Aspergillosis of the paranasal sinuses

Summary The CT appearances of 13 cases of pathologically proven aspergillosis involving paranasal sinuses were reviewed. Symptoms included rhinorrhea, nasal obstruction, headache, facial pain and foul smell from the nose. At operation, these lesions appeared yellowish, brownish, grey or black in colour, and contained dirty or muddy material. Microscopic examination of the tissue removed showed anAspergillus ball with chronic inflammation but without invasion of the nasal or sinus mucosa in 6 cases, and tissue invasion with necrosis and inflammation in 7. The structures involved, in order of frequency, were: maxillary sinus, nasal cavity, ethmoid sinus, orbit and cavernous sinus. The orbit was involved in 2 cases, therefore categorized as invasive; the other 11 cases were non-invasive as judged by CT. Calcification was seen in the lesions of 9 cases. In most cases the adjacent bony structures showed areas of erosion and sclerosis. Aspergillosis should be suspected in the presence of a mass in the paranasal sinuses or nasal cavity with calcification within it, which may not appear solid or dense and is separate from the walls of the sinus.     

鼻腔及鼻窦骨化性纤维瘤的MRI诊断

目的探讨鼻腔、鼻窦骨化性纤维瘤的MRI表现及其诊断价值。资料与方法回顾性分析经手术病理证实的8例鼻腔及鼻窦骨化性纤维瘤患者的MRI资料。结果8例中病变中心位于筛窦3例,蝶窦3例,额窦2例;5例原发病例中4例病变呈膨胀性生长,1例形态不规则呈分叶状;3例术后复发病变的形态均不规则并呈分叶状;所有病变边界均清晰,伴周围结构不同程度受压。骨化性纤维瘤T1WI呈等信号7例(与脑灰质相比),呈低信号1例;T2WI呈低信号7例,其中4例夹杂片状高信号,呈高信号1例;继发囊变者4例,T2WI均呈高信号,T1WI呈等、低信号各2例;增强后病变呈中度强化,囊变部分不强化,而囊壁及间隔明显强化。结论鼻腔及鼻窦骨化性纤维瘤的MRI表现有一定特征性,MRI对观察病变与周围组织结构的关系及手术方案制定有重要临床意义。     

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。     

多層螺旋CT在鼻竇及其相關結構檢查中的應用

目的:利用多層螺旋CT各向同性掃描進行多平面重組(multiplanar reformation,MPR)后處理,顯示鼻竇及其相關結構,探討多層螺旋CT檢查鼻竇及其相關結構的優勢。方法:搜集觀察對象55例(男32例,女23例),年齡9~75歲,利用多層螺旋CT各向同性掃描對副鼻竇進行檢查,然后對所得圖像進行多平面重組(multiplanar reformation,MPR)后處理,重組出標準層面及重點結構的最佳顯示平面,并對某些結構的常規顯示斷面和標準化斷面顯示結果進行統計學分析。結果:①標準橫斷面、冠狀面、矢狀面能清晰顯示各竇腔氣化類型以及左右結構的對稱情況等。②一些特殊結構如鉤突、額竇引流通道、鼻淚管以及蝶篩竇壁與視神經管、頸內動脈的關系需要在斜平面觀察。結論:①一次掃描后,可進行任意平面后處理。減少輻射,避免擺位困難。②多層螺旋CT各向同性一次掃描結合多平面重組(MPR)后處理能夠很好地顯示鼻竇及其相關結構。     

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。     

Radiological changes in the nasal and paranasal cavities of patients having undergone laryngectomy

A greater incidence of nasal sinus lesions is revealed in patients operated for laryngectomy than in healthy subjects. The radiographs of the paranasal sinuses of 49 patients laryngectomized for laryngeal cancer and 71 smokers, over 40, were compared. Thirty-six (73.5%) of the operated patients showed a reduction in the lucency of the sinuses (opacities, sinusitis, mucocele) and 21 (42.9%) inferior concha hypertrophy. In the control group 23 (32.4%) and 12 (16.9%) cases had the same lesions. Chi2 statistical analysis was performed on both groups. The results show a significant increase in lesions of the nasal sinuses in the group of operated patients. The reduction in the air flow through the nose and the sinus cavities during breathing seems to be the pathogenic mechanism responsible for such findings.     

鼻腔及鼻窦内翻性乳头状瘤的MRI诊断

目的 探讨鼻腔、鼻窦内翻性乳头状瘤的MRI表现,提高其诊断准确性.方法 回顾性分析36例经组织学证实的鼻腔、鼻窦内翻性乳头状瘤的MRl资料.结果 36例内翻乳头状瘤源于鼻腔外侧壁25例,上颌窦4例,筛窦2例,额、筛窦2例,筛、蝶窦2例,额窦1例;其中11例为复发病例,3例伴恶变.26例呈分叶状,10例形状不规则.病灶最大径22～82 mm,平均38 mm.36例边界均清楚.与邻近肌肉比较,MR T1WI呈等信号32例,稍高信号4例;T2WI呈不均匀高信号34例,不均匀等信号2例(伴恶变).与鼻中隔黏膜比较,增强后呈明显不均匀强化34例;32例病变在T2WI或增强T1聊上病变内部呈较规整的栅栏状,2例旱不规整的栅栏状(伴恶变).8例行MR动态增强扫描,其中7例时间-信号强度曲线(TIC)为速升缓降型,另1例局部区域的曲线呈速升速降型(伴恶变).结论 MR T2WI或增强T1WI上呈较规整的栅栏状外观是诊断鼻腔、鼻窦内翻性乳头状瘤的可靠征象,形态不规整可能提示伴发恶变.     

鼻腔鼻窦肉芽肿性血管炎的 CT 和 MRI 表现

目的：探讨鼻腔、鼻窦肉芽肿性血管炎(GPA)的 CT 和 MRI 表现。方法回顾性分析8例经手术病理证实的鼻腔、鼻窦GPA 的 CT 和 MRI 征象。其中8例均行 CT 平扫,7例行 MRI 常规平扫,3例同时行 MRI 动态增强扫描,后处理得到时间-信号强度曲线(TIC)及半定量参数增强前信号强度(SIpre ),最大信号强度(SImax ),峰值信号强度(SIpeak ),峰值时间(Tpeak ),最大上升斜率(MSI)。结果 CT 表现：8例双侧中鼻甲、钩突、部分鼻中隔缺失,双侧上颌窦内侧壁骨质破坏、余上颌窦窦壁骨质增生硬化;6例上颌窦体积减小;6例筛骨迷路缺如;4例鼻骨扁平、鼻背塌陷;2例鼻咽软组织增厚,1例眼眶受累;8例鼻窦黏膜增厚。MRI 表现：7例平扫示病变区周围黏膜呈等、稍长 T1及稍短 T2信号;3例动态增强示病变周围黏膜明显不均匀强化,TIC 整体呈平缓型,于第1~4期有1段缓升。SIpre 平均为1030;SImax 平均为2500;SIpeak 平均为2353;Tpeak 平均为100 s;MSI 平均为1.28%。结论鼻腔、鼻窦GPA 具有典型的影像学征象,总结其 CT 和 MRI 表现,有助于本病诊断。     

鼻窦曲霉菌病的MRI诊断

目的　探讨鼻窦曲霉菌病的MRI表现特征。方法　回顾分析 2 5例手术和病理证实的鼻窦曲霉菌病的MRI表现。结果　 (1)经手术和病理证实的鼻窦曲霉菌病 2 5例 ,其中上颌窦 2 0例 ,鼻腔上颌窦筛窦 4例 ,蝶窦 1例。 (2 )MRI表现 :T1加权像表现为中等信号 6例、偏高信号 10例、高信号 4例 ,T2 加权像均表现为低或极低信号改变。结论　磁共振T1加权像高信号钙化为鼻窦曲霉菌病较为特征性的MRI表现 ,此特征对正确诊断具有重要意义     

CT诊断鼻腔鼻窦脑膜瘤的作用

目的：评价CT扫描在诊断鼻腔鼻窦脑膜瘤中的作用。方法：对4例经手术证实的脑膜瘤的CT特征进行回顾性分析。结果：本组病斧正累及范围均较广泛，CT平扫时呈等，低混杂密度灶，瘤周均有环形骨质硬化，其中3例瘤内有不规则的条片状钙化影和低密度的坯 煞费苦心区；病灶均累及鼻中隔和鼻窦，鼻中隔明显偏曲或破坏消失。筛窦和蝶窦受累4例，上颌窦2例，窦腔膨胀性扩大，并被混杂密度影填塞，窦壁骨质受压变薄，但未见明显骨质溶解破坏。结论：CT扫描可正确诊断鼻腔鼻窦脑膜瘤。     

鼻腔鼻窦恶性纤维组织细胞瘤的CT诊断

目的分析鼻腔鼻窦恶性纤维组织细胞瘤（MFH）的CT表现,评价其临床诊断价值. 资料与方法回顾分析经病理证实的鼻腔鼻窦MFH 13例,3例单行平扫,4例行平扫加增强扫描,6例直接行增强扫描. 结果肿瘤主要位于鼻腔2例,上颌窦8例,鼻腔筛窦2例,颞部及上颌窦1例.肿瘤易侵犯周围组织,包括面颊部、上齿槽骨、硬腭、眼眶、翼腭窝、颞颌窝、颞下窝及颅底.CT平扫示多数肿块密度不均匀,边界欠清,注射对比剂后实质部分轻度或明显强化.5例有低密度坏死囊变区,2例有钙化灶,1例有放射状骨膜反应,均有不同程度骨质吸收破坏.6例局部复发,2例发生颈部淋巴结转移,1例晚期发生骨转移. 结论鼻腔鼻窦MFH进展快、早期侵犯邻近器官组织、易复发,可有颈淋巴结转移.CT显示肿块呈浸润性生长,密度不均匀,边界不清,可有钙化或液化坏死,骨质广泛吸收破坏,影像学对诊断和制定治疗方案有一定帮助.     

鼻及鼻窦骨折的临床诊断及治疗

目的 探讨鼻及鼻窦骨折的诊断及治疗。方法 回顾性分析我院收治的70例鼻及鼻窦骨折病例资料,其中鼻骨骨折39例,伴有鼻窦骨折7例;单纯鼻窦骨折3l例。手术治疗39例。结果 本组行鼻骨骨折复化术25例,22例随访半年,鼻外形满意,鼻腔通气无障碍;3例遗留鼻部畸形。14例行鼻窦骨折复位手术,其中11例同时手术治疗伴发的颌面、眼及颅脑损伤。结论 鼻及鼻窦骨折主要根据X线摄片及CT检查作出明确诊断,对有骨折移位者均应手术复位,早期诊断、及时治疗有利于骨折复位片获得满意效果。眼、颌面、颅脑等临近器官损伤的诊治也非常重要。     

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。     

鼻腔鼻窦淋巴瘤的CT和MRI诊断

目的 探讨鼻腔鼻窦淋巴瘤的CT和MRI表现,旨在提高其诊断准确性。资料与方法 回顾性分析46例经手术或活检证实的鼻腔鼻窦淋巴瘤患者的影像资料。结果 原发于鼻腔30例,鼻窦7例,鼻腔、鼻窦同时发病或累及邻近结构9例。CT表现：淋巴瘤位于鼻腔前部28例,后部2例,向前浸润鼻前庭、鼻翼、鼻背及邻近面部皮肤22例;病灶密度均匀8例,不均匀22例,增强后轻度强化7例,中度强化6例,鼻中隔、中下鼻甲浸润性破坏7例。鼻窦淋巴瘤表现为窦腔内充以软组织影,窦壁骨质浸润性改变5例,明显破坏2例,4例上颌窦周软组织浸润,增强后中度强化3例。弥漫型淋巴瘤表现为鼻腔中线区不同程度的骨质破坏,鼻腔及邻近鼻窦伴软组织肿块,6例并累及邻近面部软组织、眼眶、鼻咽部、口咽、颞下窝、翼腭窝,4例浸润颅底骨髓,2例破坏硬腭。MRI表现：T1WI低信号12例（与肌肉比较。以下同）。等信号8例;T2WI高信号11例,等信号9例;病变轻度强化6例,中度强化10例。4例沿翼腭窝神经周扩散。结论 多数鼻腔淋巴瘤及弥漫型鼻腔鼻窦淋巴瘤有特异影像学征象,可提示诊断;鼻窦淋巴瘤则缺乏特异影像学征象。CT是本病诊断的主要影像检查方法,MRI能更清楚显示病变的范围。帮助临床准确地分期。     

鼻和鼻窦外伤的诊治体会

目的探讨鼻外伤的诊断及治疗经验。方法回顾性分析我院收治的215例鼻及鼻窦骨折病例资料,其中软组织切裂伤51例,鼻骨骨折103例,鼻窦骨折40例,面部中段联合性骨折21例,结果本组行鼻骨骨折复位术101例,56例行鼻窦骨折复位手术,其中11例同时手术治疗伴发的颌面、眼及颅脑损伤。结论鼻及鼻窦骨折主要根据X线摄片及CT检查作出明确诊断,对有骨折移位者均应手术复位,早期诊断、及时治疗有利于骨折复位并获得满意效果。眼、颌面、颅脑等临近器官损伤的诊治也非常重要。     

X-ray computed tomography of the facial sinuses. Results in 198 patients with chronic sinusitis]

The CT studies of 198 consecutive patients with chronic sinusitis were reviewed retrospectively. CT was normal in 47 patients (23.7%). In 151 patients one or many cavities showed abnormalities. In 69 cases (34.9%), the lesions affected one or two sinuses, in 35 cases (17.7%) three to six cavities were abnormal, whereas in 47 cases (23.7%), more than six cavities were abnormal. In 87 cases (57.6%), lesions were observed both in large cavities and ethmoid cells, whereas they were selectively localized in large cavities in 55 cases (36.4%), or in ethmoid cells in 9 cases (6%). Abnormalities were observed in the maxillary sinus in 137 patients (69.2%), in the ethmoid in 96 patients (48.5%), in the frontal sinus in 51 patients (25.8%), and in the sphenoid sinus in 28 patients (14.1%). The most frequent abnormality was hypertrophic mucosa, which was visible in 275 cavities. These results were compared with date of the literature.     

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。     

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。     

Congenital nasal masses: CT and MR imaging features in 16 cases

The imaging studies of 16 children with pathologically proved nasal encephaloceles (eight), nasal dermal sinuses/nasal dermoids (seven), and nasal cerebral heterotopias, more commonly known as nasal gliomas (one), were retrospectively reviewed and compared with normal control subjects to define the normal anatomy and analyze deformities caused by these lesions. Nasal encephaloceles were always identified as complex masses of mixed soft tissue and CSF intensity that were contiguous with intracranial structures. The nasal glioma appeared as a mixed-intensity mass that, on the basis of the CT scan, appeared to be continuous with intracranial structures. Nasal dermal sinuses could only be identified as they coursed through the skin and subcutaneous soft tissue. They could not be identified when intraosseous. Moreover, on CT and, particularly, on MR, a number of potential diagnostic pitfalls were encountered. The most important of these was the normal fat deposition that occurs within bone during normal maturation and during aeration of the frontal sinuses and nasal bones. These fatty changes can easily be mistaken for fatty tumors if they are not recognized as normal anatomic changes. Interestingly, the classic plain film findings for congenital nasal masses were present only in the encephaloceles and nasal glioma; dermoids and dermal sinuses showed none of the classic plain film findings. In the six patients who had both CT and MR, the masses were easily identified and characterized by each imaging method. Congenital nasal masses are well characterized by both CT and MR. It is important to understand the normal changes in the anatomy of the nasofrontal region in the pediatric age group to avoid false-positive diagnoses in this region.     

鼻腔鼻窦原发恶性黑色素瘤的影像学表现

目的：分析鼻腔鼻窦原发恶性黑色素瘤CT及 MR 表现,探讨其诊断要点。方法回顾性分析经活检或手术病理及免疫组化证实的16例鼻腔鼻窦恶性黑色素瘤的CT、MR特征及临床资料,均行 CT 平扫及增强,其中9例行 MR 平扫及增强。结果16例CT表现均为单侧发病;肿瘤位于鼻腔8例,鼻窦4例,同时累及鼻腔、鼻窦4例;形态欠规整,呈软组织密度,其内未见钙化和囊变;周围组织均受侵;增强后不均匀中-重度强化。9例 MR表现均为单侧发病;肿瘤位于鼻腔4例,鼻窦3例,同时受累鼻腔、鼻窦2例;形态欠规则,1例呈T1 WI高信号,T2 WI低信号,3例呈T1 WI等信号,T2 WI等/稍高信号,5例呈混杂信号。增强后不均匀轻-中度强化;周围组织均有侵犯。结论鼻腔鼻窦原发恶性黑色素瘤 CT表现缺乏特异性;典型恶性黑色素瘤有 MR 特征性表现,但罕见,以非色素及混合型常见。CT联合 MRI能准确显示肿瘤部位及与周围组织、邻近骨质的关系。