鼻腔鼻窦肉芽肿性血管炎的 CT 和 MRI 表现

目的：探讨鼻腔、鼻窦肉芽肿性血管炎(GPA)的 CT 和 MRI 表现。方法回顾性分析8例经手术病理证实的鼻腔、鼻窦GPA 的 CT 和 MRI 征象。其中8例均行 CT 平扫,7例行 MRI 常规平扫,3例同时行 MRI 动态增强扫描,后处理得到时间-信号强度曲线(TIC)及半定量参数增强前信号强度(SIpre ),最大信号强度(SImax ),峰值信号强度(SIpeak ),峰值时间(Tpeak ),最大上升斜率(MSI)。结果 CT 表现：8例双侧中鼻甲、钩突、部分鼻中隔缺失,双侧上颌窦内侧壁骨质破坏、余上颌窦窦壁骨质增生硬化；6例上颌窦体积减小；6例筛骨迷路缺如；4例鼻骨扁平、鼻背塌陷；2例鼻咽软组织增厚,1例眼眶受累；8例鼻窦黏膜增厚。MRI 表现：7例平扫示病变区周围黏膜呈等、稍长 T1及稍短 T2信号；3例动态增强示病变周围黏膜明显不均匀强化,TIC 整体呈平缓型,于第1~4期有1段缓升。SIpre 平均为1030；SImax 平均为2500；SIpeak 平均为2353；Tpeak 平均为100 s；MSI 平均为1.28%。结论鼻腔、鼻窦GPA 具有典型的影像学征象,总结其 CT 和 MRI 表现,有助于本病诊断。

CT and MRI findings of granulomatosis with polyangiitis of the nasal cavity and paranasal sinus

Objective To investigate the CT and MRI findings of granulomatosis with polyangiitis of the nasal cavity and paranasal sinus. Methods The CT and MRI features of eight patients of granulomatosis with polyangiitis in the nasal cavity and paranasal sinus confirmed by histo-pathology were analyzed retrospectively.CT scanning was performed in all eight patients.Routine MRI scanning was performed in seven patients.Dynamic contrast MRI was performed in three cases.SImax ,SIpeak ,Tpeak and MSI of the time-intensity Curves(TICs)were calculated.Results On CT scanning,bilateral middle turbinate,uncinate process and nasal septum were defected in 8 cases.Medial wall of bilateral maxillary sinus showed destruction and other walls of bilateral maxillary sinus showed sclerosis in 8 cases.The ethmoid labyrinth were involved in 6 cases in which the volume of maxillary sinus reduced.The collapse of nasal dorsum and flat nasal bone occured in 4 cases.Nasopharyngeal soft tissue was thicken in 2 cases.Theorbit was involved in 1 case.The mucosal thickness of all group of sinuses were showed in all 8 cases.On MRI scanning,peripheric mucosal of the lesions showed iso or long T1 and long T2 signal in 7 cases.Dynamic-enhanced MRI showed heterogeneous enhancement.TICs showed flat.But in one to four periods showed a slow rising gradient.SIpre was 1 030, SImax 2 500,SIpeak 2 353,Tpeak 100 s,and MSI 1.28%.Conclusion Granulomatosis with polyangiitis of the nasal cavity and paranasal sinus shows some typical CT and MRI features.To summarize the features is helpful to the diagnosis and therapy of the lesion.