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。     

慢性鼻窦炎鼻内镜术中应用鼻道-窦口复合体CT三维重建的临床价值

目的 探讨慢性鼻窦炎鼻内镜手术中采取鼻道-窦口复合体CT三维重建的意义。方法 选取本院行鼻窦内镜手术的慢性鼻窦炎患者108例,均对鼻道-窦口复合体开展CT三维重建,分析鼻-鼻窦炎的炎症分布状态以及鼻道-窦口复合体变异伴鼻窦炎情况。结果 108例患者中32.41%出现泡状鼻甲,11.11%出现反常中鼻甲,15.74%出现钩突肥厚,13.89%出现钩突内侧偏移,6.48%出现钩突外侧偏移,4.63%出现钩突气化,10.19%出现Haller气房,11.11%出现鼻丘气房,25.00%出现鼻中隔偏曲。鼻窦炎症分布在前组筛窦占87.04%,后组筛窦占37.04%,上颌窦口占69.44%,上颌窦占63.89%,额隐窝占21.30%,额窦占15.74%,蝶窦占9.26%。108例患者同时存在解剖变异和鼻窦炎总共95例。结论 鼻窦内镜术式中采取鼻道-窦口复合体CT三维重建,能清晰提供出相应位置变异情况和其引起的鼻窦炎,对临床有指导价值。     

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、...     

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。     

寒区部队慢性鼻窦炎患者非手术综合治疗79例分析

目的探讨寒区部队慢性鼻窦炎患者非手术综合治疗的方法和临床疗效。方法对79例符合纳入标准和排除标准的寒区部队慢性鼻窦炎患者给予非手术综合治疗,包括丙酸氟替卡松鼻喷剂喷鼻;罗红霉素胶囊半量口服;桉柠蒎肠溶软胶囊口服以及鼻腔冲洗。上述治疗应用4周及12周后进行各项疗效评估,包括症状视觉模拟量表(VAS)主观症状评估,Lund-Kennedy法鼻内镜评估,Lund-Mackay法鼻窦CT评估和鼻腔鼻窦结局测量20条(SNOT-20)生活质量评估。结果经过4周和12周治疗后,患者主观症状、鼻内镜评分、鼻窦CT评分以及生活质量评分,均较治疗前明显改善,差异均具有统计学意义(P<0.05)。结论慢性鼻窦炎的非手术综合治疗疗效确切,并且避免了对鼻腔、鼻窦解剖、生理的破坏,因此其治疗思路应以内科治疗为主,手术治疗为辅。     

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.     

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。     

霉菌性副鼻窦炎CT表现和临床、病理分析

随着抗生素及皮质激素的广泛应用，鼻腔、鼻窦霉菌病日趋增多。CT能准确估计副鼻窦炎性病变范围和程度，已成为副鼻窦根治术和功能性鼻内镜术前必不可少的检查。笔者回顾性分析我院及外院近10年来作CT检查并经手术、病理证实的31例霉菌性副鼻窦炎的临床、病理及CT资料．以便提高对霉菌性副鼻窦炎的认识。     

鼻内镜手术后病情迁延的原因探讨

随着鼻内镜手术的不断开展,以及鼻内镜围手术期综合治疗的广泛应用,鼻窦炎、鼻息肉的治疗得以逐渐完善。但是,由于鼻内镜下的图像缺乏三维立体感,术者距离感差,定位欠准确,加之鼻窦解剖复杂、变异大,容易引起严重的并发症,故术中容易形成残留致病情迁延,从而影响手术的治愈率[2     

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。     

Remarkable anatomic variations in paranasal sinus region and their clinical importance

With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.     

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。     

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.     

Anatomie und Normvarianten der Nasennebenhöhlen in der Schnittbildgebung

CT and MRI are the radiological methods of choice in the diagnostics of diseases of the paranasal sinuses. Detailed anatomical knowledge is mandatory for correct image interpretation. Before endonasal surgery the individually variable anatomic situation has to be known. This article describes radiologically relevant anatomical structures and summarizes normal variations.     

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.     

Computed tomography scans of paranasal sinuses before functional endoscopic sinus surgery

This review aims to familiarize the radiologist with the common types of sinus surgery including their indications and techniques.We also illustrate how surgeons interpret 3D sinus anatomy when evaluating computed tomography(CT)studies.Preoperative evaluation by CT is mandatory for all patients undergoing functional endoscopic sinus surgery(FESS).In the past decade in particular,CT of the paranasal sinuses has become a roadmap for FESS.The radiologist’s goal is to report on five key points:the extent of sinus opacification,opacification of sinus drainage pathways,anatomical variants,critical variants,and condition of surrounding soft tissues of the neck,brain and orbits.We present a systematic approach to the use of coronal,axial,and sagittal images in CT evaluation before FESS.     

基于CT扫描数据的鼻腔鼻窦三维模拟手术的研究

目的 研究基于CT扫描数据的鼻窦、颈内动脉、眶壁及病变组织三维(3D)重建模型指导鼻内镜手术的可行性及实用性.资料与方法 采集11例住院患者的鼻窦CT薄层扫描图像,利用自主研发的三维重建软件FitMe DICOM viewer对所采集数据进行图像分割和三维可视化重建,并评估重建质量及对手术的应用价值.结果 选择CT薄层扫描图像数据进行分割和重建,分割后的图像边界清晰、完整,数据无丢失.重建的结构清晰、连续,可以真实反映鼻窦、颈内动脉、眶壁及病变组织结构的实际情况,为术者提供符合空间想象的图像,以指导鼻内镜手术.结论 利用FitMe DICOM viewer软件对二维CT图像进行分割,方法简单实用,分割效果理想,重建后的3D模型三维效果逼真,立体感强,既能够显示鼻腔内部各结构的情况,又能准确反映鼻窦及病变组织与周围各结构的空间位置关系,为临床和教学奠定了基础.     

Radio-anatomy of the paranasal sinuses

The imaging anatomy of the paranasal sinuses presents some complexity. The paranasal sinuses develop within facial and cranial bones. They communicate with one another and with the nasal cavity. Knowledge of normal anatomy is mandatory for accurate diagnosis of sinonasal pathology. The most frequent anatomical variants should be identified to decrease surgical risks. CT is the main imaging modality for the evaluation of sinonasal pathology. Learning objectives: to review the normal sinonasal anatomy and its frequent anatomical variants at CT imaging.     

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.