鼻窦真菌球的 CT 及磁共振成像表现

目的：探讨鼻窦真菌球的CT、磁共振成像（MRI）特征性表现及诊断价值。方法回顾性分析35例经手术、组织病理学证实的鼻窦真菌球的影像学资料，35例患者均做CT平扫，其中4例做MRI平扫加增强扫描。结果鼻窦真菌球的主要CT表现为：①病变为单侧性（100%）；②病变部位以上颌窦为主（80%），部分突入同侧鼻腔；其次为蝶窦（14%）；③病变窦腔内不均匀软组织密度影充填，其内可见呈斑点状、云絮状或条带状高密度钙化影（89%）；④局限性骨质增生（74%）及破坏（9%）。 MRI表现为：病变中心T1WI呈等信号，T2WI呈低信号，周围增厚黏膜T1WI呈低信号，T2WI呈高信号，增强扫描病变中心不强化，周围增厚黏膜明显强化。结论病变内钙化影是本病特征性的CT征象,是诊断该病较为可靠的依据，CT检查是诊断本病的重要手段；MRI能显示病变内真菌球的范围，有助于诊断。

CT and MRI manifestations of fungal ball of the paranasal sinuses

Objective To evaluate the CT and MRI manifestations and diagnostic value in fungal ball of the paranasal sinuses. Methods CT and MRI findings of 35 cases of fungal ball of the paranasal sinuses verified by histopathology and surgery were analyzed retrospectively, 35 patients underwent the CT scan, of which four cases also underwent MRI scan and enhanced scan. Results The CT features of fungus ball in the paranasal sinus were as fol-lows： ①Lesions were unilateral （100%）. ②The maxillary sinuses were infected more commonly than the other paranasal sinuses （80%）,and some broke into the ipsilateral nasal cavity; followed by the sphenoid sinus （14%）. ③The density of lesions was unhomogeneous and the patch, flocculent or ribbon calcifications were seen in the lesions （89%）. ④Destruction of bone （74%） with limited hyperostosis （9%）. MRI findings were as follows： isointensity signal in T1WI and low intensity signal in T2WI were showed in the center of the lesion ; low intensity signal in T1WI and high intensity signal in T2WI were showed in the surrounding thickening mucous membranes. By enhanced scan, the center of the lesion was not enhanced while the surrounding thickening mucosa was enhancned significantly. Conclu-sion The mainly CT feature of non-invasive fungal sinusitis have calcification inside the lesions, which is the basis of diagnosis. CT scanning can provide important diagnostic information. MRI can show the location of fungus ball, offer-ing aid to the diagnosis.