变应性真菌性鼻窦炎的CT诊断

目的 探讨变应性真菌性鼻窦炎的CT表现及其诊断价值。方法 回顾性分析12例经术后组织病理证实的变应性真菌性鼻窦炎，均经过CT检查。主要临床表现包括奶酪状黏涕、鼻阻塞感及鼻区痛。鼻内镜检查：12例受累侧鼻腔内均可见息肉、黏膜水肿，鼻窦腔内均见真菌分泌物。结果 变应性真菌性鼻窦炎累及半组鼻窦3例，累及全组鼻窦9例。CT平扫12例表现为鼻窦黏膜增厚；窦腔内充满软组织影，伴有不规则条状、匍行性或斑片状高密度影(软组织窗)，边界清楚，也可伴有云雾状高密度影(骨窗)，边界模糊；CT值80～110HU，平均92．5HU。11例鼻窦膨胀，窦壁骨质变形、变薄10例，8例窦壁骨质侵蚀。8例病变延伸到邻近结构，其中4例累及眼眶，2例累及颅内，2例同时累及眼眶和颅内。结论 半组或全组鼻窦充满软组织影，伴有多发典型的高密度影是诊断本病的特征性CT征象，根据此征象可能首先提出本病的诊断。CT不但可以准确显示病变累及的范围，也能够帮助与其他病变进行鉴别。     

慢性侵袭性真菌性鼻窦炎的CT和MRI诊断

目的探讨慢性侵袭性真菌性鼻窦炎的CT和MRI表现及诊断价值。方法回顾性分析经手术、组织病理学证实的10例慢性侵袭性真菌性鼻窦炎的影像学资料。结果慢性侵袭性真菌性鼻窦炎发生于蝶窦5例，上颌窦3例，筛窦2例。CT表现：受累窦腔内充以软组织影，其中1例伴斑点状钙化；窦壁骨质破坏，同时伴周围骨质增生肥厚。MRI表现：T1WI为低信号（与脑实质比较，以下相同）2例，等信号7例；T2WI信号不均匀，7例以低信号为主，2例以高信号为主；增强后病变明显强化。侵犯邻近结构：眼眶9例，其中6例累及眶尖区，可见不规则软组织肿块影，与邻近眼外肌分界不清楚，7例包绕视神经；6例侵犯海绵窦，可见形态不一的软组织影；脑膜增厚、强化5例，3例侵犯脑实质，表现为水肿1例，肉芽肿2例；4例侵犯翼腭窝及颞下窝；3例鼻咽部软组织增厚；2例上颌神经和1例下颌神经明显增粗、强化；3例面颊部软组织肿胀；1例硬腭骨质破坏。结论窦壁骨质破坏伴硬化、MR T2WI低信号、易侵犯眶尖及海绵窦为本病特征性影像学表现。结合CT和MRI2种检查方法能够对本病的诊断、鉴别和治疗提供更可靠的信息。     

CT and MRI features in Bipolaris fungal sinusitis

Bipolaris is an increasingly recognized cause of fungal sinusitis. Reports of imaging features are sparse. Our purpose was to review the imaging features in patients with Bipolaris fungal sinusitis. A review of our data showed seven patients with culture-proven Bipolaris fungal sinusitis. Computed tomography of the paranasal sinuses in all the patients and MRI in five patients were analysed for the location, nature, extent of the disease and density/signal characteristics on CT/MRI. The sphenoid and posterior ethmoid sinuses were most often involved (six of seven), followed by the anterior ethmoid sinus (five of seven), frontal sinus (four of seven) and maxillary sinus (three of seven) involvement. Five of seven cases had bilateral disease. Secretions were seen to fill the sinus and were expansile in nature in six of seven cases. Bony erosion was noted in all the patients. Air-fluid levels and bony sclerosis were rarely seen. Computed tomography showed central hyperdensity in all the cases. In the corresponding MR images (n = 5), the sinus contents appeared hyperintense on T1-weighted images and hypointense on T2-weighted images. Extension into the nasal cavity was found in six of seven cases. Five of seven cases had intracranial (extradural) spread. Intraorbital extension was seen in three of seven cases, with associated optic nerve compression in two. All the patients responded to surgical debridement, and systemic antifungal therapy was not required. Bipolaris fungal sinusitis typically presents with an allergic fungal sinusitis picture with expansile sinus opacification and bony erosions. There is central hyperdensity on CT scan, which appears hyperintense on T1-weighted and hypointense on T2-weighted MR images.     

CT诊断真菌性鼻窦炎100例分析

目的回顾性总结真菌性鼻窦炎CT影像表现,并结合临床,探讨CT检查对诊断真菌性鼻窦炎的临床价值。方法收集100例确诊为真菌性鼻窦炎的病人资料并结合临床检查结果,与CT检查进行分析比较。鼻窦CT扫描采用骨窗和软组织窗扫描。结果 100例患者均为单侧鼻窦发病,其中真菌球型68例,慢性侵袭性真菌性鼻窦炎4例,变应性真菌性鼻窦炎28例。CT扫描影像特点为鼻窦腔散在较均匀毛玻璃特征或极不规则的线状,有星状分布的钙化点;伴不同程度骨质吸收或结构不清;窦壁骨质侵蚀15例。病变延伸到邻近结构3例,其中1例累及眼眶。有2例侧颅底骨质吸收。鼻腔或鼻窦内分布黏蛋白与CT显示毛玻璃样高密度影一致。结论真菌性鼻窦炎的鼻窦CT扫描显示与其他鼻窦炎不同。CT检查有助于准确诊断真菌性鼻窦炎。     

空勤人员鼻科疾病谱研究

目的 通过分析空勤人员鼻科疾病谱提出飞行人员鼻科疾病的防治建议.方法 对1966-2007年间住院的320名空勤人员的373例次鼻科疾病谱进行对比分析.结果 排在鼻科疾病谱前位的为慢性鼻窦炎鼻息肉、鼻窦气压伤、鼻中隔偏曲、变应性鼻炎、慢性鼻炎、鼻窦囊肿、急性鼻窦炎、鼻腔鼻窦肿瘤和鼻外伤等.飞行合格283人,暂时飞行不合格12人,飞行不合格25人.结论 飞行人员鼻科疾病较常见,且与气压伤的关系密切,应积极治疗Ⅰ类鼻腔鼻窦疾病(地面生活有症状),阻止其向地面生活无症状、飞行中出现鼻窦气压伤和(或)耳气压伤症状的Ⅱ类疾病转化.有效治疗Ⅱ类疾病是降低停飞率的重要措施. Abstract： Objective To suggest the protection of aircrews on the base of analyzing disease spectrum of nasal cavity and sinus. Methods The disease spectrum of nasal cavity and sinus was made by analyzing 373 cases of 320 aircrews who were hospitalized from 1966 to 2007. The medical evaluation was reviewed. Results The top diseases in spectrum were chronic sinusitis and nasal polyp, sinus barosinusitis, deviation of nasal septum, allergic rhinitis, chronic rhinitis, cyst in nasal sinus, acute sinusitis, tumor in nasal cavity and sinus, and nasal injuries. In medical evaluation, 283 aircrews were qualified for flying compared to 12 were temporarily grounded and 25 were permanently grounded. Conclusions The nasal cavity and sinus diseases are common in aircrews and usually character barosinusitis and (or) aural barotrauma. The type Ⅰ nasal cavity and sinus diseases (with symptoms on ground) should be treated in time to prevent their transition to type Ⅱ (no obvious symptoms on ground but with symptoms of sinus barosinusitis and (or) aural barotrauma in flight).Duly treating type Ⅱ nasal cavity and sinus diseases would be the effective measure for reducing aircrew's grounding rate.     

鼻咽癌侵犯翼腭窝的CT研究

目的：加深对鼻咽癌（NPC）侵犯翼腭窝（PPF）CT表现的认识,以提高临床对NPC侵犯范围诊断的准确性。方法：回顾分析66例颅底受侵的NPC病例,并对30例颅底受侵的NPC病例作了前瞻性研究。回顾性病例均为常规扫描,前瞻性病例则加作高分辨率CT（HRCT）扫描。结果：96例中,共有41例PPF受累,经蝶腭孔累及者21例,经颞下窝累及者5例,不能确定途径者15例。PPF受侵后可经蝶筛隐窝或翼管侵犯蝶窦,本组共有7例。经HRCT发现翼管和蝶窦受累的病例中,冠状面显示分别为11例和10例,而横断面显示分别为5例和3例,二者间差异具有显著性意义（P＜0．05）。结论：PPF是NPC易于累及的部位,肿瘤经此常累及相邻结构,其中对蝶窦的侵犯方式值得注意。横断面HRCT较常规横断面CT更能清楚显示翼管、蝶窦管结构的骨质破坏;而冠状面HRCT显示翼管及蝶窦受累的情况则显著优于横断面HRCT。     

飞行人员年度体检和特殊体检鼻窦炎和鼻窦囊肿的比较分析

目的比较飞行人员年度体检（又称大体检）和特殊体检（如航天员临床医学选拔）鼻窦炎和鼻窦囊肿的特点,为规范飞行人员鼻科体检方法提供依据。方法回顾分析9312名飞行人员疗养大体检（大体检组）、151名飞行员特殊体检（特殊体检组）的鼻科体检资料。大体检时依据病史行鼻镜检查,必要时行鼻窦数字化摄影（digital radiography,DR）检查;特殊体检鼻科体检时,全部行鼻窦CT扫描。对两组人员患鼻窦炎和鼻窦囊肿的资料进行对比分析。结果①大体检组飞行人员中,鼻窦炎170例,占1．8％（170／9312）;需要治疗者90例,占1．0％（90／9312）。特殊体检组飞行员中,鼻窦炎22例,占14．6％（22／151）;需要治疗者2例,占1．3％（2／151）。②大体检组飞行人员中,鼻窦囊肿112例,占1．2％（112／9312）;特殊体检组飞行员中,鼻窦囊肿18例,占11．9％（18／151）,囊肿均无需治疗。③大体检组鼻窦炎、鼻窦囊肿的检出率均低于特殊体检组（X^2-120．11、125．98,P〈0．01）;但鼻窦炎需要治疗者,两组所占比例没有显著差异。结论飞行人员疗养大体检鼻科检查时,依据病史行鼻镜和鼻内镜检查,必要时行鼻窦X线、CT等影像学检查可满足诊断需求;但特殊体检鼻科检查时,应全部行鼻窦CT扫描,才能满足诊断和医学鉴定需求。     

Craniofacial mucormycosis: assessment with CT

Computed tomographic (CT) scans of ten patients with rhinocerebral mucormycosis were reviewed. Early paranasal sinus involvement appeared as mucosal thickening on CT scans, usually without air/fluid levels. Recognition as mucormycosis was facilitated by knowledge of the clinical setting or by identification of invasive disease. Evidence of bone destruction on CT scans was seen in only two patients, was a late finding, and usually was absent despite deep extension of disease beyond the bony confines of the paranasal sinus. Five cases had intracranial involvement, either as fungal abscess or infarction. Intracranial mucormycosis usually involved the base of the brain and cerebellum following invasion of the infratemporal fossa or orbit. Intracerebral fungal abscess appeared as low-density masses on CT scans, with variable peripheral enhancement and little surrounding vasogenic edema. Identification of a rim of spared cortex was useful in distinguishing infection from bland infarct. Serial CT scans were also useful in assessing response to hyperbaric oxygen treatment, surgery, and chemotherapy.     

鼻腔淋巴瘤的CT诊断

目的：探讨原发鼻腔淋巴瘤的CT诊断。材料和方法：回顾性分析34例鼻腔淋巴瘤的CT表现,对肿瘤范围、密度、形态边缘和骨质情况进行分析。结果：肿瘤侵犯外鼻及鼻旁皮下20例、上颌窦17例、筛窦16例、鼻咽12例、眼眶10例、蝶窦7例、额窦4例、对侧鼻腔5例,个别病例侵犯颞下窝、颅前窝、颞窝、上腭和眶下裂。肿瘤分期：一期6例,二期10例,三期16例,四期2例。大多数病例病灶呈弥漫浸润状,边缘不清楚,密度均匀23例,稍不均匀11例,多数呈轻度强化。22例伴有骨质吸收破坏,12例无骨质异常。结论：鼻腔T细胞型淋巴瘤的CT表现具有一定特征,CT对其诊断具有较大的价值。     

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，     

鼻内镜在孤立性蝶窦霉菌病诊疗中的应用

目的：探讨鼻内镜在孤立性蝶窦霉菌病诊疗中的应用价值。方法对13例孤立性蝶窦霉菌病患者的临床资料进行回顾性分析,并对手术方法及治疗效果进行讨论。结果根据症状、体征和影像学检查,13例患者的诊断均为孤立性霉菌性蝶窦炎,并行鼻内镜下蝶窦开放手术,病理检查确诊;术后随访6-12个月,无复发病例。结论孤立性蝶窦霉菌病临床表现无特异性,易漏诊及误诊,CT/MRI检查结合鼻内镜检查可有效提高术前诊断率。运用功能性鼻内镜手术治疗孤立性蝶窦霉菌病优势明显,为首选的治疗方式。     

Concha bullosa: Frequency and appearances on CT and correlations with sinus disease in 308 patients with chronic sinusitis

The purposes of this study were to determine the prevalence of concha bullosa in patients with chronic sinusitis, to assess the origin of the pneumatisation (from the anterior or posterior ethmoid cells), and to evaluate the significance of the concha bullosa in the genesis of inflammatory sinus disease. We reviewed the CT studies of 308 patients with chronic sinusitis, assigning four grades of pneumatisation: absent, small, medium and large. Unilateral or bilateral concha bullosa was found in 164 patients (53%). In 79% of cases it was pneumatised via the posterior ethmoidal cells and in 21% via the anterior. A small concha bullosa was associated with abnormalities of the maxillary sinus, ethmoidal cells and ostiomeatal unit respectively in 49%, 28% and 34% of cases, whereas with a large concha bullosa the association was 55%, 36% and 41% respectively on the ipsilateral side and 55%, 32% and 41% on the contralateral side. The usually accepted hypothesis that the concha bullosa may contribute to the pathogenesis of inflammatory sinus disease seems doubtful.     

Do abnormalities of the frontonasal duct cause frontal sinusitis? A CT study in 198 patients.

OBJECTIVE. The purpose of the study was to determine the correlation between frontonasal duct abnormalities (narrowing or obstruction caused by hypertrophic mucosa) and frontal sinusitis. This study was based on the hypothesis that abnormalities of the frontonasal duct cause frontal sinusitis by impairing normal drainage of the sinus. MATERIALS AND METHODS. CT studies of 198 consecutive patients with clinical diagnoses of chronic sinusitis were reviewed retrospectively. Criteria for inclusion were (1) no history of sinus surgery or facial trauma and (2) absence of polyps at rhinoscopy. As 37 frontal sinuses were undeveloped, a total of 359 sinuses were evaluated. CT scans were obtained in oblique axial and coronal planes. The following CT features were assessed: (1) the frequency of detection of the frontonasal duct, (2) the appearance of the frontonasal duct: normal vs abnormal (narrowed or obstructed), and (3) the correlations between abnormalities of the frontonasal duct and frontal sinusitis. RESULTS. The frontonasal duct was detected in all 359 cases, either in both CT planes (81%) or only in the axial oblique plane (19%). In 267 (74%) of 359 cases, the duct appeared normal; among these, isolated frontal sinusitis was detected in five cases (2%). In 92 (26%) of 359 cases, the duct was abnormal; it was narrowed in 18 cases (5%) and obstructed in 74 cases (21%). Frontal sinusitis was noted in 78 (85%) of the 92 cases of frontonasal duct abnormalities. The sensitivity and specificity of the correlations between frontonasal duct abnormalities and frontal sinusitis were 98% and 85%, respectively. CONCLUSION. Because our results show a strong correlation between abnormalities of the frontonasal duct and frontal sinusitis, it seems highly probable that abnormalities of the frontonasal duct cause frontal sinusitis.     

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     

Radiological differentiation of intrasellar aneurysms from pituitary tumours

Summary The changes produced by aneurysms which project into the pituitary fossa as seen on plain films and radiological investigations have been reviewed and then compared with those caused by pituitary tumours. Erosion of the lateral wall of the sphenoid sinus and a filling defect within the cavernous sinus were features seen only in the aneurysm cases. A widened superior orbital fissure, non-filling of cavernous sinus (especially with a normal contralateral sinus), and, on CT, unilateral sellar erosion, calcification and eccentric (in relation to sella) circular attenuation on enhanced scan, were more commonly associated with aneurysms. A completely eroded area of bone, a completely eroded fossa, a soft tissue opacity in the sphenoid sinus, bilateral displacement of the cavernous sinuses and, on CT, general enlargement of the fossa were seen only with cases of pituitary tumour. Abnormalities pointing to the presence of an aneurysm were seen in every case in which one was present. Our review suggests that innocuous techniques will demonstrate the presence of a vascular anomaly in the pituitary fossa and validates the policy in this Institute of relying on these measures and of dispensing with routine angiography as a preliminary to transsphenoidal hypophysectomy or microadenomectomy.     

Extensions of paranasal sinus tumors and inflammatory disease as evaluated by CT and pluridirectional tomography

Summary CT and pluridirectional tomography are compared in their ability to show the extent of paranasal sinus tumors or benign aggressive processes. Thirty-one cases are reviewed; CT was superior to pluridirectional tomography in showing spreads of tumor to all clinically important areas, including the infratemporal fossa, nasopharynx, orbit, and intracranial compartment. CT not only consistently allowed less equivocal interpretation, but also enabled us to qualify orbital involvement as intra- or extraconal, and to quantitate better both brain and infratemporal fossa involvement. We feel that CT scanning is the better way to determine the extent of such pathology.     

霉菌性鼻窦炎的CT诊断

目的探讨霉菌性鼻窦炎的CT表现特征并评价其诊断意义。方法12例经手术病理证实为霉菌性鼻窦炎患者均经鼻上颌部CT扫描,而后对所有患者的CT资料进行回顾性分析。结果CT扫描显示本组霉菌性鼻窦炎患者大多表现为一侧上颌窦混浊化,有的同时累及相邻其他鼻窦;鼻腔内见肿块状软组织密度影,密度不甚均匀,其内可见斑点状、结节状钙化;窦腔可见膨胀性增大,窦壁骨质吸收、破坏,亦可见窦壁骨质增厚,硬化。结论霉菌性鼻窦炎具有明显的CT特征,颇有助于该病的正确诊断。     

骨关节结核的CT诊断(附33例报告)

目的：探讨CT对骨关节结核的诊断价值。方法：收集经临床和手术病理证实的骨关节结核(脊柱结核24例，骶髂关节结核5例，髋关节结核4例，耻骨联合结核1例)，对其CT表现作回顾性分析。结果：24例脊柱结核均有不同程度的骨质破坏，22个椎体可见溶骨性骨质破坏，15个椎体边缘见到虫蚀状骨质缺损，病变严重者可见椎体膨胀、碎裂或塌陷。多数病例伴有死骨、椎旁脓肿或腰大肌脓肿。骶髂关节结核常见单侧发病，关节面模糊、骨质破坏及死骨形成；关节间隙增宽，常伴冷脓肿和窦道形成。髋关节结核表现为骨性关节面、髋臼及股骨头侵蚀破坏，髋臼变浅或变平，导致关节脱位。结论：CT能较好地显示骨质破坏的程度和范围以及死骨、冷脓肿等结核特征性的表现，是诊断骨关节结核的重要影像学手段。     

Radiography and ultrasonography in paranasal sinusitis

In order to analyze whether ultrasonography with a reasonable degree of confidence can replace radiography in the diagnosis of sinusitis, 138 patients with clinical signs of sinusitis were examined with both methods. It was found that maxillary sinus fluid was recognized ultrasonographically with a confidence that increased with the amount of fluid, judged from radiographic examinations. In a sub-group of 45 cases, fluid confirmed by maxillary sinus puncture was detected by ultrasonography in 35/45 sinuses (78%) and by radiology in 38/45 sinuses (84%). In patients with radiographically normal maxillary sinuses, the correlation to ultrasound was good. However, mucosal swelling and polyps or cysts observed at radiography were poorly demonstrated by ultrasonography. In addition, the ultrasound method was not reliable for frontal sinus diagnosis. It was concluded that ultrasonography can be recommended in maxillary sinusitis for follow-up of treatment and as a screening method before sinus radiography.     

鼻窦内镜手术治疗儿童慢性鼻窦炎

目的：探讨鼻窦内镜下治疗儿童鼻窦炎的手术疗效及相关影响因素.方法：回顾性分析经鼻窦内镜下手术治疗的病例25例儿童鼻窦炎的临床资料.结果：随访半年至一年,按照海口会议1997鼻窦内镜手术标准进行评定,治愈20例,好转3例,无效2例.总有效率为92%.术后无1例出现严重并发症,术后主要并发症为术腔粘连.结论：鼻窦内镜下手术治疗儿童慢性鼻窦炎是一种理想的方式,术后定期随访和综合治疗影响手术远期疗效.