Complementary role of MR imaging of ethmomaxillary sinus disease depicted at CT in cystic fibrosis

Purpose: To assess whether MR imaging can improve characterization of ethmomaxillary opacification diagnosed at CT in patients with cystic fibrosis (CF) in order to select patients that may benefit from functional endoscopic sinus surgery (FESS).Material and Methods: Sixty-two CF patients (26 females and 36 males) aged 4-50 years (median 20 years) with ethmomaxillary sinus disease at CT underwent MR examination of the paranasal sinuses (coronal T1 and STIR sequences). FESS had been performed in 28 of the patients prior to this study. MR signal intensities were interpreted as mucosal thickening or infectious material, according to a previous study.Results: Three major maxillary sinus MR patterns could be distinguished: Air-filled, oval-shaped pus-filled, and streaky-shaped pus-filled sinus lumen. For air-filled maxillary sinuses with mucosal thickening, CT and MR imaging were diagnostically equivalent. Where CT showed homogeneous opacification of the maxillary sinuses, MR imaging differentiated between thickened mucosa and pus-filled areas. Patients who had undergone FESS most commonly had air-filled or streaky-shaped pus-filled maxillary sinus lumen. In non-operated patients oval-shaped pus-filled sinus lumen was most common and could occur without ethmoid disease.Conclusion: MR imaging of the paranasal sinuses can differentiate between infectious material and thickened mucosa and should be used to select CF patients with pus-filled areas that can be eradicated with FESS.     

鼻腔及鼻窦粒细胞肉瘤的影像诊断

目的 分析鼻腔及鼻窦粒细胞肉瘤的临床及影像特征,提高粒细胞肉瘤的影像诊断水平。方法 报道3例经病理确诊的鼻腔及鼻窦内粒细胞肉瘤的影像表现,并结合相关文献进行分析。结果 鼻腔及鼻窦粒细胞肉瘤CT上呈等密度,浸润性生长,常累及相邻结构,如咽腔、咽旁、眶内及颅内等,病变区骨质破坏吸收,无硬化改变;MRI上病变呈等T1、稍长T2信号,增强扫描呈中重度强化,周围环形强化程度较高。结论 鼻腔及鼻窦软组织肿瘤伴有邻近多个结构受累、骨质破坏,并有白血病病史的病人,要考虑到粒细胞肉瘤的可能性;白血病病史不明确,但影像表现典型,建议积极做相关检查;最终确诊仍需与病史、病理相结合。     

颅底骨折的CT诊断

本文对98例颅底骨折病例CT扫描中所出现的各种征象,加以统计、分析,结果表明:颅底骨折线不是颅底骨折后所出现的唯一征象,颅内积气、副鼻窦积血、乳突积血等间接征象,对颅底骨折的CT诊断,同样具有十分重要的意义。     

冠状位高分辨CT对副鼻窦疾病的诊断价值

Objective The value of coronal high-resolution CT was assessed in the evaluation of paranasal sinus diseases. Methods A retrospective study of paranasal sinus CT imaging of 100 patients,which were confirmed by surgery and pathology. Bachlying、 coronal scanning, 3 mm slice thickness, 6 mm slice pitch and high-resolution bone algorithm reconstruction for all the patients. We got there groups according to the CT manifest: anatomy variation、inflammation and tumor Results There were 55 patients and 118 sites in anatomy variation group, all the images can display the important structure of anatomy variation and ostiomeatal complex clearly ;70 patients in inflammation group and 10 patients in tumor group,which were all confirmed by surgery and pathology. Conclusion HRCT could accurately diagnose paranasal sinus diseases,and completely describe the lesion of either the sinus wall and out of the sinus. HRCT should be the routine examination before FESS, it has great clinical value for designing surgical plan and evaluating the effect and recurrence.     

鼻腔鼻窦血管外皮瘤

目的 鼻腔鼻窦血管外皮瘤是一非常少见的的肿瘤,为了更好的了解和认识此病的临床特点,我们总结了1975年至2005年收治的14例患者的临床资料。方法 用回顾性研究方法分析鼻窦血管外皮瘤的临床特点。结果 9例资料完整,5例失访。从完整的9例资料显示预后与病理的分级密切相关。高度恶性肿瘤的死亡率明显高于中间性和低度恶性的患者;低度恶性的预后又和肿瘤大小和血供相关,肿瘤大于6cm,血供丰富容易复发,预后差。治疗以手术彻底切除为主。结论 鼻腔鼻窦血管外皮瘤的临床行为与病理分级密切相关,临床医师要重视组织病理学的描述。     

颅鼻眶部骨性病变的手术治疗

目的根据病变累及部位将颅鼻眶部划分不同区域,并讨论手术入路的选择及手术技巧.方法自1998年1月至2004年8月收治74例颅鼻眶部骨性病变患者,按手术所需将颅鼻眶部划分成四部三区.根据不同部位的病变,选择不同的手术入路,在术中结合使用影像导航及鼻内镜技术.结果21例骨纤维结构不良患者,除早期1例失明外,术前视力高于0.1的术后视力恢复较好,术前视力低于0.1的术后视力稍有改善或基本维持术前状态.53例占位性病变其中病灶全切45例,约占84.9%,大部切除8例.术后无眼球内陷者.鼻塞均有好转.位于眶尖部的病灶切除后症状基本消失且无视神经损伤.结论选择避免面部切口的经颅入路可更好地显露手术野,使用术中影像导航及鼻内镜技术能提高全切率,减少血管神经的损伤.     

Histopathologic Assessment of Fungal Involvement of the Paranasal Sinuses in Turkey

Objective To assess paranasal sinus material histopathologically for the presence of fungus.

Material and Methods Paraffin-embedded archival biopsy samples of patients who underwent endonasal sinus surgery between 1992 and 2002 were retrospectively assessed for the presence of fungi. Hematoxylin-eosin-stained sections of the materials were re-evaluated, and Gomori's methanamine silver stain was also applied as required.

Results Fungus (Aspergillus) was detected histopathologically in only 21476 patients, both of whom were immunocompetent. One patient was considered to have chronic indolent sinusitis and the other allergic fungal sinusitis.

Conclusion Although histopathologic assessment is one of the most important diagnostic tools, on its own it may lead to underestimation of fungal involvement of the paranasal sinuses. Alternatively, fungal involvement of the paranasal sinuses may be very infrequent in Turkey.     

微创技术在开颅术后矢状窦,横窦附近迟发性血肿的应用

目的探讨微创手术方法治疗颅脑外伤行开颅术后矢状窦,横窦附近迟发性血肿的患者手术效果及远期疗效。方法选取本院2002年4月至2013年6月收治的颅脑外伤行开颅术后矢状窦,横窦附近迟发性血肿患者48例作为观察组,取1998年1月至2002年3月收治的开颅术后矢状窦,横窦附近迟发性血肿患者29例患者中26例行二次开颅手术患者为对照组。比较两组患者的手术效果及远期疗效。结果观察组患者的术后显效及总有效率（60.42%,95.83%）及远期疗效（78.76%）均显著高于对照组（34.62%,76.92%,42.31%）,差异均有统计学意义（P＜ 0.05）。29例中的3例保守治疗患者死于脑疝。结论颅脑外伤患者颅内血肿清除术后迟发硬膜外血肿,选择硬通道微创颅内血肿清除术的预后明显优于开颅手术。