HRCT及MRI对鼻腔鼻窦内翻性乳头状瘤的诊断价值探讨

目的:结合鼻腔鼻窦内翻性乳头状瘤(NIP)的鼻窦高分辨率CT(HRCT)及MRI影像,以及鼻内镜术中所见情况,探讨HRCT及MRI对NIP的诊断价值。方法:总结17例术前行鼻窦HRCT及MRI检查的NIP患者;所有患者均采用全身麻醉/局部麻醉下鼻内镜下切除病变切除术。术中观察病变范围、骨质破坏情况等,并结合术前影像检查。结果:所有患者术中所见病变情况与术前影像相比较,术前影像有局部骨增生者5例,但在鼻内镜手术中仅有3例发现有明显的骨质增生,较硬,偶尔呈松质骨样变化。术前影像发现有12例有不同部位及程度的骨质吸收破坏征象,表现为上颌窦内侧壁较多见、眶内侧壁、眶底壁、上颌窦后外侧壁及钩突等处骨质吸收、破坏,病变破坏的范围和部位与肿瘤的基底部、大小等有关。这与术中所见相符合。结论:术前HRCT及MRI对鼻腔鼻窦内翻性乳头状瘤的具有较大的诊断价值,并能指导手术方式的选择,手术风险的规避。

Investigation of diagnostic value of nasal inverted papilloma by HRCT and MRI

Objective To evaluate the diagnostic value of nasal inverted papilloma(NIP) by HRCT and MRI,combined with the images of HRCT,MRI and nasal endoscopy finds.Method Retrospective analysis of 17 patients with NIP,who had been performed HRCT and MRI examination before surgery,were all performed intranasal endoscopic lesion resection under anesthesia or local anesthesia.The extent of disease,bone destruction and images of HRCT and MRI before surgery were observed.Results Intraoperative findings and images before surgery were compared.Five cases of local bone hyperplasia were observed before surgery,but only 3 cases of endoscopic sinus surgery were found proliferation of bone or changes like cancellous bone.Preoperative imaging findings of 12 cases with different location and degree of bone resorption or damage,the common bone were maxillary sinus medial wall,the medial orbital wall,orbital floor wall,lateral wall of the maxillary sinus and uncinate process,etc.The scope and location of lesions were related to the base and the size of tumor.Conclusion Preoperative HRCT and MRI have greater diagnostic value,and can guide the choice of surgical approach of NIP,and reduce the risk of surgery.