鼻副窦CT表现对鼻内窥镜手术的临床意义（附56例分析）

目的：分析鼻窦CT表现并探讨对内窥镜手术的指导价值。方法：收集分析经手术病理证实的56例鼻窦炎的术前CT片并分析其CT表现。结果：（1）术前CT片可确定病变的程度和范围;（2）中鼻道及鼻窦解剖变异;中鼻甲气化11例,中鼻甲偏曲21例,钩突异常3例,Haller气房9例;（3）筛窦和蝶窦毗邻解剖变异;纸板缺如或破坏3例,视神经管突人后组筛窦1例,双侧颈内动脉与蝶窦毗邻4例。结论：鼻窦CT扫描对功能性鼻内窥镜手术有肯定指导价值,是术前必不可少的检查手段。     

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。     

鼻腔鼻窦病变CT扫描与鼻内窥镜检查的对照观察

目的　比较CT和鼻内窥镜 (nasalendoscope ,NE)对鼻腔和鼻窦病变的诊断价值 ,为临床诊断提供理论依据。方法　收集80例同一时期内具有鼻腔鼻窦区CT和鼻内窥镜检查结果 ,并得到病理证实的病例 ,对两者进行对照分析。结果　CT、NE的检查结果与病理结果对照 ,鼻窦炎、鼻窦肿瘤诊断正确率相似 ,鼻腔、鼻窦息肉、鼻腔肿瘤、鼻甲肥大NE诊断正确率高于CT ,副鼻窦体的解剖变异、鼻窦囊肿CT高于NE。结论　NE可以了解病变的形状、质地、颜色 ,并可在镜下活检 ,有助于病变的定性。CT可以了解病变的大小、形状和病变与邻近解剖结构的关系 ,两者互补可更全面诊断病变     

沈阳军区108例飞行人员鼻部检查临床研究

目的探讨飞行人员鼻部体检的相关方法,以早期发现并干预鼻部疾病或与疾病相关的解剖变异,提高体检质量和效能。方法选择2013年1月至2015年12月在解放军第四六三医院进行住院或体检的108例飞行人员,应用前鼻镜、电子内镜及鼻窦CT三种方法进行鼻部检查,并对三种检查方法的结果进行比较分析。结果 108例飞行人员中,解剖总变异率为100.0%(108/108),其中窦口鼻道复合体(OMC)处解剖变异的发生率为89.0%(96/108),鼻部疾病发生率为19.4%(21/108)。前鼻镜只能发现部分鼻中隔偏曲(不包括后端偏曲)和肥厚性鼻炎(不含骨质增生),电子内镜可以发现更多的微小或深在的解剖变异或病变。鼻窦CT检查可以确定所有的骨性解剖畸形,但不足之处在于对炎症或软组织病变无法做到确诊。结论飞行人员中存在常规检查无法发现的鼻部解剖变异或病变,对飞行会有潜在影响。鼻部的三种检查手段各有优势和不足,应根据情况合理选择,以提高飞人行员鼻部体检的准确性和效能。     

鼻腔鼻窦炎性病变的CT分析

本文收集４０例鼻腔鼻窦炎性病变患者，均采用冠状位ＣＴ扫描及扫描后再次重建放大处理，结合解剖研究，显示出复杂的鼻腔结构及各鼻窦的开口，描述了炎性病变的ＣＴ表现，对鼻腔解剖（包括变异）与炎症的关系，粘膜软组织病变及骨吸收破坏的表现作了讨论分析。     

鼻内接触性头痛的发病机制及诊治

目的 探讨鼻内接触性头痛的发病机制及其有效的诊治手段.方法 回顾性分析73例鼻腔接触性头痛患者的临床资料,经鼻窦CT及内镜检查评估鼻腔解剖异常情况及接触类型,同时测定骨间隙CT值,并通过内镜手术纠正鼻腔解剖结构异常.结果 73例中,67例局部麻醉后头痛消失,5例上颌窦穿刺后头痛消失;内镜检查发现,73例中筛泡肥大31侧,钩突肥大、内移、气化59侧,中鼻甲异常91侧,鼻中隔高位偏曲51例,其中57例存在同侧2处及以上相邻解剖结构黏膜接触.73例中,术后1周内头痛消失64例(87.67%),头痛减轻9例(12.33%).随访12个月,痊愈59例(80.82%),有效12例(16.44%),无效2例(2.74%).结论 接触性头痛患者鼻腔解剖异常以鼻中隔高位偏曲、中鼻甲变异及其邻近结构的病变最明显.解剖结构黏膜挤压及鼻窦自然口阻塞是接触性头痛的主要原因,内镜及鼻窦CT结合局麻试验可有效诊断鼻内接触性头痛.     

锁骨下动脉解剖变异的CT血管成像

目的:采用CT血管成像分析锁骨下动脉解剖变异类型,并探讨其临床意义.方法:回顾性分析2000例患者的主动脉弓分支的CT血管成像资料,观察锁骨下动脉解剖变异并进行分型.部分患者行食管钡餐造影、彩色多普勒超声检查或对比增强MR血管造影.结果:锁骨下动脉解剖变异的发生率为1.05％ (21/2000),包括迷走锁骨下动脉16例(其中迷走右锁骨下动脉15例,迷走左锁骨下动脉l例)和锁骨下动脉及其分支起源变异5例,女性占81％ (17/21),4例合并先天性心脏病.结论:CT血管成像可用于观察锁骨下动脉解剖变异,锁骨下动脉解剖变异常合并先天性心脏病.     

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。     

低剂量CT扫描在儿童副鼻窦炎的应用

目的探讨儿童副鼻窦炎低剂量CT的表现并对其病因进行初步分析,以减少儿童X线检查的辐射剂量,协助临床诊断。方法回顾性分析50例副鼻窦炎儿童。分2组,30例使用低剂量:60~80 k V,20例使用常规剂量:80~120 k V。所有患者均观察鼻窦炎症的病变累及范围、周围组织情况,分析不同CT剂量其对副鼻窦的显示情况。结果 CT检查患者中单组鼻窦炎症27例(占54%),以上颌窦最常见;多组鼻窦炎症23例(占46%),常规剂量患者得到信噪比较高图像,但所接受射线量较大。低剂量扫描大大地减少了儿童的辐射剂量,图像均能达到临床诊断要求。结论低剂量CT检查能准确显示儿童副鼻窦炎的鼻窦黏膜改变及邻近鼻腔鼻窦的解剖关系。CT检查,有助于熟悉儿童副鼻窦解剖及病因诊断;使用低剂量检查,既能减少儿童检查所受剂量,又能临床提供影像学依据。     

鼻及鼻窦常见病变和解剖变异的CT冠状位靶扫描(附507例分析)

目的：探讨鼻及鼻窦常见病变和解剖变异的CT特征。方法：回顾性分析507例病人的冠状位CT表现。结果：慢性鼻及鼻窦炎占61．73％(313／507)；鼻息肉占22．87％(116／507)；囊肿占4．93％(25／507)，真菌性鼻窦炎占1．38％(7／507)；恶性占位性病变占0．79％(4／507)，未见异常占7．88％(40／507)。鼻中隔弯曲占65．66％(333／507)。Onodi气房占29．19％(148／507)；Haller气房占12．42％(63／507)。蝶窦发育不良占3．94％(20／507)；上颌窦发育不良占1．97％(10／507)。结论：冠状位CT靶扫描可对各种鼻及鼻窦病变做出诊断，并可显示其解剖变异的特征。     

The ostiomeatal unit and endoscopic surgery: anatomy, variations, and imaging findings in inflammatory diseases.

Recent and ongoing advances made in endoscopic surgical techniques require the radiologist to understand the anatomy and pathophysiology of the paranasal sinuses and nasal passage. Endoscopy and CT are complementary procedures, and, as such, the normal anatomic relationships and their CT appearances need to be well understood in order for radiologists to offer continued support as consultants to their clinical colleagues. In this article, we review the pertinent anatomy of the lateral nasal wall and paranasal sinuses, discuss the most frequently encountered normal variations that may predispose a patient to inflammatory sinus disease, outline imaging protocols for evaluation of this region, and introduce the reader to current endoscopic surgical techniques. Last, the imaging findings in various inflammatory processes involving the sinuses, as well as the local and regional complications associated with paranasal sinus inflammatory diseases, are presented.     

鼻咽癌侵犯鼻窦的MRI表现(附86例病例分析)

目的：分析鼻咽癌侵犯鼻窦的磁共振（MRI）表现,探讨MRI在诊断鼻咽癌侵犯鼻窦中的作用。方法：回顾分析鼻咽癌并鼻窦侵犯的86例患者的MRI表现。结果：MRI表现为窦壁破坏100%,窦壁黏膜增厚52.3%,窦腔内软组织肿块65.1%,鼻窦内侵犯病灶与鼻咽肿瘤相连97.7%,合并积液25.6%。横断面T1WI、T2WI、CE-T1WI所示病灶三者间差异无显著性意义,矢状面T1WI、冠状面FSIR和冠状面CE-T1WI示肿瘤侵犯蝶窦为100%,横断面T2WI和CE-T1WI对显示筛窦、上颌窦受侵最佳。结论：窦壁骨质破坏、连续性中断;窦壁黏膜不均匀性增厚;窦腔内肿块与鼻咽肿瘤主体相连,且有相同程度的强化;T1WI呈等或稍低信号,T2WI为等或稍高信号;增强扫描明显强化,是诊断鼻窦受侵犯的要点。因此,MRI的横断面T2WI、矢状面T1WI、冠状面FSIR及增强扫描在鼻咽癌鼻窦受侵犯的诊断中作用较大。     

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.     

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.     

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.     

鼻窦真菌球的 CT 及磁共振成像表现

目的：探讨鼻窦真菌球的CT、磁共振成像（MRI）特征性表现及诊断价值。方法回顾性分析35例经手术、组织病理学证实的鼻窦真菌球的影像学资料,35例患者均做CT平扫,其中4例做MRI平扫加增强扫描。结果鼻窦真菌球的主要CT表现为：①病变为单侧性（100%）;②病变部位以上颌窦为主（80%）,部分突入同侧鼻腔;其次为蝶窦（14%）;③病变窦腔内不均匀软组织密度影充填,其内可见呈斑点状、云絮状或条带状高密度钙化影（89%）;④局限性骨质增生（74%）及破坏（9%）。 MRI表现为：病变中心T1WI呈等信号,T2WI呈低信号,周围增厚黏膜T1WI呈低信号,T2WI呈高信号,增强扫描病变中心不强化,周围增厚黏膜明显强化。结论病变内钙化影是本病特征性的CT征象,是诊断该病较为可靠的依据,CT检查是诊断本病的重要手段;MRI能显示病变内真菌球的范围,有助于诊断。     

霉菌性鼻窦炎的CT诊断

目的 探讨霉菌性鼻窦炎CT特征性表现及诊断价值。方法 回顾性分析12例经手术病理证实的霉菌性鼻窦炎CT表现，提出诊断和鉴别诊断要点。结果 霉菌性鼻窦炎主要CT表现有：病变为单侧性，对侧鼻窦正常；病变仅位于上颌窦或以上颌窦为主，累及其他鼻窦；病变窦腔密度增高，不均匀，内有小团状，砂粒状，条状极高密度区；可有鼻窦骨质破坏。结论 霉菌性鼻窦炎的CT表现上有特异性，CT是诊断该病有价值的方法。