下裂，圆孔，海绵窦等。窦腔呈膨胀性扩大和骨壁侵蚀性吸收破坏，并沿三叉神经分支润蔓延（表现为软组织侵及翼腭窝，眶下裂，圆孔，海棉窦等）。CT检查23例，其中20例表现为肿块内有低密度囊变区，占86％；2例肿块内有钙化，占8％；1例肿块密度较均匀。结论：鼻腔鼻旁窦腺样囊性癌多表现为圆形或类圆形肿块，肿块内有大小不等低密度囊性区，窦腔呈膨胀性扩大和骨壁呈侵蚀性吸收破坏，并有沿三叉神经浸润蔓延的特性。     

CT characterization of inflammatory paranasal sinus disease in cystic fibrosis

Purpose: In patients with cystic fibrosis (CF) the prevalence of paranasal sinus affection approaches 100%. We hypothesized that the hyperviscous mucus reducing mucociliary clearance in CF patients could give sinonasal inflammatory patterns different from those in non-CF patients. We wanted to compare the extent and distribution of paranasal sinus disease and the inflammatory patterns in these two groups of patients.Material and Methods: One-hundred-and-eight CF patients (3-54 years old) and 79 controls (7-51 years old) with paranasal sinus disease confirmed at coronal CT were compared. The extent of disease was noted for each sinus and summed for all sinuses. Inflammatory patterns were identified and classified into: 1) routine surgery group (sporadic, infundibular and ostiomeatal complex (OMC) patterns) and 2) complex surgery group (sinonasal polyposis and sphenoethmoid recess (SER) patterns).Results: CF patients had more widespread sinonasal inflammatory changes and more advanced disease for each sinus. Most CF patients displayed sinonasal polyposis and SER patterns while most controls displayed sporadic, infundibular or OMC patterns. As a result, 67% of CF patients were classified to the complex surgery group, compared to only 19% of controls.Conclusion: The impaired mucociliary clearance in CF causes widespread inflammatory paranasal sinus disease, with inflammatory patterns more often requiring extensive surgery, with a higher risk of cerebrospinal fluid leak or bleeding, or involving areas that are more difficult to reach with the endoscope.     

Simulated aggressive skull base erosion in response to benign sinonasal disease

Benign sinonasal masses and slow-growing neoplasms tend to remodel the nasal vault and facial bones, and this is particularly true of nasal polyps and inverted papillomas. However, when such benign masses press against the floor of the anterior cranial fossa and the walls of the sphenoid sinuses, simulated aggressive bone destruction rather than bone remodeling usually occurs. This type of bone destruction implies to the radiologist that a carcinoma may also be present, and this information could dissuade a surgeon from operating with an attempt at cure. In fact, about 90% of the time with inverted papillomas and in virtually all cases of nasal polyposis, no carcinoma is present. The computed tomographic (CT) scans and magnetic resonance images of 14 patients are used to demonstrate these changes. In addition, the CT scans of three patients with malignancies are shown to illustrate the similarity in the bony skull base changes.     

Evaluation of variations in sinonasal region with computed tomography

AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases.METHODS: The study included 400 cases (191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography (CT) examination in axial plane. Reformatted CT images were studied in all planes.RESULTS: Age range of the patients was 20-83 (mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell (74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus (P < 0.001). Besides, the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus, and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant (P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases (P = 0.004 and P = 0.002, respectively).CONCLUSION: Sinonasal region has a great number of variations, and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.     

CT characterization of developmental variations of the paranasal sinuses in cystic fibrosis

Purpose: To describe variations of paranasal sinus development in patients with cystic fibrosis (CF) and in non-CF patients examined for inflammatory sinonasal disease. We focused on anatomic variants that predispose to orbital and cerebral penetration during functional endoscopic sinus surgery (FESS), e.g. hypoplasia of the maxillary sinus and low ethmoid roof.Material and Methods: One hundred and sixteen CF patients (3-54 years, median 18) and 136 control patients (7-51 years, median 31) were examined with coronal CT of the paranasal sinuses. CF patients were grouped according to number of confirmed mutations: CF-2 (n=70), CF-1 (n=32), CF-0 (n=14). CT images were evaluated with respect to paranasal sinus development, pneumatization variants and bony variants.Results: Frontal sinus aplasia and maxillary, ethmoid, and sphenoid sinus hypoplasia were markedly more frequent in CF-2 than in control patients. No CF-2 patient had pneumatization variants such as Haller cells or concha bullosa. Low ethmoid roof was seen in 30% of CF-2 children, but in no control children. CF-1 and CF-0 groups had prevalences of aplasia and hypoplasia intermediate to that of CF-2 and control patients.Conclusion: Genetically verified CF patients had less developed sinuses, lacked pneumatization variants, and more often had anatomic variants that predispose to complications during FESS. Normally developed sinuses and pneumatization variants in some genetically unverified CF patients (CF-1, CF-0) suggest that these patients may be erroneously diagnosed.     

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。     

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.     

鼻腔及鼻旁窦神经鞘瘤的影像学表现

目的 分析鼻腔和鼻旁窦神经鞘瘤的CT与MRI表现,提高诊断及鉴别水平.资料与方法 经病理证实的鼻腔、鼻旁窦神经鞘瘤8例,均行CT平扫,其中4例行增强扫描;MRI检查2例,同时行平扫和增强扫描.结果 良性4例,恶性4例.肿瘤原发于鼻腔4例,上颌窦3例,筛窦1例,无一例发生颈淋巴结转移.肿块在CT上多呈较均匀中等密度,3例密度不均;MRI T1WI呈中等信号,T2WI示中等或不均匀稍高信号,增强扫描肿瘤呈轻至中度强化或边缘强化.结论 鼻腔、鼻旁窦神经鞘瘤的CT与MRI表现无显著特异性,均能很好地显示肿瘤侵犯范围及骨质破坏情况.     

头颈部腺样囊性癌的CT影像分析

目的　评价头颈部腺样囊性癌 (ACC)的CT表现。方法　回顾性分析头颈部ACC33例 ,其中 2 2例手术、11例为病理穿刺活检证实并行放射治疗。结合临床及病理 ,观察CT表现。结果　肿瘤来源 :腮腺、口底、鼻腔鼻咽各 5例 ;舌 4例 ;腭、气管各 3例 ;颌下腺、扁桃体、上颌窦及颊部各 2例。CT表现 :(1)筛样改变 2 1例 ,部分筛样改变 5例。 (2 )肿瘤形态不规则呈无定形生长 17例 ,边缘不清晰 2 0例。 (3)肿瘤常沿神经生长并侵犯神经 ,表现为颅底骨质破坏 5例 ,咀嚼肌群萎缩 3例以及面肌和 (或 )颊肌萎缩 3例。结论　 (1)头颈部ACC的CT影像有以下特征 :低密度筛样改变 ;浸润性生长 ;沿神经生长并侵犯神经 ;黏膜下生长。其中又以筛样改变为最重要征象 ,CT凭此可以作出ACC的组织学诊断。 (2 )CT往往对肿瘤范围估计不足。 (3)MRI能够显示肿瘤沿神经生长的情况。     

CT appearance distinguishing benign nasal polyps from malignancies

In many cases the common nasal polyp is confused clinically, radiographically, and, on occasion, pathologically with a tumor of the nasal vault and paranasal sinuses. Similarly, this distinction often cannot be made by CT. However, we have identified in 12 patients a CT appearance of looping, minimally or nonenhancing soft tissue densities within a mucoid density background matrix, that is associated with cases of polyposis (nine patients) and fungal disease (three patients). We believe that when this CT appearance is present, malignant disease can be essentially eliminated from the differential diagnosis.     

Prevalence of ethmoid sinus abnormalities on brain CT of asymptomatic adults

To evaluate the prevalence of ethmoid sinus abnormalities in adults without clinical history of sinusitis or allergic rhinitis, the brain CT scans of 156 patients were analyzed prospectively. In 17 cases (10.9%) the ethmoid labyrinth showed abnormalities. In most of these cases (88%) the ethmoid disease was localized to four or fewer cells. Men were more often affected than women (ratio, 2.5:1), and the prevalence of abnormalities was fairly similar across age groups.     

X-ray computed tomographic study of the ethmoid bone and middle meatus. III. Application to chronic infectious sinus pathology]

As nasal endoscopy, high resolution CT is a part of the chronic rhinosinusitis pre-operative assessment. It shows, thanks to a precise and anatomical study of the ethmoid and sinusal draining, the extension of the diseases and the local morphological variations which predispose to chronic diseases. The main aspects of chronic sinusitis, nasal polyposis and fungal maxillary sinus diseases are reported. The frequency of individual morphological variations and the mucosal changes due to a nasal cycle require a great care in the interpretation of the diseases.     

缩鼻黏膜药物在慢性鼻炎鼻窦炎性病变CT诊断中应用价值

目的进一步探讨缩鼻黏膜药物在慢性鼻炎鼻窦炎性病变CT诊断中应用价值。方法31例临床疑有鼻炎鼻窦炎患者均经CT冠状位扫描,层厚、层距5mm。首次扫描后,如鼻腔或鼻道有实变,在实变侧鼻孔滴入1％麻黄碱滴鼻液3-4滴,体位引流、擤出鼻涕。再行鼻窦扫描,体位、参数同前。CT表现按照改良法分为6型：Ⅰ型漏斗型,Ⅱ型鼻道窦口复合体型,Ⅲ型蝶筛隐窝型,Ⅳ型息肉型,Ⅴ型特发型,Ⅵ型混合型。结果31例中CT表现为：Ⅰ型、Ⅲ型、Ⅴ型各3例,Ⅱ型8例,Ⅳ型5例,Ⅵ型4例。慢性鼻炎5例,伴有中下鼻甲肥大12例,鼻中隔偏曲9例,上颌窦黏膜下囊肿、右侧筛窦黏液囊肿、霉菌性上颌窦炎各2例。使用滴鼻液前,20例鼻腔或鼻道有分泌物影响观察。使用滴鼻液后,鼻腔、鼻甲黏膜收缩,分泌物排出,可明确判定有无息肉存在。2例用药前后扫捕分型改变。9例用药前后扫描无明显变化。结论在慢性鼻炎鼻窦炎性病变CT扫描前给予缩鼻黏膜药物,使分泌物排出、黏膜收缩,有助于息肉的显示。     

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.     

The incidence of concha bullosa and its relationship to nasal septal deviation and paranasal sinus disease

BACKGROUND AND PURPOSE: The incidence of middle turbinate pneumatization, or concha bullosa, has been well described in the literature. However, to our knowledge, no study has evaluated concha bullosa in relation to nasal septal deviation. We sought to analyze the incidence of concha bullosa and any correlation with nasal septal deviation and paranasal sinus disease. METHODS: Three neuroradiologists retrospectively reviewed findings of 1095 consecutive paranasal sinus CT studies conducted between 2001 and 2002. All examinations were performed for evaluation of a symptom referable to the sinonasal region. Paranasal sinus inflammatory disease was identified and graded as mild, moderate, or severe. Sphenoid, ethmoid, maxillary, and frontal sinuses were each graded separately on both sides. If a concha bullosa was present, it was graded in size as small, moderate, or large. If bilateral concha were present, sizes were compared and when one was larger, it was identified as dominant. When nasal septal deviation was present, it was graded as mild, moderate, or severe. The direction of nasal septal deviation was identified as the face of the convex surface. RESULTS: There was a clear association between the presence of a unilateral concha, or a dominant concha (in the case of bilateral concha), and the presence of nasal septal deviation (P < .0001). Moreover, there was a significant relationship between the presence of concha bullosa and deviation of the nasal septal to the contralateral side (P < .0001). This inverse association was present regardless of the size of the concha bullosa or degree of septal deviation. In every case, there was some preservation of air channels between the dominant concha and the nasal septum. Seventy-three percent of patients with concha bullosa had paranasal sinus inflammatory disease; 78% of patients without concha bullosa also had some form of inflammatory disease. CONCLUSION: Concha bullosa is a common anatomic variant. There is a strong association between the presence of a concha bullosa and contralateral deviation of the nasal septum. Nasal septal deviation away from the dominant concha, with preserved adjacent air channels, suggests that the deviation is not a direct result of mass effect from the concha. No increased incidence of paranasal sinus disease exists in patients with concha bullosa.