鼻窦真菌球CT和MRI诊断

目的探讨鼻窦真菌球的CT和MRI表现及诊断价值.方法回顾性分析经手术、组织病理学证实的68例鼻窦真菌球的影像学资料.结果发病部位:单个鼻窦发病60例(88.2 %),其中上颌窦最常见,占41例(60.3%),依次为蝶窦12例(17.6%),筛窦6例(8.8%),额窦1例(1.5%);CT表现:受累鼻窦腔内充以软组织影,其中64例(94.1%)中央见点状、不规则细条状或云絮状高密度影,融合成团块状,代表菌丝,窦壁骨质有不同程度增生肥厚,35例(76.1%)上颌窦内壁见骨质吸收破坏;MRI表现:病变T1WI呈等或稍高信号(与脑实质比较,以下相同),T2WI均呈极低信号,增强后均未见强化;病变周围黏膜明显增厚,T1WI多呈等信号,T2WI均表现高信号,有明显强化.结论 CT是目前诊断鼻窦真菌球最佳影像学检查方法,MRI能够显示真菌球范围和帮助鉴别诊断,可作为一种补充影像学检查方法.

CT and MRI diagnosis of fungus ball in the paranasal sinus

Objective To evalute CT and MRI findings and their diagnostic value of fungus ball in paranasal sinus.Methods All 68 patients with fungal balls arising from the paranasal sinuses were confirmed by histopathology and surgery.CT and MRI appearances were analyzed retrospectively.Results In 68 patients,only one single sinus was involved in 60 (88.2%).The maxillary sinus (60.3%) was the most commonly infested,followed by the sphenoid sinus (17.6%),and the ethmoid sinus (8.8%).Frontal sinus (1.5%) was rare involved.On CT images,complete or subtotal opacification was showed in the affected sinus.Of these,Punctate,irregularly fine-linear,or fog-like patterns of radiodensities with the central portion of the soft tissue mass was demonstrated in 64 cases (94.1%).These could conglomerate and represent dense hyphae.Walls various bony thickening or sclerosis was revealed in the involved sinus.Bony destruction of the internal walls of maxillary sinuses were observed in 35 cases (70.1%).On MR imaging,the fungus balls showed isointense or mild hyperintense singal with respect to brain on T1WI,marked hypointense singal on T2WI and with no enhancement.The affected paranasal sinus mucosas were thickened around the fungal balls,revealing moderate signal intensity with respect to brain on T1WI,high signal intensity on T2WI with marked postcontrast enhancement on MR imaging.Conclusion CT may be the best imaging method in diagnosis of fungus ball of the paranasal sinus.MRI can demonstrate the extent of the fungus ball and contribute to differential diagnosis,which may be a complementary imaging modality.