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。     

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。     

眼眶副鼻窦区多层螺旋CT扫描冠状面重建与直接冠状面扫描图像的对比研究

目的分析眼眶、副鼻窦多层螺旋CT扫描MPR冠状面重建与直接冠状面扫描图像,探讨冠状面重建能否代替直接冠状面扫描。方法使用GE lightspeed p lus 4层面螺旋CT扫描仪对116例眼眶、副鼻窦病变患者进行扫描,在横断面图像基础上进行MPR重建。由资深专家对重建冠状面图像与直接冠状面扫描图像进行评价和对比分析。结果116例中,62例同时行MPR重建对眼眶、副鼻窦解剖结构及病变的显示与直接冠状面扫描图像相似,图像质量均为Ⅰ级。54例不能进行直接冠状面扫描者,冠状面重建多数也能达到诊断效果(Ⅰ级32例,Ⅱ级3例)。结论多层螺旋CT扫描对眼眶、副鼻窦的MPR冠状面重建图像能够代替直接冠状面扫描。     

螺旋CT图像后处理技术在结肠的临床应用

目的：研究螺旋CT不同成像技术在结肠疾病诊断中的应用价值。方法：采用GE HiSpeed DX/i螺旋CT扫描仪，对25例疑结肠疾病患者进行一次屏气容积扫描，然后将图像传至工作站，进行多平面容积重建(MPVR)三维重建(3D)和CT仿真内窥镜(CTVE)显示。结果：CT横断面图像和三种后处理图像在显示结肠的解剖及病变方面相互弥补，更为全面。结论：螺旋CT多种图像重建后处理技术能从不同方面反映结肠病变，有利于对疾病的整体理解，在CT横断面的基础上对结肠疾病做出更为完美的评价。     

蝶筛区域解剖结构的CT评价及对功能性内窥镜鼻窦外科的指导意义

目的探讨CT对蝶筛区域解剖结构的评价能力,以期为功能性内窥镜鼻窦外科手术提供帮助。材料和方法冠状和横轴位薄层CT扫描54例无病变的蝶筛区域,并重建矢状位图像。结果CT图像中蝶上筛房出现率13.0％。蝶窦气化CT分型中,甲介型占8.3％,半鞍型占51.9％,全鞍型占39.8％。蝶窦中隔居正中位置占24.1％。蝶窦的其他变异有翼突气化、前床突气化、蝶骨大翼气化和蝶骨小翼气化。视神经管纵轴与蝶筛窦的毗邻关系在CT图像上分为三型,视神经管横轴对蝶筛窦的压迫关系分为四型,并统计出各型的分布情况。结论CT扫描能显示蝶筛区域与功能性内窥镜鼻窦外科手术有关的绝大部分解剖结构及其变异,对手术有很大的指导作用。     

多层螺旋CT在腹股沟区解剖中的应用

目的:探讨多层螺旋CT三维重建在腹股沟区解剖的应用.方法:回顾性分析20例行多层螺旋CT腹股沟区扫描的三维重建图像,观察在横断面、冠状面及矢状面上腹股沟韧带、腹壁下动脉、圆韧带或精索的显示情况.结果:20例病例中腹壁下动脉在3个轴面上均能显示,显示率100％.横断面不能很好的显示腹股沟韧带,圆韧带或精索的显示率为70％...     

影像检查在鼻骨骨折中的应用价值

目的：利用影像学检查方法，探讨鼻骨骨折的最佳显示方法。材料和方法：对90例鼻外伤患者进行X线侧位摄影和CT扫描．其中54例行双侧摄影，所有CT扫描图像都经过三维重建同时应用多平面重组技术、重建冠状位及水平位图像。结果：X线发现鼻骨骨折74例（82．2％），螺旋CT90例均有骨折，伴有其他部位骨折39例。结论：X线是鼻骨骨折重要的首选检查方法，但漏诊率较高，螺旋CT冠状位加水平位扫描能很好的显示骨折，而CT三维重建技术对临床价值极高。     

45例窦口鼻道复合体骨折CT诊断分析

目的：分析窦口鼻道复合体骨折的CT表现特征，以提高诊断水平。材料和方法：对371例颌面部外伤病人行螺旋CT横断位扫描，扫描后行冠状位重建（MPR）处理，对冠状位重建图像进行诊断和分析。结果：检出45例病人有窦口鼻道复合体骨折。其中单纯型骨折11例（24．44％），复合型骨折34例（75．56％），错位性骨折14例（31．11％），粉碎性骨折31例（68．89％）；10例（22．22％）为双侧窦口鼻道复合体骨折，35例（77．78％）为单侧骨折。45例病人均合并颌面部其他部位骨折。所有病例均可在螺旋CT冠状位重建（MPR）图像中显示。结论：窦口鼻道复合体骨折以单侧复合型骨折最多见，骨折类型多为粉碎性。螺旋CT冠状位重建（MPR）图像能清楚显示窦口鼻道复合体骨折及窦口鼻道的阻塞情况，对于指导手术治疗及评价预后具有重要的临床价值。     

头颈部肿瘤多层螺旋CT冠状面多平面重建与常规扫描图像的对比研究

目的 分析头颈部肿瘤多层螺旋CT冠状面多平面重建(MPR)与常规扫描图像，探讨冠状面MPR能否替代常规冠状面扫描。方法 使用GE Lightspeed Ultra 8层螺旋CT扫描仪对90例头颈部肿瘤患者进行扫描，在横断面基础上行MPR。由3位资深放射科医生对冠状面MPR像与常规扫描图像进行对比分析。结果 90例冠状面MPR像对正常鼻咽、鼻腔、鼻窦、上颈部等部位软组织的显示与常规扫描冠状面像相似，图像质量好，均为1级。59例(65．6％)冠状面MPR像对骨质的显示优于常规扫描像，68例(75．6％)对颅底孔道的显示优于常规扫描像。增强CT扫描中，51例明显肿瘤病灶，46例(90．2％)对肿瘤的显示优于常规扫描冠状面像。结论 多层螺旋CT扫描MPR图像除对口腔、口咽的显示欠佳外，均近似或优于常规冠状面扫描像，多层螺旋CT扫描的冠状面MPR可以替代常规扫描。     

多排螺旋CT在骨关节创伤中的应用

目的：分析骨关节创伤中多排螺旋CT三维图象重建常见形式及应用价值。方法：使用GE Light Speed Qxi Plus多排螺旋CT扫描仪。对35例骨外伤患者进行扫描，在横断面基础上行SSD、RaySum、MPR。由资深影像科及骨科医师各3人分别对普通经X光片及多排螺旋CT三维重建图像进行分析、评价。结果：35例骨外伤患者阳性率100％，SSD、RaySum及MPR图像重建以任意角度、全方位，精确显示骨折形态，直观准确展现与周围组织空间关系，在骨折检查治疗中体现极大优势。结论：三维图像技术能够清晰、立体地展示骨关节正常解剖结构与病变，图像直观，感观性强。其主要表现形式SSD、RaySum及MPR，应注意相互借鉴，并要结合源影像和常规断面影像。     

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。     

多层螺旋CT重组技术对眶下筛房的影像解剖研究

目的 研究眶下筛房的影像解剖学特点,分析其与鼻窦黏膜增厚的相关性,探讨其在慢性鼻窦炎发病中的作用.方法 根据纳入及排除标准,从头面部多层螺旋CT(MSCT)扫描的连续病例中采用随机数字表法抽取260例(520侧)进行回顾性研究,图像数据行多层面重组(MPR)及仿真内镜重组(VR),观察眶下筛房的显示率、起源、分型等情况;分析眶下筛房的存在与鼻窦黏膜增厚的关系;测量上颌窦口区眶下筛房的最大横径、上颌窦口横径,观察眶下筛房炎性征象及上颌窦1:I黏膜碰触情况,应用X2检验和Logistic回归方法与鼻窦黏膜增厚进行相关性研究.结果 (1)260例眶下筛房的显示率:单侧26.1%(68例),双侧对称31.2%(81例),单双侧显示率差异无统计学意义(x2=1.59,P>0.05).左右分侧观察,两侧显示眶下筛房合计230侧,左侧占52.2%(120侧),右侧占47.8%(110侧),左、右侧显示率差异无统计学意义(x2=0.78,P>0.05).(2)眶下筛房的起源:单纯起源于前组筛房124侧(53.9%),单纯起源于后组筛房62侧(27.O%),既有起源于前组筛房、又有起源于后组筛房的眶下筛房44侧(19.1%).(3)眶下筛房的分型:共分3型,起源于前组筛房的以I型为主(160侧),Ⅱ、Ⅲ型少见;起源于后组筛房的Ⅱ(48侧)、Ⅲ型(45侧)更为多见,不同起源的眶下筛房分型差异有统计学意义(x2=193.433,P<0.01).(4)眶下筛房与鼻窦黏膜增厚的关系:眶下筛房鼻窦黏膜增厚165侧,无鼻窦黏膜增厚192侧,差异无统计学意义(X2=1.824,P>0.05).鼻窦黏膜增厚时上颌窦13区眶下筛房的最大横径为(4.48±1.28)mm,未增厚时为(4.54±1.18)mm.二者差异无统计学意义(t=0.273,P>0.05);鼻窦黏膜增厚时上颌窦口径线为(2.63±1.64)mill.未增厚时为(2.28±0.75)mm,上颌窦13径线与鼻窦黏膜增厚无明显相关关系(Wald=2.534.P>0.05);眶下筛房炎性征象与鼻窦黏膜增厚有明显相关关系(Wahl=10.817,P<0.Ol,OR:4.125),上颌窦口黏膜碰触与鼻窦黏膜增厚具有明显相关关系(Wald=6.64,P<0.0l,OR=3.728).结论 MSCT三维重组技术可以满意显示眶下筛房的解剖学特征;在影像分析中,不能简单地把眶下筛房的存在作为慢性鼻窦炎患病的危险因素,应根据不同个体的具体情况分析眶下筛房解剖特征及对窦口鼻道复合体的影响,为临床选择不同的处理方法提供依据.     

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.     

The frontal intersinus septal air cell: a new hypothesis of its origin

BACKGROUND AND PURPOSE: Air cells are often seen within the frontal intersinus septum. These cells have traditionally been thought to arise from displaced ethmoid cells from the frontal recess. This study explores the possibility that such cells may actually be diverticula from the frontal sinuses themselves and not of a direct ethmoid origin.MATERIALS AND METHODS: A prospective study of 200 consecutive CT scans in the coronal and axial planes was performed on patients without a history of recent trauma. The images were interpreted independently by a radiologist and an otolaryngologist. The CT studies were evaluated for the presence of a central intersinus septal air cell. If such a cell was identified, it was further classified as either being completely isolated from both frontal sinuses by a bony rim or as a communicating diverticulum from one of the frontal sinuses. If a central cell was present, it was also assessed for how much of the height of the intersinus septum it involved (lower one-half or full height).RESULTS: There was a complete concordance of the results between the 2 observers. An intersinus septal air cell was seen in 61 (30.5%) of the 200 cases, and 85.3% of these cells were clearly seen to communicate anteromedially with either one of the frontal sinuses or both frontal sinuses (3 cases). In 9 (4.5%) of the 200 cases, the central cell had no demonstrable connection to either frontal sinus. Of the 61 cases with a central cell, 55 (90.16%) of the cells occupied the full height of the septum, and 6 (9.84%) only involved the lower half of the septum.CONCLUSION: Contrary to the present convention that frontal intersinus septal cells originate as displaced ethmoid cells from the frontal recess, we found that most such cells are actually diverticula from the frontal sinuses themselves.

The development of the frontal sinus from the anterior ethmoid labyrinth allows for the presence of extramural ethmoid cells both around and within the frontal sinus proper. These cells, which communicate with the frontal recess, include supraorbital, infrafrontal, and intersinus septal cells. Such cells were identified by anatomic dissection studies in the first part of the 20th century and were subsequently detailed by radiographic imaging in living patients.^1–3The belief that there was a common embryogenesis of the frontal sinus and associated cells by evagination and pneumatization from the frontal recess have resulted in a generally accepted unifying hypothesis of their formation. However, our study challenges the concept that the intersinus septal cell is uniformly of an ethmoid derivation. Rather, we suggest that such a cell may most often represent a diverticulum from the frontal sinus itself.     

Evaluation of variations in sinonasal region with computed tomography

AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases.METHODS: The study included 400 cases (191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography (CT) examination in axial plane. Reformatted CT images were studied in all planes.RESULTS: Age range of the patients was 20-83 (mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell (74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus (P < 0.001). Besides, the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus, and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant (P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases (P = 0.004 and P = 0.002, respectively).CONCLUSION: Sinonasal region has a great number of variations, and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.     

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.     

X-ray computed tomographic study of the ethmoid and middle meatus. II. Radio-anatomy (axial incidence) and morphological variations

Chronic rhinosinusitis endoscopic surgery needs an accurate evaluation of diseases and paranasal sinus anatomic variations. High resolution CT by thin section (2 mm) allow this pre-operative assessment. An anatomical study of the ethmoid air cell system is always possible in axial plane. The bidimensional CT exploration (axial and coronal plane) displays the anatomic variations of ostiomeatal unit, that have been reported to predispose sinusitis. They are nasal septal deviation, pneumatization and paradoxical curvature of the middle turbinate, pneumatization of unciform process, Haller's cells, prominent agger nasi cell and ethmoid bulla. The endoscopic endonasal surgery landmarks, the individual morphologic variations, the topographic relations to the orbit and to the brain are also well shown by CT.     

CT findings in involvement of the paranasal sinuses by lepromatous leprosy.

The role of nasal infection in the transmission of leprosy has been extensively studied. Leprosy can affect the paranasal sinuses due to mucosal continuity and bacillaemia. This prospective study was performed on 25 untreated patients with lepromatous leprosy. 5 mm contiguous axial and coronal CT sections of paranasal sinuses, on soft tissue and bone windows, were obtained in all patients. Each sinus was examined for mucosal thickening, soft tissue densities and bony outlines. Representative biopsies were taken from ethmoid sinus to confirm the radiological diagnosis in 12 patients with multiple paranasal sinus involvement. Ethmoid aircells were involved in 20 patients (80%). Maxillary, frontal and sphenoid sinuses showed abnormalities in 12, four and three patients, respectively. The ethmoid biopsy showed involvement by lepromatous leprosy in seven of 12 patients (58.3%). Involvement of paranasal sinuses is common in lepromatous leprosy and is of considerable epidemiological significance.     

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.