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.     

Assessment of the lacrimal recess of the maxillary sinus on computed tomography scans

Objective

To assess the frequency of the lacrimal recess in the maxillary sinus (MS) in computed tomography (CT) of the paranasal sinuses.

Methods

CT of the paranasal sinuses (CT PNS) done in a total of 78 patients. According to the discoveries, the MS were classified in two types: anterior or lateral.

Results

41 CT PNS of 41 patients of a total of 78 patients preselected were excluded. 37 CT of the paranasal sinuses from 37 patients, in a total of 68 maxillary sinuses were studied. In the 33 right maxillary sinuses, 10 lacrimal recesses were found, 9 from male patients. Eleven left maxillary sinuses with lacrimal recess were found from a total of 35 left maxillary sinuses.

Conclusion

From the analysis of 68 MS, a frequency of 30.9% of lacrimal recesses in the maxillary sinuses in CT was observed.     

真菌性鼻窦炎的CT诊断(附16例分析)

目的　探讨真菌性鼻窦炎的CT特征性表现及诊断价值。方法　分析 16例经手术病理证实的真菌性鼻窦炎CT表现。结果　真菌性鼻窦炎主要CT表现有 :病变仅发生于一侧 ,以上颌窦或以上颌窦为主 ,同时累及其他鼻窦 ;鼻旁窦内软组织呈结节状或息肉样不规则增生 ,内可见点状、结节状钙化 ;部分窦腔增大 ,骨壁破坏。结论　真菌性鼻窦炎在CT表现上有特异性 ,CT对该病诊断有重要价值     

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.     

沈阳军区108例飞行人员鼻部检查临床研究

目的探讨飞行人员鼻部体检的相关方法,以早期发现并干预鼻部疾病或与疾病相关的解剖变异,提高体检质量和效能。方法选择2013年1月至2015年12月在解放军第四六三医院进行住院或体检的108例飞行人员,应用前鼻镜、电子内镜及鼻窦CT三种方法进行鼻部检查,并对三种检查方法的结果进行比较分析。结果 108例飞行人员中,解剖总变异率为100.0%(108/108),其中窦口鼻道复合体(OMC)处解剖变异的发生率为89.0%(96/108),鼻部疾病发生率为19.4%(21/108)。前鼻镜只能发现部分鼻中隔偏曲(不包括后端偏曲)和肥厚性鼻炎(不含骨质增生),电子内镜可以发现更多的微小或深在的解剖变异或病变。鼻窦CT检查可以确定所有的骨性解剖畸形,但不足之处在于对炎症或软组织病变无法做到确诊。结论飞行人员中存在常规检查无法发现的鼻部解剖变异或病变,对飞行会有潜在影响。鼻部的三种检查手段各有优势和不足,应根据情况合理选择,以提高飞人行员鼻部体检的准确性和效能。     

Optimal CT evaluation for functional endoscopic sinus surgery.

PURPOSETo evaluate the optimal parameters for the CT examination of patients who are having functional endoscopic sinus surgery.METHODSCT scanning was performed on two fresh cadaveric heads in the direct coronal plane, varying the section thickness, intersection gap, scanner gantry angle, and amperage. The nasal cavity and paranasal sinuses were examined independently in a blinded fashion by four staff neuroradiologists and a staff otolaryngologist with special attention to 10 anatomic landmarks within the ostiomeatal unit that are considered important for preoperative planning. A score of 0 (nonvisualization/incomplete visualization) or 1 (clear/complete visualization) was assigned to each of these 10 landmarks. Analysis of variance was used in which reader, subject, and side were simultaneously controlled by "blocking." Multiple comparison methods (ie, Bonferroni) were used to compare the different protocols.RESULTSWe found a significant reduction in the delineation, and therefore the perception, of the ostiomeatal unit structures when the section thickness was greater than 5mm, any intersection gap was used, and the gantry angle was greater than 10 degrees from the plane perpendicular to the hard palate. However, a reduction in the radiation exposure from 200 mA to 80 mA did not affect the display of the anatomic landmarks.CONCLUSIONWe found the optimal screening CT protocol for the paranasal sinuses to be a section thickness of 3 mm, no intersection gap, and a section angle within 10 degrees from the plane perpendicular to the palate. Also, owing to inherent contrast between air, soft tissue, and bone in the paranasal sinuses, a reduction in the radiation exposure parameter to 80 mA did not affect image quality.     

鼻腔及鼻窦内翻性乳头状瘤CT误诊分析

目的　探讨鼻腔鼻窦内翻乳头状瘤的CT误诊原因。方法　对 10例病理证实为鼻腔鼻窦内翻乳头状瘤而术前CT误诊的病例进行分析。结果　鼻腔鼻窦内翻乳头状瘤主要表现为单侧鼻腔鼻窦呈匍匐生长的软组织团块 ,轻到中度增强 ,可伴有骨质破坏和骨质硬化。结论　严格操作规程 ,行增强扫描 ,可降低本病的误诊率。     

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.Correspondence to: M. Mantoni     

CT and MR imaging of the paranasal sinuses in cystic fibrosis. Correlation with microbiological and histopathological results

PURPOSE: To compare CT and MR findings of the paranasal sinuses in patients with cystic fibrosis (CF) with microbiology and histopathology. Further, to compare microbiology from the maxillary sinuses, nasopharynx and sputum. MATERIAL AND METHODS: CT and MR imaging of the paranasal sinuses were performed in 10 CF patients. Endoscopy and maxillary sinus aspirates were obtained (guided by the MR findings) and analyzed microbiologically and histologically. Samples from the nasopharynx and sputum were analyzed microbiologically. RESULTS: CT and MR were equal in displaying the extent of soft tissue masses, which at CT were homogeneous, while MR showed heterogeneous signals. MR images also demonstrated circumscribed areas with signal void at the STIR sequence with corresponding high to intermediate signal at the T1-weighted sequence. P. aeruginosa was frequently cultured from these areas which we named the "black hole sign". Maxillary sinus cultures revealed the same bacteria as nasopharynx and sputum cultures combined. CONCLUSION: MR images were superior to CT in differentiating soft tissue masses in the paranasal sinuses in CF patients. Bacteria with potential for specialized iron uptake mechanisms were present in areas with signal void at the STIR sequence. Our hypothesis is that the MR "black hole sign" can be explained by paramagnetic properties related to bacterial agents.     

300例鼻窦骨折的CT与临床分析

目的探讨CT扫描诊断鼻窦骨折的价值。方法对300例鼻窦骨折的临床症状、CT表现资料进行回顾性分析。结果单窦单壁骨折49例,单窦多壁骨折96例,多窦骨折155例,上颌窦腔“泪滴征”、积液和眼外肌等改变。结论CT能全面、准确地诊断鼻窦骨折,对患者治疗方法的选择十分重要。     

Significance of CT and MR findings in sphenoid sinus disease

Disorders of the paranasal sinuses, particularly the sphenoid sinus, can be associated with significant disorders of the optic and other cranial nerves. We examined 100 consecutive routine CT scans, 100 posterior fossa CT scans, and 100 MR scans to look for evidence of sinus disease, especially of the sphenoid sinus. The sphenoid sinus was abnormal in 7% of scans by all methods. Other sinuses were more frequently abnormal, including maxillary (23%), ethmoid (34%), and frontal (16%). Although MR was more sensitive in detecting sinus inflammation in the ethmoid and maxillary sinuses, the frequency of visible sphenoid sinus abnormalities detected by MR was not significantly greater when compared with CT. Of those patients with abnormal sphenoid sinuses, 24% had visual problems associated with the abnormality.     

鼻窦真菌球的 CT 及磁共振成像表现

目的：探讨鼻窦真菌球的CT、磁共振成像（MRI）特征性表现及诊断价值。方法回顾性分析35例经手术、组织病理学证实的鼻窦真菌球的影像学资料,35例患者均做CT平扫,其中4例做MRI平扫加增强扫描。结果鼻窦真菌球的主要CT表现为：①病变为单侧性（100%）;②病变部位以上颌窦为主（80%）,部分突入同侧鼻腔;其次为蝶窦（14%）;③病变窦腔内不均匀软组织密度影充填,其内可见呈斑点状、云絮状或条带状高密度钙化影（89%）;④局限性骨质增生（74%）及破坏（9%）。 MRI表现为：病变中心T1WI呈等信号,T2WI呈低信号,周围增厚黏膜T1WI呈低信号,T2WI呈高信号,增强扫描病变中心不强化,周围增厚黏膜明显强化。结论病变内钙化影是本病特征性的CT征象,是诊断该病较为可靠的依据,CT检查是诊断本病的重要手段;MRI能显示病变内真菌球的范围,有助于诊断。     

鼻及鼻窦常见病变和解剖变异的CT冠状位靶扫描(附507例分析)

目的：探讨鼻及鼻窦常见病变和解剖变异的CT特征。方法：回顾性分析507例病人的冠状位CT表现。结果：慢性鼻及鼻窦炎占61．73％(313／507)；鼻息肉占22．87％(116／507)；囊肿占4．93％(25／507)，真菌性鼻窦炎占1．38％(7／507)；恶性占位性病变占0．79％(4／507)，未见异常占7．88％(40／507)。鼻中隔弯曲占65．66％(333／507)。Onodi气房占29．19％(148／507)；Haller气房占12．42％(63／507)。蝶窦发育不良占3．94％(20／507)；上颌窦发育不良占1．97％(10／507)。结论：冠状位CT靶扫描可对各种鼻及鼻窦病变做出诊断，并可显示其解剖变异的特征。     

The value of the occipitomental (Waters') view in diagnosis of sinusitis: a comparative study with computed tomography

AIM: Sinus X-rays are still frequently used in the evaluation of paranasal sinusitis. Many radiology departments nowadays provide the referring doctors with a single Waters' projection. Our purpose was to evaluate the diagnostic accuracy of a single Waters' view vs high resolution computed tomography (CT) in the diagnosis of paranasal sinusitis. SUBJECTS AND METHODS: A total of 134 patients with suspected paranasal sinusitis underwent a Waters' view X-ray and high resolution CT on the same day. The radiographs were evaluated independently by nine experienced radiologists, who observed each sinus separately. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated for each sinus and for each observer, using the CT findings as a 'gold standard'. RESULTS: The weighted mean sensitivity for diagnosis of any abnormality in the maxillary sinus was 67.7%, specificity 87.6%, accuracy 78.6%, positive predictive value 82.5% and negative predictive value 76.9%. For this sinus the variation between observers was small, however, the sensitivity for diagnosis of any disease in the frontal and ethmoid sinuses varied widely between observers (range 1.9-54.0% and 0-58.9%, respectively). The sensitivity for the sphenoid sinus was very low (range 0-3.8%), even in radiographs which seemed to demonstrate it well. CONCLUSION: The Waters' view has its limits in the diagnosis of sinusitis of the maxillary sinuses and its contribution for diagnosing lesions in the remaining sinuses is very poor. Whenever access to CT is available, a low dose high-resolution CT study of the paranasal sinuses is highly recommended.Konen, E. (2000). Clinical Radiology55, 856-860.     

鼻窦部结外Rosai-Dorfman病的诊治

目的　探讨鼻窦部结外Rosai Dorfman病的临床表现、组织学特征、诊断、鉴别诊断及治疗。方法　分析国内罕见的发生于鼻窦的结外Rosai Dorfman病的临床、组织学和影像学资料。结果　病变位于鼻窦 ,曾先后多次复发、手术切除并病理误诊。组织学分析可见大量梭形细胞混有泡沫细胞和少量浆细胞 ,胞质丰富呈泡沫样。免疫组化分析显示 ,组织细胞呈S 10 0和CD6 8阳性。结论　鼻窦部结外Rosai Dorfman病诊断困难 ,易误诊 ,临床应与鼻硬结病、嗜酸性肉芽肿、浆细胞瘤、良性纤维组织细胞瘤等进行鉴别 ,免疫组化细胞呈S 10 0、CD6 8阳性有助诊断。此病可采用化疗、放疗和手术治疗等综合治疗 ,对重要部位的病变侵犯 ,彻底的手术切除是最有效治疗方法 ,术后应跟踪随访     

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。     

螺旋CT多平面重组在副鼻窦检查中的应用

目的 :利用螺旋CT多平面重组技术探讨副鼻窦轴位扫描能否代替直接冠状位扫描。方法 :对 15例能合作的患者 ,均行副鼻窦轴位及冠状位扫描。使用美国GEProspeedFII双排螺旋CT机 ,层厚 5mm ,螺距 0 .75 ,连续横轴位扫描 ,利用多平面重组 (MPR)技术得到冠状位、矢状位重组图像 ;直接冠状位扫描获取冠状位图像 ;将同一患者的两组不同冠状位图像比较 ,主要观察各鼻窦窦壁及窦口。结果 :轴位扫描后重组所获图像亦能从多方位多角度观察 ,清楚显示各鼻窦及窦口。结论 :重组冠状位图像与直接冠状位扫描图像效果相同 ,可以取代直接冠状位扫描。避免后者检查时头部后仰造成的不适 ,患者容易接受 ,值得推广。     

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。     

Meningioma of the paranasal sinuses

Summary Meningiomas originating in the paranasal sinuses are rare. These tumors are thought to arise from embryonal arachnoid nests which were pinched off and left behind during embryonic development. We have described various radiographic findings of two patients with meningioma arising in the paranasal sinuses (frontal sinus origin in a 65-year-old female, and sphenoid sinus origin in a 26-year-old female). The paranasal origin of meningioma was accurately determined on the basis of CT and arteiography. A review of the 11 cases previously reported and our cases indicates that there are no specific clinical or radiographic findings of meningiomas of the paranasal sinuses.     

Ventilation imaging of the paranasal sinuses using xenon-enhanced dynamic single-energy CT and dual-energy CT: a feasibility study in a nasal cast

Objective

To show the feasibility of dual-energy CT (DECT) and dynamic CT for ventilation imaging of the paranasal sinuses in a nasal cast.

Methods

In a first trial, xenon gas was administered to a nasal cast with a laminar flow of 7?L/min. Dynamic CT acquisitions of the nasal cavity and the sinuses were performed. This procedure was repeated with pulsating xenon flow. Local xenon concentrations in the different compartments of the model were determined on the basis of the enhancement levels. In a second trial, DECT measurements were performed both during laminar and pulsating xenon administration and the xenon concentrations were quantified directly.

Results

Neither with dynamic CT nor DECT could xenon-related enhancement be detected in the sinuses during laminar airflow. Using pulsating flow, dynamic imaging showed a xenon wash-in and wash-out in the sinuses that followed a mono-exponential function with time constants of a few seconds. Accordingly, DECT revealed xenon enhancement in the sinuses only after pulsating xenon administration.

Conclusion

The feasibility of xenon-enhanced DECT for ventilation imaging was proven in a nasal cast. The superiority of pulsating gas flow for the administration of gas or aerosolised drugs to the paranasal sinuses was demonstrated.

Key Points

? Ventilation of the paranasal sinuses is poorly understood. ? Dual-energy CT ventilation imaging has been explored using phantom simulation. ? Xenon can be seen in the paranasal sinuses using pulsating xenon flow. ? Dual-energy CT uses a lower radiation dose compared with dynamic ventilation CT.