霉菌性鼻窦炎的CT诊断（附8例分析）

目的：旨在认识霉菌性鼻窦炎ＣＴ表现的特征，以便作出准确的定性诊断。材料与方法：搜集经手术病理证实的霉菌性鼻窦炎８例，其中曲霉菌病５例，毛霉菌病２例，隐球菌病１例。对它们的ＣＴ征象结合病理改变进行回顾性分析。同时对本病与一般性炎症、肿瘤之间的鉴别诊断作了讨论。结果：以下ＣＴ征象可作秋诊断该病的重要依据：（１）病变为单侧性，对侧鼻腔鼻窦正常；（２）病变仅位于上颌窦或以上颌窦为主，累及同侧鼻腔及其他鼻窦     

上颌窦曲菌病的平片和CT诊断(附8例报告)

目的 :探讨上颌窦曲菌病的 X线平片和 CT表现及其诊断意义。方法 :经手术和病理诊断的上颌窦曲菌病 8例 ,均照有站立或坐位平片和轴位 CT扫描。结果 :病变累及上颌窦 8例 ,同时累及筛窦 2例 ,额窦 1例 ,均有粘膜肥厚 ,窦腔内肿块 3例 ,高密度钙化影 4例。结论 :有慢性上颌窦临床表现而治疗效果不佳 ;平片或 CT未见液气平面 ;软组织肿块破坏或不破坏骨质 ;异常高密度影应高度怀疑曲菌病的可能     

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，     

单发干酪性上颌窦炎的CT与病理对照分析(附6例报告)

目的：探讨单发干酷性上颌窦炎的ＣＴ征象及其病理基础，以期与上颌窦癌鉴别。方法：搜集６例经手术、病理证实的单发干酪性上颌窦炎ＣＴ及临床资料，并进行回顾性分析。结果：主要ＣＴ表现：①单侧上颌窦实变且无强化。②粘膜肥厚并强化。③骨壁不规整增厚，骨壁破坏（５例６处）。手术所见：①窦腔内充满大量干酪坏死物，无血供。②粘膜肥厚糜烂。③骨质增生硬化，部分骨质破坏。结论：ＣＴ检查对干酪性上颌窦炎的正确诊断很有帮助     

霉菌性鼻窦炎的CT诊断

目的 探讨霉菌性鼻窦炎CT特征性表现及诊断价值。方法 回顾性分析12例经手术病理证实的霉菌性鼻窦炎CT表现，提出诊断和鉴别诊断要点。结果 霉菌性鼻窦炎主要CT表现有：病变为单侧性，对侧鼻窦正常；病变仅位于上颌窦或以上颌窦为主，累及其他鼻窦；病变窦腔密度增高，不均匀，内有小团状，砂粒状，条状极高密度区；可有鼻窦骨质破坏。结论 霉菌性鼻窦炎的CT表现上有特异性，CT是诊断该病有价值的方法。     

上颌窦乳头状瘤CT诊断

目的：探讨上颌窦乳状瘤的ＣＴ诊断和鉴别诊断。材料与方法：回顾分析１０例经病理证实的上颌窦乳突状瘤。男性６例，女性４例，年龄在３０岁以上。主要症状为单侧性鼻塞和鼻衄。结果：此病好发于一侧上颌窦，按病理发生部位分为２型：内翻型和外翻型。ＣＴ扫描表现为＂峰窝征＂，上颌窦内侧骨壁破坏。结论：ＣＴ能显示肿瘤的部位和大小，对指导临床治疗、确立手术方式有重要意义。     

CT诊断上颌窦疾病的研究

笔者回顾分析了ＣＴ诊断的５３例上颌窦疾病，经手术病理证实。ＣＴ扫描提示上颌窦炎性病变２３例，息肉样病变７例，囊性病变９例，良性肿瘤４例，恶性肿瘤９例，骨纤维异常增殖症１例。与病理诊断对比基本符合，仅１例（２％）为假阳性。在诊断上颌窦疾病方面，ＣＴ可以解决一些传统难题，如提高对窦壁周围组织估计的正确性，可证实肿瘤对翼部、咽部及鼻腔的侵犯，有助于手术方案的制定。由于ＣＴ密度分辨率高，超越了平片及多轨迹体层，得以确定软组织、骨壁及含气腔的隐匿性变化，加上增强扫描可推测病变为血管性或非血管性。对于鉴别囊肿、脓肿、良恶性肿瘤等均起到重要作用。     

颈动脉海绵窦瘘的眼眶CT表现(附23例报告)

目的分析２３例经ＤＳＡ检查证实的颈动脉海绵窦瘘的眼眶ＣＴ表现。材料与方法本组２３例，其中有外伤史者１５例，占６５％。颈内动脉海绵窦瘘（ＣＣＦ）１４例，硬脑膜动脉海绵窦瘘９例。均行眼眶ＣＴ检查并经ＤＳＡ造影证实。结果主要ＣＴ表现为：（１）眼球突出；（２）眼上静脉扩张；（３）海绵窦增大；（４）眼外肌增粗；（５）眶内软组织肿胀。结论对突眼的病人进行ＣＴ扫描，发现有上述表现时可考虑颈动脉海绵窦瘘的诊断，但应进行必要的鉴别诊断，ＤＳＡ检查可明确瘘的部位和类型，并可决定治疗的方法     

胆脂瘤型中耳炎的CT诊断

本文回顾性分析了经手术病理证实的４９耳胆脂瘤型中耳炎和８耳胆固醇性肉芽肿的临床和ＨＲＣＴ检查资料。中耳胆脂瘤的ＣＴ表现为：（１）鼓室、鼓窦内软组织影和骨质破坏；（２）听骨移位及破坏；（３）鼓膜增厚、内陷、穿孔；（４）严重者可破坏乙状窦板、天装置、半规管和面神经管等。笔者对后天性胆脂瘤的组织密度、颞骨各部位胆脂瘤的ＣＴ诊断，胆固醇肉芽肿的病理机制、临床和ＣＴ表现、与胆脂瘤的鉴别诊断等进行了探讨。     

侵袭性肺曲菌病的CT表现

目的 探讨侵袭性肺曲菌病（ＩＰＡ）的ＣＴ表现。方法 经病理及临床证实的ＩＰＡ８例,均行常规ＣＴ扫描,２例４周后ＣＴ复查。结果 ＣＴ表现为肿块样浸润（３例）;炎症样病变（３例）;多发结节（２）。结论 ＩＰＡ的早期ＣＴ征象有肿块,多发结节,实变;ＣＴ“晕轮征”的出现强烈提示的早期诊断。     

Marker-free registration for the accurate integration of CT images and the subject's anatomy during navigation surgery of the maxillary sinus

Objective

This study compared three marker-free registration methods that are applicable to a navigation system that can be used for maxillary sinus surgery, and evaluated the associated errors, with the aim of determining which registration method is the most applicable for operations that require accurate navigation.

Methods

The CT digital imaging and communications in medicine (DICOM) data of ten maxillary models in DICOM files were converted into stereolithography file format. All of the ten maxillofacial models were scanned three dimensionally using a light-based three-dimensional scanner. The methods applied for registration of the maxillofacial models utilized the tooth cusp, bony landmarks and maxillary sinus anterior wall area. The errors during registration were compared between the groups.

Results

There were differences between the three registration methods in the zygoma, sinus posterior wall, molar alveolar, premolar alveolar, lateral nasal aperture and the infraorbital areas. The error was smallest using the overlay method for the anterior wall of the maxillary sinus, and the difference was statistically significant.

Conclusion

The navigation error can be minimized by conducting registration using the anterior wall of the maxillary sinus during image-guided surgery of the maxillary sinus.     

Comparison of the panoramic radiographic and CT features of post-Caldwell-Luc maxillary sinuses

OBJECTIVE: To clarify the panoramic radiographic features of the post-Caldwell-Luc maxillary sinus. METHODS: The panoramic radiographs were compared with the axial CT scans of 48 symptomatic post-Caldwell-Luc maxillary sinuses which had been operated on more than 5 years previously. RESULTS: The two characteristic features of the post-Caldwell-Luc maxillary sinus on panoramic radiographs were a right-angled triangular shape, due to absence of the floor of the maxillary sinus and radiopacity of the posterior wall and zygomatic bone, and an ill-defied panoramic innominate line. This shape was related to the finding of a contracted sinus with a radiolucent lumen on the CT scans. There was also close relationship between the ill-defined panoramic innominate line and thickened posterior wall on the CT scans. CONCLUSION: The characteristic features of the post-Caldwell-Luc maxillary sinus on panoramic radiographs were a right-angled triangular shape and an ill-defined panoramic innominate line. These features were related to a contracted sinus and a thickened posterior wall on the CT scans.     

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.     

出血坏死性上颌窦炎的CT诊断（附20例分析）

本文复习２０例出血坏死性上颌窦炎的ＣＴ表现，笔者认为特征性ＣＴ表现为：上颌窦与鼻腔内软组织肿块；窦腔的不均等性膨胀扩大；窦壁骨质吸收或破坏，此外，对出血坏死性上颌窦炎同上颌窦癌的ＣＴ鉴别作了讨论     

非侵袭性真菌性上颌窦炎的CT诊断

目的总结非侵袭性真菌性上颌窦炎的CT表现特征,以提高本病的正确诊断率。方法对经手术、病理证实的50例非侵袭性真菌性上颌窦炎的CT表现进行回顾性分析。结果 43例病变累及一侧上颌窦,7例累及同侧筛窦及鼻腔。病变窦腔内充以软组织密度影,内见斑点斑块状钙化36例,窦腔高密度影内见气泡影19例。34例见上颌窦窦壁骨质改变,窦壁骨质增生硬化26例;窦壁骨质吸收破坏24例。结论非侵袭性真菌性上颌窦炎具有特征性的CT表现,CT对该病的诊断有较高价值。     

Comparison of CT findings in non-Hodgkin lymphoma and squamous cell carcinoma of the maxillary sinus.

The findings at CT in 11 patients with primary non-Hodgkin lymphoma (NHL) of the maxillary sinus were compared with the CT findings in 21 patients with squamous cell carcinoma (SCC) of the maxillary sinus. In NHL, the segmental bone destruction was in alignment with the bony wall with a massive tumor infiltration into the neighboring structures. In contrast, all patients with SCC were characterized by a soft tissue mass with aggressive bone destruction. About half of the patients with NHL had cervical lymphadenopathy. Post-treatment recalcification of previous bone destruction was seen in 4 out of 5 NHL patients on follow-up CT. In the patients with SCC, only a few had metastatic lymphadenopathy, and no recalcification occurred after treatment. CT is therefore of importance in differentiating NHL from SCC of the maxillary sinus.     

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。     

CT features in second cancers of the maxillary sinus

Five patients with a second maxillary cancer (squamous cell carcinoma), which developed 6 to 17 years after initial treatment for the first cancer on the opposite side, were compared with 21 control cases with a primary cancer on the basis of computed tomography (CT) findings. Generally, the second cancer was found at an earlier stage. The specific CT findings of early sinus carcinoma were uneven soft tissue distribution in the antrum and tumor permeation with bone fragments remaining at the original tumor site. These findings may be helpful for distinguishing this cancer from benign chronic sinusitis and/or other malignant sinus disease. The pterygoid process, medial bony wall, and ethmoid sinus had a tendency to be spared in most of the 5 patients with second maxillary cancer compared to the 21 control cases.     

Pneumatization of the inferior turbinates: incidence and radiologic appearance

OBJECTIVE: The objective of this work was to determine the incidence and radiologic appearance of pneumatized inferior turbinates (PITs). METHODS: Pneumatized inferior turbinates were investigated among 2500 consecutive cases with coronal paranasal sinus computed tomography (CT) scans that were performed for different reasons between 2000 and 2004. RESULTS: Ten new PIT cases diagnosed with CT were identified. Pneumatization was diagnosed in 2 patients aged 7 and 14 years. Therefore, this is the first time that PIT has been described in the pediatric age group. Complete or incomplete pneumatizations were unilateral in 7 cases and bilateral in 3 cases. In bilateral PIT cases, pneumatizations were asymmetric. In 2 cases, only bulbous parts of the inferior turbinates (ITs) were involved. Inferior turbinate expansion related to pneumatization was not observed in any case. In cases with maxillary sinus communication, axial CT sections revealed a defect on the medial wall of the maxillary sinus. CONCLUSIONS: The incidence of PIT was found to be 1 in 250 cases. It is suggested that most PIT cases may be a result of articulation defects between the maxillary process of the palatine bone and the maxillary bone. In such a situation, the maxillary process of the palatine bone and the nasal process of the maxillary bone, which form the medial wall of the maxillary sinus at the IT level, can attach to the IT separately.     

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。