鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的CT影像表现

目的 探讨鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的特征性CT影像表现及其与慢性鼻窦炎鼻息肉在CT表现上的区别。 方法 (1) 回顾性分析17例经组织病理学证实的双侧嗅裂区呼吸道上皮腺瘤样错构瘤的CT资料,探讨其影像学特点。(2) 分别测量17例错构瘤患者、36例鼻息肉患者和41例正常人在轴位和冠状位CT上的嗅裂区的宽度和鼻腔总宽度,计算嗅裂宽度和鼻腔宽度的比值,并进行统计学分析。 结果 错构瘤患者的CT层面上显示嗅裂区有与脑灰质呈等密度的软组织影,嗅裂宽度增大。嗅裂宽度的中位数,在轴位和冠状位CT上分别是,错构瘤组11.5 mm和11.8 mm,鼻息肉组7.5 mm和7.8 mm,对照组5.4 mm和5.4 mm。各组间差异均有统计学意义(所有P< 0.001)。鼻腔的总宽度在各组中及两个扫描方位上均没有显著差异。嗅裂宽度和鼻腔宽度比值的中位数,在轴位和冠状位CT上分别是,错构瘤组45.5%和43.5%,鼻息肉组30.0%和30.0%,对照组为22.0%和21.0%。各组间差异均有统计学意义(所有P< 0.001)。 结论 错构瘤组CT扫描下的嗅裂宽度及嗅裂宽度和鼻腔总宽度的比值较正常组和鼻息肉组显著增加。嗅裂膨胀性增宽是提示错构瘤的特征性征象之一,其可以作为错构瘤与鼻息肉鉴别诊断的参考依据。尤其是双侧对称增宽更有诊断价值,双侧嗅裂宽度大于10 mm应高度怀疑有错构瘤的可能性。

Characteristics of respiratory epithelial adenomatoid hamartomas in the nasal olfactory cleft on computed tomography

Objective To study the characteristic computed tomography(CT)features of respiratory epithelial adenomatoid hamartomas in the olfactory clefts and to explore the differences found between hamartoma and chronic sinusitis with nasal polyps on a CT scan. Methods (1) The CT findings of 17 patients with histologically proven respiratory epithelial adenomatoid hamartoma in the bilateral olfactory clefts were retrospectively reviewed and CT features were analyzed. (2) The widths of the olfactory fissure area and the total nasal cavity on axial and coronal CT of 17 patients with hamartoma, 36 patients with nasal polyps, and 41 normal persons were measured and the ratio of the olfactory cleft to the nasal width was calculated. Results The analysis showed that patients with hamartoma presented with a soft tissue shadow in the olfactory fissure zone of equi-density with gray matter, and the width of olfactory cleft was increased. Median olfactory cleft widths in the axial and coronal CT images were: hamartoma, 11.5 and 11.8 mm; nasal polyps, 7.5 and 7.8 mm; and control group, 5.4 and 5.4 mm, respectively. The differences among the groups were statistically significant(all P<0.001). Total nasal width was not significantly different among the groups in either scan orientation. The median olfactory cleft width and total nasal width ratios were 45.5% and 43.5% for the hamartoma group, 30.0% and 30.0% for the nasal polyp group, and 22.0% and 21.0% for the control group, respectively, in the axial and coronal planes. The differences among the groups were statistically significant(all P<0.001). Conclusion Compared to normal and nasal polyposis CT-scans, REAH significantly enlarges the olfactory clefts width and olfactory cleft width / total nasal width. The enlargement of olfactory cleft is one of the characteristic signs of REAH,and CT can be used as a basis for the differential diagnosis of hamartoma and nasal polyps. Especially bilateral symmetry broadening is more valuable in diagnosis, and an olfactory cleft width more than 10 mm should be considered highly suggestive of hamartoma.