慢性侵袭性真菌性鼻腔鼻窦炎影像学表现

发布时间：2018-04-07 15:17

本文选题：鼻腔鼻窦炎　切入点：真菌　出处：《中国医学计算机成像杂志》2017年02期

【摘要】：目的:通过分析慢性侵袭性真菌性鼻腔鼻窦炎(CIFR)的影像学表现,提高本病的诊断率。方法:回顾性分析经病理证实的16例CIFR的临床和影像资料,16例均行CT检查(10例平扫,6例增强扫描),其中5例行MRI平扫及增强检查(3例加扩散加权成像)。结果:(1)部位:发生于上颌窦者7例,蝶窦5例,筛窦3例,上鼻道1例。(2)CT表现:窦腔内软组织影,CT平扫中等或稍低密度,6例病灶内有钙化,增强扫描后呈不均匀强化;骨质增生硬化或伴吸收破坏各7例,单纯骨质吸收破坏2例。(3)MRI表现:T1WI等信号,T2WI等或低信号,增强后明显不均匀强化,扩散受限,平均表观扩散系数值(ADC)为0.516±0.128(×10-3mm2/s)。(4)邻近结构侵犯:侵犯眼眶6例,其中眶尖区5例,眶底1例;眶下裂区5例;海绵窦及翼腭窝各4例;颞下窝及鼻咽顶各3例;上颌神经3例;视神经2例;脑膜和颞叶各1例。结论:CT可显示病灶内钙化及周围骨质受累情况,常规MRI联合DWI对明确本病诊断提供更多的信息。
[Abstract]:Objective: to improve the diagnostic rate of chronic invasive fungal sinusitis by analyzing the imaging findings of CIFR.Methods: the clinical and imaging data of 16 cases of CIFR proved by pathology were retrospectively analyzed. Ct scans were performed in 10 cases and plain scan in 6 cases, of which 5 cases were performed with MRI plain scan and 3 cases with diffusion-weighted imaging.Results: the lesions occurred in 7 cases of maxillary sinus, 5 cases of sphenoid sinus, 3 cases of ethmoid sinus and 1 case of superior nasal canal.There were 7 cases of osteogenesis sclerosis and 7 cases of resorption destruction, 2 cases of simple bone resorption and destruction of bone, and 2 cases of simple bone resorption. MRI showed iso-or hypointensity on T _ 1WI. After enhancement, the enhancement was not homogeneous and the diffusion was limited.The mean apparent diffusion coefficient was 0.516 卤0.128 (脳 10-3mm ~ (-2) / s ~ (-1)), including 6 cases of orbital invasion, 5 cases of orbital apical region, 1 case of orbital floor, 5 cases of inferior orbital fissure area, 4 cases of cavernous sinus and pterygopalatine fossa, 3 cases of infratemporal fossa and 3 cases of nasopharyngeal roof, 3 cases of maxillary nerve, and 3 cases of infratemporal fossa and nasopharyngeal roof, respectively.There were 2 cases of optic nerve, 1 case of meningeal and 1 case of temporal lobe.Conclusion the calcification and the surrounding bone involvement in the lesions can be demonstrated by CT scan. Routine MRI combined with DWI can provide more information for the diagnosis of the disease.
【作者单位】：复旦大学附属金山医院放射科;复旦大学附属眼耳鼻喉科医院放射科;复旦大学附属眼耳鼻喉科医院病理科;
【基金】：上海市医学重点建设专科No.ZK2015A05~~
【分类号】：R445.2;R765;R816.96

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