CT 值鉴别鼻腔鼻窦软组织肿物的意义

目的：探讨CT值是否有助于鉴别鼻腔鼻窦软组织肿物的病变性质。方法：回顾性分析277例患者的术前非增强CT资料，以术后病理结果作为确诊及分类依据。计算各类病变CT值范围并比较各类病变CT值之间的差异。将各类样本重新分析作出诊断，比较将病变CT值范围纳入诊断依据前后的诊断准确率。结果：鼻息肉CT值为(25.3±3.5) Hu，浆液囊肿CT值为(7.9±3.5) Hu，黏液囊肿CT值为(42.2±4.7) Hu，乳头状瘤CT值为(40.7±5.3) Hu，真菌球CT值为(112.3±10.9) Hu，血管瘤CT值为(41.7±4.8) Hu，恶性黑色素瘤CT值为(51.2±9.9) Hu，鳞状细胞癌CT值为(47.1±9.9) Hu。鼻息肉CT值高于浆液囊肿，低于黏液囊肿、乳头状瘤、真菌球、血管瘤、恶性黑色素瘤及鳞状细胞癌，差异均有统计学意义(均P<0.05)；浆液囊肿CT值低于其他类疾病，差异均有统计学意义(均P<0.05)；真菌球CT值高于其他类疾病，差异均有统计学意义(均P<0.05)；黏液囊肿、乳头状瘤、血管瘤、恶性黑色素瘤、鳞状细胞癌平均CT值之间差异均无统计学意义(均P>0.05)。将病变CT值范围纳入诊断依据后，诊断准确率由71.1%提高至92.4%，差异有统计学意义(χ2=42.150，P<0.01)。结论：浆液囊肿、鼻息肉、真菌球的CT值明显不同于其他病变，单从CT值就可以将这3种病变与其他病变区分；黏液囊肿、乳头状瘤、血管瘤、鳞状细胞癌、恶性黑色素细胞瘤CT值范围相近，需要结合影像及临床其他特征进行鉴别诊断。将CT值纳入诊断依据可提高诊断准确率。

Significance of differential diagnosis for sinonasal mass by#br#CT value

Objective: To explore whether CT value is useful in identifying different disease in tumors ofrhinosinus parenchyma.Methods: The data of preoperation noncontrast CT in 277 patients were retrospectively reviewed.The final diagnosis and classification were based on the result of surgical histopathologicalexamination. The CT value range for different classification was calculated and was compared. Allpatients were re-diagnosed according to CT value range combined with pathological results by thesame doctor team. The diagnosis rates according to CT value range were compared.Results: The CT value was (25.3±3.5) Hu in nasal polyp, (7.9±3.5) Hu in serous cyst, (42.2±4.7)Hu in mucocele, (40.7±5.3) Hu in papilloma, (112.3±10.9) Hu in fungus ball, (41.7±4.8) Hu inhemangioma, (51.2±9.9) Hu in malignant melanoma, and (47.1±9.9) Hu in squamous carcinoma.The CT value in nasal polyp is significantly higher than that in serous cyst, which was significantlylower than that in mucocele, papilloma, fungus ball, hemangioma, malignant melanoma andsquamous carcinoma (all P<0.05); the CT value in serous cyst was significantly lower than that inother classification diseases (all P<0.05); the CT value in fungus ball was significantly higher thanthat in other classification diseases (all P<0.05); there was no significant difference in CT valueamong mucocele, papilloma, hemangioma, malignant melanoma, squamous carcinoma (all P﹥0.05). The diagnosis rate was elevated (from 71.1% to 92.4%) according to CT value range, withsignificant difference (χ2=42.150, P<0.01).Conclusion: CT value in nasal polyp, serous cyst, fungus ball is different from other diseases, andthe 3 diseases can be distinguished only by CT value range; the CT value in mucocele, papilloma,hemangioma, malignant melanoma and squamous carcinoma is similar, and their differentialdiagnosis should combine with imaging data and other clinical characters. The diagnosis rates canbe improved when the CT value range is taken into account.