CT检查在真菌性鼻窦炎术前诊断的意义

目的 探讨CT检查在真菌性鼻窦炎术前诊断的意义.方法 对64例真菌性鼻窦炎患者的CT改变、临床表现和术中所见进行回顾性对比分析.结果 CT表现为:鼻窦充填密度不均软组织影20例,CT明确诊断为真菌性鼻窦炎10例;窦内充填软组织影伴散在不规则钙化灶20例,CT均明确诊断为真菌性鼻窦炎;上颌窦内壁吸收破坏15例,CT明确诊断为真菌性鼻窦炎10例;上颌窦骨壁出现增生硬化9例,CT明确诊断为真菌性鼻窦炎6例.64例中CT诊断鼻窦炎10例,真菌性鼻窦炎46例,8例为上颌窦/筛窦肿物或占位性病变.结论 窦腔内散在斑块状钙化的充填软组织影是真菌性鼻窦炎CT诊断的主要征象,其他的CT表现常会导致术前误诊.虽然真菌性鼻窦炎的确诊有赖于病理学检查,但CT在其诊断中仍具有重要参考价值,并且是显示鼻窦解剖结构和病变范围的较好方法.     

CT检查在真菌性鼻窦炎术前诊断的意义

目的探讨CT检查在真菌性鼻窦炎术前诊断的意义。方法对64例真菌性鼻窦炎患者的CT改变、临床表现和术中所见进行回顾性对比分析。结果CT表现为：鼻窦充填密度不均软组织影20例，CT明确诊断为真菌性鼻窦炎10例；窦内充填软组织影伴散在不规则钙化灶20例，CT均明确诊断为真菌性鼻窦炎；上颌窦内壁吸收破坏15例，CT明确诊断为真菌性鼻窦炎10例；上颌窦骨壁出现增生硬化9例，CT明确诊断为真菌性鼻窦炎6例。64例中CT诊断鼻寞炎10例，真菌性鼻窦炎46例，8例为上颌窦／筛窦肿物或占位性病变。结论寞腔内散在斑块状钙化的充填软组织影是真菌性鼻窦炎CT诊断的主要征象，其他的CT表现常会导致术前误诊。虽然真菌性鼻窦炎的确诊有赖于病理学检查，但CT在其诊断中仍具有重要参考价值，并且是显示鼻实解剖结构和病变范围的较好方法。     

CT检查在真菌性鼻窦炎术前诊断的意义

目的：探讨CT检查在真菌性鼻窦炎术前诊断中的意义。方法：对于58例真菌性鼻窦炎患者CT改变．临床表现和术中所见进行回顾性对比分析。结果：CT表现为鼻窦充填密度不均软组织影响20例。术前明确诊断为真菌性鼻窦炎10例；窦内充填软组织影伴散在不规则钙化灶加例，术前均明确诊断为真菌性鼻窦炎；上领窦内壁吸收破坏15例，术前明确诊断为真菌性鼻窦炎10例；上领窦骨壁出现增生硬化9例，术前明确诊断为真菌性鼻窦炎6例。58例中CT诊断鼻窦炎症48例，其中46例术前临床初诊为真菌性鼻窦炎，12例为上颌窦／筛窦肿物或占位性病变。结论：窦腔内散在斑块状钙化的软组织充填是真菌性鼻窦炎CT诊断的主要征象，其他的CT表现常会导致术前误诊。虽然真菌性鼻窦炎的确诊有赖于病理学检查，但CT在其诊断中仍具有重要参考价值，并且是显示鼻窦解剖结构和病变范围的较好方法。     

霉菌性副鼻窦炎临床与CT特征

目的 分析霉菌性副鼻窦炎的临床表现和影像学特征,探讨霉菌性副鼻窦炎影像学诊断价值。方法 回顾分析15例经手术病理证实的霉菌性副鼻窦炎的CT表现。结果 单侧副鼻窦发病12例,双侧副鼻窦发病3例,全部病变均累及上颌窦,累及2个以上副鼻窦腔4例,病变侵犯后鼻孔2例。霉菌性副鼻窦炎的CT表现主要为:病变窦腔内密度增高,不均匀,病灶内出现点状、条状钙化灶,窦腔骨壁增厚伴破坏,窦腔缩小。结论 真菌性副鼻窦炎的诊断主要根据临床症状及影像学检查,确诊有赖于病理;CT是首选的影像检查方法,病变内钙化影的出现是本病的主要CT表现,是诊断该病较为可靠的依据。     

真菌性鼻窦炎的CT影像学特征分析

目的总结真菌性鼻窦炎的CT影像学特点并初步探讨真菌性鼻窦炎CT诊断要点。方法观察和记录143例病理确诊的真菌性鼻窦炎患者的鼻窦,比较慢性侵袭性真菌性鼻窦炎和非侵袭性真菌性鼻窦炎（真菌球和变应性真菌性鼻窦炎）的CT影像学特点。结果单窦病变125例,最多见为上颌窦,其次是蝶窦、筛窦;127例（89%）病变鼻窦内不均匀不透光区,101例（71%）病变膨入临近鼻窦或鼻腔;97例（68%）软组织窗位鼻窦内可见CT值80~160Hu的钙化斑（点）。慢性侵袭性真菌性鼻窦炎多窦病变比例高于非侵袭性真菌性鼻窦炎。结论真菌性鼻窦炎的CT特征有单窦病变;病变鼻窦内不均匀的不透光区,病变常膨入临近鼻窦或鼻腔;软组织窗位鼻窦内可见的钙化斑;可有鼻窦骨质压迫性破坏。其中以鼻窦病变内钙化斑最具特异性。早期慢性侵袭性真菌性鼻窦炎的CT特征与非侵袭性真菌性鼻窦炎较相似,但其多窦病变比例较高。     

鼻内镜手术治疗真菌性鼻窦炎21例分析

目的 观察鼻内镜手术治疗真菌性鼻窦炎的疗效.方法 对21例真菌性鼻窦炎患者采取鼻内镜手术治疗,随访2个月～3年,观察疗效.结果 手术后患者真菌性鼻窦炎临床表现消失,窦腔内无异常分泌物,窦口引流通畅.结论 鼻内镜下治疗真菌性鼻窦炎方法确实可靠、不易复发.     

变应性真菌性鼻窦炎和真菌球型鼻窦炎CT影像学表现对比研究

目的分析变应性真菌性鼻窦炎的CT影像学特征,提高诊断准确率。方法选取非侵袭性真菌性鼻窦炎患者32例,经病理确诊12例为变应性真菌性鼻窦炎(AFS),20例为真菌球型鼻窦炎(FBS)。所有患者均行CT检查,观察患者CT影像学表现,并与病理组织检查结果对照。结果 12例AFS患者CT检查结果显示,5例单侧鼻窦发病,7例双侧鼻窦发病,12例患者均伴随全部鼻窦受累。CT影像学显示鼻窦腔呈高密度影,呈均匀状;病变组织中心部位密度与鼻窦密度一致,呈毛玻璃状,部分存在钙化点特征,病变组织周围呈软组织影。7例伴随鼻腔内骨质吸收;3例鼻窦膨胀,2例病变累积眼眶。20例FBS患者CT检查结果显示,16例上颌窦病变,4例上颌窦合并筛窦病变。CT影像学显示鼻窦腔内密度呈明显增高趋势,呈不均匀状;软组织影呈团块状(边缘模糊),可见高密度钙化影。13例伴随明显的骨质增生症状,4例出现鼻息肉,3例轻微骨质增生。结论鼻窦CT扫描可清楚显示鼻窦病变以及周围组织受累情况,对临床制定治疗方案具有一定的指导意义。     

慢性侵袭性真菌性鼻窦炎的CT和MRI诊断要点探讨

目的：探讨慢性侵袭性真菌性鼻窦炎的CT及MRI诊断价值。方法：随机选取2012年10月~2014年10月我院收治的慢性侵袭性真菌性鼻窦炎患者10例，回归性分析患者的临床影像学资料，总结CT及MRI诊断的要点。结果：10例患者中，发生于蝶窦5例、筛窦3例及上颌窦2例。其中，CT检查的表现为：受累窦腔内充软组织影、窦壁骨质破坏且伴有周围骨质增生肥厚；MRI检查表现：TIWI低信号3例、等信号7例，信号增强后病变发生明显的强化。结论：在慢性侵袭性真菌性鼻窦炎的诊断中，CT及MRI检查发挥着重要的作用，可联用两种方法提高诊断及鉴别的有效性。     

CT检查对慢性化脓性鼻窦炎与霉菌性鼻窦炎的鉴别诊断价值

目的:探讨CT检查对慢性化脓性鼻窦炎与霉菌性鼻窦炎的鉴别诊断价值.方法:将2014年3月1日至2017年2月28日期间在本院接受治疗的30例鼻窦炎患者按照疾病类型分为A组(慢性化脓性鼻窦炎患者)和B组(霉菌性鼻窦炎患者),各15例.对比两组患者CT影像学下的病变范围、病变密度以及窦壁骨质受累情况.结果:A组患者双侧多鼻窦累及概率(80.00%)高于B组,B组单侧上颌窦累及概率(60.00%)、钙化灶出现概率(86.67%)、窦壁骨质破坏发生概率(40.00%)均高于A组,上述数据组间对比存在较大差别(p<0.05).结论:CT检查可有效鉴别诊断慢性化脓性鼻窦炎和霉菌性鼻窦炎.     

真菌性鼻窦炎临床治疗20例分析

目的探讨真菌性鼻窦炎的临床治疗方法及疗效.方法案例分析法.对本院近年来收治的20例真菌性鼻窦炎患者临床资料进行回顾性分析.本组20例患者中单侧上颌窦发病15例,双侧发病3例,蝶窦炎2例,其中鼻中隔偏曲患者2例.所有患者均出现血性涕,且有腥臭味,伴随头部疼痛,部分患者出现面部麻木,患者数钱鼻窦CT扫描结果显示钙化影或者结节致密影,病变部位密度增加.20例患者中行上颌窦根治术加鼻内镜病变清除术8例,行鼻内镜手术12例,对鼻中隔偏曲患者予以矫正且在术中进行引流,术中可见部分患者鼻腔内部有不同程度的灰褐色干酪物以及棕黄色物,部分患者出现粘膜水肿,对出现筛窦病变患者予以开放筛窦,使用吸引器吸取患者鼻腔内部干酪物及脓液,尽量保留粘膜,保证窦壁不出现骨质破坏,术中使用生理盐水对窦腔进行冲洗,鼻腔采用膨胀性止血材料进行填塞.患者于术后48h拔出鼻腔填塞物,使用生理盐水对鼻腔进行冲洗.结果20例患者经过手术治疗之后症状消失,对患者进行随访,时长2至12个月,所有患者血性涕及鼻塞、头痛症状均消失,未出现任何术后并发症,窦腔粘膜清洁、窦口引流通畅,取得满意的疗效.结论临床针对真菌性鼻窦炎采取手术治疗,通过鼻窦内窥镜下手术清除患者鼻窦及鼻腔病变组织,建立鼻窦引流及通气,术后定期清理分泌物有助于患者快速愈合,可取得满意的疗效.     

Magnetic resonance imaging of the nose and paranasal sinuses.

Seventy-five patients with a wide range of sinus disease have been investigated by magnetic resonance (MR): these included congenital conditions, allergic and inflammatory sinus disease, fungus infections, and the necrotizing granulomata. In addition, a variety of benign and malignant tumours have been examined, and in the more recent sinus malignancies the paramagnetic contrast agent, Gadolinium (Gd) DTPA (Schering Health Care) has been used. This experience of magnetic resonance scanning has shown that it is superior to computed tomography in demonstrating the extent of malignant disease in the nose and sinuses; most especially when Gd DTPA is used, reaching an accuracy of over 96% by biopsy correlation. An additional advantage of this technique is the wide coverage of the head and neck for the assessment of malignant disease, provided by direct 3 plane imaging and the multislice facility. The main disadvantage of magnetic resonance of the sinuses is the poor demonstration of calcification and bone. For this reason the MR scans may need to be augmented by high resolution CT performed specifically to show bone detail.     

Optimal computed tomographic (CT) examination technique for microendoscopic sinus surgery

AIM: Functional endoscopic sinus surgery is widely utilized to assess and treat inflammatory sinonasal diseases. The use of this surgical technique has resulted in a dramatic increase of the radiologic studies carried out as part of presurgical preparation. Computed tomography (CT) has become a standard for pre-endoscopic and postoperative assessment of the paranasal sinuses. In our study we aimed at finding the optimal imaging technique for CT examination of the sinuses. MATERIALS AND METHODS: We examined 60 patients with inflammatory sinonasal diseases using Sytec 3000 CT scanner. The scans were performed in the coronal and axial plane. The kilovolt peak was kept constant and the milliampere second setting was reduced without image compromise. CONCLUSION: CT study is a method of choice in diagnosing inflammatory diseases of the sinuses. The technique we suggest in the study provides maximal diagnostic information at reduced cost and radiation exposure of the patient.     

Adenocarcinoma of the nose and paranasal sinuses in shoemakers and woodworkers in the province of Florence, Italy (1963-77).

Adenocarcinoma of the nose and paranasal sinuses has been associated with occupational exposure to wood and leather dust. Strong evidence has been found for such an association in Florence, Italy, from 1963 to 1977. Sixty-nine cases of primary cancer of the nose and paranasal sinuses were identified from hospital records. There were 13 cases of adenocarcinoma, 11 of which were successfully traced and interviewed (patient or relative). Of the 11 cases, three were woodworkers with substantial exposure to wood dust (17 years' average employment) and seven were shoemakers, mostly trimmers. When matched to either of two separate sets of controls (non-cancer hospital patients, and non-adenocarcinoma nose or paranasal sinus cancer patients), the association with occupation was statistically significant. Smoking was ruled out as a source of bias.     

Endonasal surgery in mucopyocele of the paranasal sinuses

INTRODUCTION: Mucopyocele of the paranasal sinuses generally develops as complication in patients with chronic inflammatory diseases of the paranasal sinuses, but could also be secondary to trauma, tumor or surgical manipulation. Surgery is the definitive method of cure. AIM: The aim of the study was to assess the endonasal microsurgical marsupialization in treatment of mucopyocele. MATERIAL AND METHODS: Five patients (3 females and 2 males) with mucopyocele of the frontal and/or ethmoidal sinuses were treated in the Department of Ear, Nose, and Throat Diseases at the Medical University in Plovdiv for the period 1996-1999. The process location was exactly defined by high-resolution computed tomography. Endonasal microendoscopic anterior ethmoidectomy with marsupialization was performed. In two patients (frontal sinus mucocele) the endonasal approach was combined with an extranasal approach keeping the functional principles. RESULTS: The control endoscopic and computer tomographic examinations did not show recurrence of the disease. CONCLUSION: Surgical approach in mucocele of the sinuses should be based on the findings of accurate computed tomography, rather than performed as a routine technique. This allows the operation to be particularized, trauma and duration of the operation reduced and function of the sinunasal system preserved.     

Clinical study of malignant lymphoma of head and neck in the nasal cavity and Waldyer's ring

Clinical outcome of fifty-one cases of non-Hodgkin's lymphoma limited to the head and neck were studied for differences with involvement of one of two sites: Waldyer's ring, and the nasal cavity and paranasal sinuses taken together. The median survival for patients with involvement of Waldyer's ring was 58.6 months, and for the other group, 10.3 months. The patients with involvement of the nasal cavity and paranasal sinuses responded poorly to treatment and the lymphoma rapidly progressed. In these patients, the lymphomas were not of the diffuse small cell type, which has a relatively good prognosis: but T cell type. The poor outcome with involvement of the nasal cavity and paranasal sinuses may be due to histological and immunological factors, and to inadequate therapy. Early combination chemotherapy might give better results for this group.     

自适应迭代重建算法对儿童副鼻窦CT能谱成像质量及辐射剂量的影响研究

目的:探讨自适应迭代重建(ASIR)算法对儿童副鼻窦CT能谱成像质量及辐射剂量的影响。方法:选取在医院行能谱CT检查的86例疑似副鼻窦病变患儿,按就诊顺序随机将其分为对照组和观察组,每组43例,对照组采用常规能谱CT诊断,观察组采用ASIR算法结合能谱CT诊断,采用ASIR算法对儿童副鼻窦病变诊断效能、成像质量、辐射剂量的容积CT剂量指数(CTDIvol)和剂量-长度乘积(DLP)、成像噪声值和比较噪声比(CNR)等指标的影响进行分析比较。结果:常规能谱CT成像诊断副鼻窦病变的灵敏度、特异度和准确率分别为86.84%、60.00%和83.72%;ASIR算法结合能谱CT成像诊断副鼻窦病变分别为91.67%、85.71%和90.70%,ASIR算法结合能谱CT成像诊断副鼻窦病变的准确率较常规能谱CT成像略高,差异无统计学意义;观察组成像质量较对照组明显高,而CTDIvol和DLP较对照组明显低,差异有统计学意义(t=14.135,t=525.366,t=44.830;P<0.05);两组成像噪声值和CNR相比较差异无统计学意义。结论:ASIR算法结合能谱CT诊断儿童副鼻窦病变的效能与常规能谱CT相当,在提高成像质量的同时降低患儿辐射剂量,且不会增加成像噪声。     

Association Between Diabetes and Increased Prevalence of Paranasal Sinus Disease: A Cross-Sectional Study in Japanese Adults

Background

The association between diabetes and paranasal sinus disease has not been thoroughly investigated.

Methods

We cross-sectionally investigated the association between diabetes and the presence of paranasal sinus disease, which was confirmed by a head MRI scan in 1350 adults who underwent a health screening program focusing on brain diseases and metabolic syndrome. Logistic regression, which was adjusted for age, sex, body mass index, waist-to-hip ratio, hypertension, smoking status, alcohol intake, and white blood cell count, was performed to calculate the odds ratio (OR) of having paranasal sinus disease among adults with diabetes in relation to those without. The dose-response relationship between hemoglobin A1c (HbA1c) levels and the presence of paranasal sinus disease was also investigated.

Results

Of the 1350 participants (mean age, 61.6 ± 10.0 years; 71.6% men), 220 diabetes cases were identified. Paranasal sinus disease was diagnosed in 151 adults. The adjusted OR of having paranasal sinus disease was 1.74 (95% confidence interval [CI], 1.12–2.71) in those with diabetes. The odds of having paranasal sinus disease increased with HbA1c levels. Compared to those with HbA1c of ≤5.4%, those with HbA1c of 5.5%–6.4%, 6.5%–7.9%, and ≥8.0% were more likely to have paranasal sinus disease, with adjusted ORs of 1.32 (95% CI, 0.88–1.98), 1.63 (95% CI, 0.86–3.09) and 2.71 (95% CI, 1.12–6.61), respectively (P for trend = 0.019).

Conclusions

Diabetes may be significantly associated with higher prevalence of paranasal sinus disease in Japanese adults. We should keep this increased risk in mind when a diabetic patient is suspected of having paranasal sinus disease.Key words: diabetes, glycemic status, paranasal sinus disease     

A case of aspergillosis of the nose and paranasal sinuses

Until recently aspergillosis of the paranasal sinuses has been considered a rare disease but nowadays it is frequently discussed in the literature. The reason is the nonspecific clinical course of the disease resembling recurrent chronic rhinosinusitis and its difficult histological and radiological verification. Although there have been clinical suspicions of this diseases in quite a few patients presenting with recurrent polyposis of the sinuses associated with aspirin intolerance and bronchial asthma we could prove sinus aspergillosis histologically and computed-tomographically only in one patient.     

Follow-up study of children after functional endoscopic sinus surgery

In the pathology of recidive infection of upper and lower respiratory tract the chronic diseases of the paranasal sinuses play an important role. The authors ordered for their FESS patients a control examination, 1 year after operation. They present examination data of 30 patients. They analyzed the respiratory complaints, the results of anterior rhinoscopy and CT, the allergies and the performed surgery. 17 patients were healed, 10 got better and in 3 cases the complaints were unchanged. Allergic rhinitis or bronchial asthma were found in more then 2/3 of their patients. According to their opinion the FESS is effective method in treatment of he chronic respiratory tract infections. In the background of the recidive respiratory tract inflammation the chronic diseases of the paranasal sinuses are often found if they are looked for.     

Post-operative responses of paranasal Aspergillus granuloma to itraconazole.

Paranasal Aspergillus granuloma is an invasive infection, seen mainly in tropical countries, involving the paranasal sinuses, orbit and brain. Previously surgical excision has been followed by a high relapse rate, 80% in some series, and mortality. This study involved the use of post-operative therapy with oral itraconazole in doses of 200-300 mg daily. Twenty-two patients were treated for a mean period of 19.7 weeks. Of 19 patients for whom follow-up data were available, 12 (62%) were rated as being in complete remission in a mean period of 17.2 months after the end of therapy. Only one patient developed progressive disease during itraconazole therapy. No serious adverse effect was seen. Use of itraconazole shows promise as a means of preventing relapse after surgery in this progressive infection.