变应性真菌性鼻窦炎CT影像特征  

Characteristics of computed tomography of allergic fungal sinusitis

作　　者：周兵[1] 刘铭[1] 韩德民[1] 王振常[2] 张罗[1] 鲜军舫[2] 刘华超[1] 黄谦[1] 张永杰[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [2]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第7期493-496,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市科委合作项目(9555103100);北京市自然科学基金资助项目(7012008)

摘　　要：目的回顾性总结变应性真菌性鼻窦炎CT影像表现,并与手术中所见比较,探讨其CT影像特征及其在诊断中的参考作用。方法收集21例确诊为变应性真菌性鼻窦炎患者的CT影像资料。男17例,女4例;年龄15岁-50岁。鼻窦CT扫描采用骨窗和软组织窗扫描。术前行鼻内镜检查、皮肤点刺变态反应皮试、总IgE及鼻分泌物嗜酸粒细胞涂片检查。手术中记录鼻窦和鼻腔病变且与CT影像对照。术后行组织病理学检查和真菌涂片+培养。结果鼻内镜检查见所有病例鼻腔单发或多发半透明粉白色息肉,周围稀薄黄色或黏白色分泌物。9例11侧鼻腔可见果酱样黄褐色黏着分泌物。鼻窦CT扫描提示单侧鼻窦发病10例(10侧),双侧病变为11例(22侧);单侧或双侧病变全组鼻窦均受累;鼻窦腔散在均匀高密度影,呈毛玻璃样特征,周边为软组织影,3例4侧颅底骨质吸收,1例颅内侵犯。20例行鼻内镜手术,1例行双冠经路+鼻内镜手术。术中见17例窦腔有果酱样黄褐色黏着分泌物(黏蛋白),4例窦腔为褐绿色泥样分泌物。随访6个月至7年,治愈14例,好转7例,其中3例术后2年再手术。结论鼻窦CT扫描显示鼻窦腔内片状毛玻璃样高密度影,可伴骨质吸收或侵袭性生长,为变应性真菌性鼻窦炎具有诊断意义的影像检查特征。Objective To sum up the characteristics of computed tomography of allergic fungal sinusitis （AFS） and to compare the CT changes with the findings in the operation. The diagnostic role of CT scan was discussed. Methods The CT scans of 21 patients diagnosed as AFS were analyzed. The patients ranged from 15 to 50 years old,there were 17 males and 4 females. The CT was scanned with both bony and soft tissue windows. The preoperative examinations included nasal endoscopy, skin prick test, total serum IgE and nasal secretion smear. The findings in the operation were compared with the preoperative CT scans. Histopathology and fungal smear were done postoperatively. Results Endoscopy showed that all patients had polyps with washy yellow or inspissated white secretion. Nine cases （11 sides） showed yellow-to-brown material similar to peanut butter in the nasal cavities. Nasal CT scan demonstrated unilateral lesion in 10 cases （10 sides） and bilateral lesions in 11 cases （22 sides） , who were all pansinus diseases. CT scan demonstrated a sheet areas of high-attenuation like ＂ ground glass＂ within sinuses coupled with soft tissue image around them. Bone erosion of anterior skull base was encountered in 3 cases （ 4 sides）. One case showed the intracranial extension. Twenty cases had conceived nasal endoscopic sinus surgeries. One case underwent endoscopic sinus surgery combined with coronal approach. The yellow-to-brown material （ allergic mucin） was detected in the cavities of 17 cases. Four cases had green-to-brown secretion like mud. After follow-up of 6 months to 7 years, 14 eases were cured,7 cases improved. Among them, 3 cases had to get revision surgeries because of recurrence 2 years after surgery. Conclusions The characteristic of a sheet area of high-attenuation like ＂ ground glass＂ within sinuses coupled with soft tissue image around them in computed tomography of nasal sinus, accompanied with invasive expansion or bone erosion, has a diagnostic significance for AFS.

关 键 词：超敏反应 真菌 鼻窦炎 体层摄影术 X线计算机 

分 类 号：R763[医药卫生—耳鼻咽喉科]