鼻腔副鼻窦恶性肿瘤的CT诊断

目的探讨鼻腔副鼻窦CT检查方法和肿瘤的形态、密度、窦壁骨质破坏、周围脂肪层侵犯、窦腔外软组织肿块等征象在鼻腔副鼻窦恶性肿瘤中的诊断作用.材料与方法逐项对比观察分析经病理证实的鼻腔副鼻窦恶性肿瘤32例和良性肿物139例的CT表现.结果CT冠状位扫描显示15例恶性肿瘤破坏25个窦腔骨壁,20例腔外软组织肿块累及23个相邻部位.轴位扫描发现骨壁受累12例,有20个侧壁骨质显示破坏,15个腔外肿块累及18个相邻结构.恶性组和良性组突出于窦腔外的软组织肿块分别为71.9%和5.0%、窦壁骨质侵蚀性破坏59.4%和14.4%、窦腔周围脂肪层的侵犯消失56.3%和13.7%,而软组织肿块形态不规则和密度不均匀,两组间无显著差异.结论鼻腔副鼻窦腔外软组织肿块、侵蚀性骨质破坏和窦壁周围脂肪层的侵犯消失,是诊断鼻腔副鼻窦恶性肿瘤的可靠征象.冠状扫描观察解剖内容和病变侵犯范围优于轴位扫描.

CT Diagnosis of Primary Malignant Tumors of Nasal Cavity and Paranasal Sinus

Purpose: To investigate the value of mass shape and density, bone destruction, neighbor fat tissue invasion, and soft tissue mass outside the sinus in diagnosing primary malignant tumours of nasal cavity and paranasal sinus. Materials and methods: The CT data of 32 malignant and 139 benign tumours pathologically proven were analyzed. Results: In the malignant group, the bone erosion in 25 of the 15 cases and soft tissue mass outsids the sinus in 23 of the 20 cases were demonstrated with coronaI CT scan, while axial CT detected bone destructin in 20 of the 12 cases and soft tisslle mass outsids the sinus in 18 of the 15 cases. Comparison of malignant and bonign groups, the difference of soft tissue mass outside the sinus (71.9%/5.0%) and bone erosion (59.4%/14.4%), as well as neighbouring fat tissue invasion (56.3%/13.7%) were signification. The difference of irregular shape and heterodensity of tumour were not significant. Conclusion: The mass outside the sinus, bone erosion and neighbouring fat tissue erosion are reliable criteria in diagnosing malignant tumour. Coronal scan is better than axial scan in demonstrating anatomic structure and tumour invasion.