筛骨解剖变异的CT评价及其临床意义

目的 评价冠状位CT对功能性内镜鼻窦外科有关的筛骨解剖变异的显示能力，讨论筛骨解剖变异的CT评价对临床手术的指导意义。资料与方法 冠状位CT薄层扫描整个筛骨45例，以筛骨的断层为依据，以内镜鼻窦手术为对照，认证筛骨的解剖变异，并计算各种变异的出现率。结果 筛顶的解剖学特征中，倾斜式占73．3％，高台式占26．7％；蝶上筛房占13．3％；眶下筛房占8．9％；中鼻甲的气化和反向偏曲各占17．8％和2．2％；鼻中隔的气化占6．7％，偏曲占22．2％，形态呈S型、弧型、侧置V型等。结论 冠状位CT能很好显示有关内镜鼻窦手术的筛骨解剖变异，为手术提供详细的影像学资料，对该手术有很大的指导意义。     

螺旋CT三维重建评价筛窦解剖变异及临床意义

目的：探讨应用螺旋CT对筛窦进行三维图像重建，认证筛窦解剖变异及临床意义。材料和方法：应用GE Lightspeed Plus多排螺旋机扫描仪，对75例病例进行筛窦横断面扫描，通过GE W4．0工作站，在三维重建软件支持下作冠状位图像重建。结果：筛窦常见的解剖变异有5种：筛大泡占52％，Onodi气房21％，眶五气房5％，筛凹低位4％，纸样板过度内移7％。结论：经横断面CT扫描，通过三维重建，能够很好地显示筛窦冠状面图像及其解剖变异，为手术提供详细的影像学资料，对鼻内镜外科有重要临床指导意义。     

慢性额窦炎额窦引流系统CT解剖特征及临床价值

目的 探讨慢性额窦炎额窦引流系统CT解剖特征及临床价值。方法 对50例慢性鼻窦炎患者应用螺旋CT作横断面扫描，然后经工作站作冠状和矢状面三维重建。结果 螺旋CT三维成像技术能清楚地显示钩突附着部位和类型，在：100侧钩突中，附着纸样板41侧(41％)、鼻丘后壁11侧(11％)、中鼻甲19侧(19％)、前颅底16侧(16％)、钩突分叉13侧(13％)。在额隐窝气房98侧中，终未气房28侧(28．6％)、鼻丘气房18侧(18．4％)、前筛气房18侧(18．4％)。额窦内气房98侧中，其中额气房22侧(22．4％)、眶上气房38侧(38．8％)、额窦中隔气房(M气房)16侧(32％)。发现不同类型的解剖变异与慢性炎症的关系。结论 慢性额窦炎额窦引流系统CT解剖特征的显示可为术前提供有价值的信息，对开展鼻内镜外科有重要的临床指导意义。     

冠状位CT扫描在霉菌性鼻窦炎术前诊断中的应用价值

目的 探讨冠状位CT扫描在霉菌性鼻窦炎术前诊断中的价值.资料与方法 回顾性分析34例经手术病理证实的霉菌性鼻窦炎患者的冠状位CT特征.结果 单窦或单侧鼻赛发病30例,双侧鼻窭发病4例.发现病灶38个,其中34个位于上颌窦.冠状位CT表现:窦腔内均可见软组织影充填,密度不均,其中28个病灶内可见点状、结节状、团片状钙化,29个窦壁增厚及窭腔变小,8个窦壁骨质破坏.合并窦口鼻道复合体阻塞34个;合并鼻腔、鼻窦息肉7个.34例中检出各种变异76个.结论 CT诊断霉菌性鼻窦炎主要特征是窦腔内软组织影充填,其内散在钙化并窦壁增厚.冠状位CT扫描能较好地显示鼻腔鼻窦的解剖结构和病变范围,对功能性内镜手术有一定指导意义.     

青少年慢性鼻窦炎的鼻内窥镜手术与CT对照研究

目的：探讨青少年慢性鼻窦炎CT检查的价值。方法：对150例青少年患者行冠状位CT扫描，并行功能性内窥镜手术，对其CT表现和手术观察情况进行对照研究。结果：150例中，146例冠状位CT显示鼻窦炎，50例解剖变异者，47例同时伴发鼻窦炎，均经手术证实，多数与手术所见相符，仅4例CT结果阴性，临床表现典型鼻窦炎症状，经手术证实为鼻窦炎。结论：冠状位CT扫描是青少年慢性鼻窦炎患者鼻内窥镜手术前必要的检查方法。CT检查阴性时不能除外鼻窦炎的可能。     

鼻息肉的CT诊断价值

目的评价CT扫描对鼻息肉的诊断价值。材料和方法42例鼻息肉行轴位及冠状位扫描,其中轴位5例、俯卧冠状位37例,全部病例经鼻内窥镜手术及病理证实。结果42例鼻息肉累及73侧,双侧发病31例、单侧11例。息肉主要发生在筛窦及中鼻道,部分累及上颌窦及下鼻道。全部合并不同程度鼻窦炎,部分见以直形中鼻甲为主的解剖变异及上颌窦囊肿。结论CT特别是俯卧冠状位能提供与功能鼻内窥镜手术方位一致的解剖层面,能清晰显示鼻腔及鼻窦的病变、解剖结构及变异,对手术及防止发生并发症有重要指导意义。     

多层螺旋CT在窦口-鼻道复合体变异及鼻窦炎的临床应用价值

目的探讨多层螺旋CT后处理技术在显示窦口-鼻道复合体解剖变异及其相关鼻窦炎的临床应用价值。方法收集96例慢性鼻窦炎患者的影像及临床资料,其中鼻-鼻窦内窥镜手术20例。通过多层螺旋CT多平面重组,观察窦口-鼻道复合体的解剖变异、鼻窦炎症,以及其在鼻-鼻窦内窥镜手术中的临床作用。结果 96例慢性鼻窦炎患者中,窦口-鼻道复合体解剖变异82例(85.4%),其中泡状鼻甲29例(30.21%),反常中鼻甲9例(9.38%);钩突肥厚13例(13.54%),内侧偏移11例(11.46%),外侧偏移4例(4.17%),气化3例(3.13%);Haller气房8例(8.33%);鼻丘气房9例(9.38%)和鼻中隔偏曲24例(25%)。鼻窦炎症显示率为100%,病变分布:前组筛窦84例,后组筛窦36例,上颌窦开口处67例,上颌窦63例,额隐窝19例,额窦14例和蝶窦8例。20例鼻-鼻窦内窥镜手术所见与CT显示一致。结论多层螺旋CT后处理技术可清晰显示窦口-鼻道复合体解剖变异以及其所致的鼻窦炎症,对鼻-鼻窦内窥镜手术具有重要的临床指导价值。     

冠状位CT对副鼻窦炎诊断及临床手术的指导意义

鼻内窥镜手术的开展，在临床中被越来越广泛地应用。副鼻窦的CT检查，尤其是冠状位CT扫描，能直观地发现副鼻窦炎的范围和程度，可以确切地判断其病因所在鼻窦的解剖关系以及病变情况，对术前疗效评估及手术方案起着重要的指导作用，从而为制定准确的手术方案提供了有力保证。就结合临床需要，我院自开展此项工作以来已进行了100多例检查。证明冠状位CT鼻窦扫描成为开展手术必不可少的检查。     

鼻窦解剖变异的CT观察

目的 增进对鼻窦各种解剖变异的识别能力．提高鼻窦内镜手术对鼻窦炎的疗效．降低并发症。资料与方法 对200例受检者行鼻窦CT扫描,对鼻窦的各种解剖变异进行评估。结果 统计了鼻窦各种解剖变异的出现率。结论 CT检查有助于鼻窦内镜手术方案的制订,不仅可以评估病变,而且还可检出与鼻窦炎发生相关和增加手术危险性的解剖变异。     

256层螺旋CT轴位与冠状位重建对窦口-鼻道复合体正常解剖及变异的对比观察

目的：探讨多层螺旋CT（MSCT）轴位和冠状位重建对窦口-鼻道复合体（OMC）区域的正常解剖结构和变异显示能力及差异。方法：利用32例健康体检者和23例因非鼻及副鼻窦疾病而行头颈部CT扫描者,常规扫描后进行轴位和冠状位标准重建,分别对比观察OMC区域的正常解剖结构和变异及显示能力。结果：轴位和冠状位重建图像对双侧额窦开口、中鼻甲和中鼻道的显示能力无明显差异。但轴位图像在显示筛漏斗、前中组筛窦、上颌窦开口及钩突等的显示能力明显较冠状位差。结论：对OMC区域的正常结构和变异的显示冠状位明显优于轴位,冠状位重建可以代替冠状位扫描,以消除冠状位扫描给患者带来的不便。     

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.     

慢性鼻窦炎鼻窦CT报告书写内容现状调查

目的:调查目前慢性鼻窦炎（CRS）鼻窦CT报告对临床诊疗关注的鼻窦病变和解剖变异（或异常）的描述情况,并对描述较少的病变和解剖变异（或异常）进行总结分析,提高报告质量。方法:于2020年3月在全国范围内对书写鼻窦CT报告医师通过电子问卷调查鼻窦CT报告描述鼻腔鼻窦病变和解剖变异（或异常）的情况,并比较分析不同级别医院、...     

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.     

Ethmomaxillary sinus: a particular anatomic variation of the paranasal sinuses

We assessed the morphological and radiological characteristics of ethmomaxillary sinus (EMS), which is an enlarged posterior ethmoidal air cell occupying the superior portion of the maxillary sinus while draining into superior meatus. This study is based on 1450 patients submitted to CT examination of the paranasal sinuses between 1998 and 2002. Sequential CT scans were obtained in the coronal plane in all the patients with 2.5- to 5-mm section thickness and were evaluated for EMS. The diagnosis of EMS was made when there was a posterior ethmoidal cell occupying the superior part of the maxillary sinus while draining to the superior meatus. When EMS was diagnosed, the morphology of the septum between the and maxillary sinus, and width of the superior meatus, were noted. The EMS was found in 10 of 1450 (0.7%) patients. The coexisting anatomic variations were concha bullosa (50%), upper concha pneumatization (20%), maxillary sinus hypoplasia (20%), uncinate bulla (10%), hypertrophied inferior concha (10%), paradoxic middle concha (10%), and septate maxillary sinus (10%). There was no relation between EMS and sinus disease. The EMS is a rare anatomic variation and does not appear to be associated with sinusitis. The EMS is not a well-studied anatomic variation, and the literature is lacking adequate information about this anatomic variation. This study performed in a large series of patients will possibly contribute to better understanding of this particular anomaly.     

Radiologic imaging of chronic sinusitis in the adult

The diagnosis of chronic sinusitis is based on clinical presentation, nasal endoscopy and CT scan. As a matter of fact, the CT scan of the paranasal sinuses is absolutely necessary to characterise the lesions, to visualise anatomic variations which are risk factors for the endoscopic surgery and to follow up treated and/or operated patients with recurrent symptoms. Nowadays, plain films of paranasal sinuses do not have any indication. MR Imaging may be indicated in selected cases of complicated sinusitis and of pseudotumors associated to sinusitis.     

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。     

How does nose blowing effect the computed tomography of paranasal sinuses in chronic sinusitis?

OBJECTIVE: Our aim was to determine whether inward or outward movement of the secretions in the paranasal sinuses due to nose blowing after nasal decongestion has any effect on the paranasal sinus computed tomography (CT) images in patients with sinusitis and to asses whether nose blowing may result in misdiagnosis or overdiagnosis in radiological evaluation of sinusitis. MATERIALS AND METHODS: Twenty-four patients with chronic sinusitis were evaluated in an academic tertiary care hospital and data were collected prospectively. After coronal sinus computed tomography scans were performed at 100 mA setting which was half the value of the standard radiation dose suggested by the manufacturer, topical decongestion was applied to each nostril followed by nose blowing 10 min later. Sinus CT scans were then repeated at the same setting. We evaluated the mucosal thickness of medial, lateral, superior and inferior maxillary and frontal sinus walls and the maximal thickness in anterior ethmoidal cells. The measurements prior to and following nose blowing were compared with Wilcoxon signed ranks test. The obtained images were also staged using Lund-McKay staging system separately and the scores were compared with Student's t-test. RESULTS: We observed a tendency towards reduction in mucosal thickness after nose blowing. There were statistically significant differences between maxillary sinus inferior wall and frontal sinus inferior wall mucosal thickness values prior to and after nose blowing. The difference however was very small, about 0.5 mm in magnitude and Lund-McKay score did not change in any of the patients after nose blowing. CONCLUSION: Nose blowing and topical nasal decongestion does not have any effect on the diagnostic accuracy of sinus CT in chronic sinusitis patients.     

Recent trends in the diagnosis and treatment of sinusitis

The almost simultaneous introduction of nasal endoscopy and CT imaging led to better understanding of normal and pathologic function of the paranasal sinuses. Diagnosis and treatment of many paranasal sinus diseases improved considerably. Endoscopy and CT are not concurrential; they are complementary, but they have specific strengths and weaknesses, as well as specific indications and considerations. Staging systems for chronic sinusitis are currently used based on CT findings and response to medical therapy. Functional endoscopic sinus surgery (FESS) has become the standard procedure for most surgical cases of chronic sinusitis. Indications for FESS have enlarged beyond chronic sinus problems and even beyond the borders of the sinuses. Functional endoscopic sinus surgery aims to gain maximal result (restoring normal function) with minimal trauma and morbidity. Correspondence to: M. Jorissen     

副鼻窦CT对功能性鼻内窥镜手术的价值

通过对１００例慢性副鼻窦炎术前ＣＴ影像的分析结果，作者认为副鼻窦的ＣＴ检查能准确地反映变范围、程度，并可做出分型，分期；同时还可显示副鼻窦多种解剖变异，骨质改变，与周围结构的关系等，因此，对功能性鼻内窥镜手术有肯定的指导价值，是术前必不可少的最佳影像学检查手段。     

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