不同真菌所致鼻窦真菌球的CT鉴别诊断  

CT differential diagnosis of fungal ball in paranasal sinus caused by different mycotic pathogenic agents

作　　者：陈晓丽[1] 王振常[1] 鲁辛辛[2] 鲜军舫[1] 李静[1] 耿佳靖[2] 

机构地区：[1]首都医科大学附属北京同仁医院影像中心,100730 [2]首都医科大学附属北京同仁医院检验科,100730

出　　处：《中华放射学杂志》2012年第7期611-614,共4页Chinese Journal of Radiology

摘　　要：目的探讨不同真菌所致鼻窦真菌球的cT表现特点及鉴别诊断。方法回顾性分析自2007年至2009年经真菌学和病理检查，确诊为鼻窦真菌球的74例患者的临床及CT资料，男32例、女42例，年龄15-80岁，中位年龄50岁。比较曲霉菌和非曲霉菌所致鼻窦真菌球的病变范围、钙化发生率、部位、形态、窦壁骨质改变及合并症情况。统计学方法采用χ^2检验。结果74例中致病菌以曲霉菌多见，共58例，其中黄曲霉菌36例、烟曲霉菌15例、杂色曲霉菌7例；非曲霉菌共16例，包括青霉菌5例、裂褶菌6例、尖端赛多孢子菌5例。所致鼻窦真菌球在病变范围（曲霉菌单窦病变29例，非曲霉菌单窦病变2例，χ^2=7．245，P=0．007）、累及筛窦的阳性率[曲霉菌为39．7％（23／58），非曲霉菌为81．3％（13／16），χ^2=8．685，P=0．003]、钙化发生率（曲霉菌58例中发生钙化40例，非曲霉菌16例中5例，χ^2=7．485，P=0．006）和钙化部位（曲霉菌4J0例钙化发生部位中央型26例，周围型14例，非曲霉菌5例全部为周围型，χ^2=7．697，P：0．006）上差异有统计学意义；而在病变侧别（0=1．002，P=0．317），上颌窦（χ^2=0．020，P=0．888）、蝶窦（χ^2=0．704，P：0．401）、额窦（χ^2=0．126，P=0．723）受累，窦壁骨质改变（χ^2=2．024，P=0．155），钙化形态（χ^2=2．045，P=0．153）以及合并鼻息肉（χ^2=0．018，P=0．893）或黏膜囊肿（χ^2=0．779，P=0．378）上差异无统计学意义。结论鼻窦真菌球的共同特征是多单侧鼻窦受累，窦腔内密度不均匀增高并可见斑片状钙化。曲霉菌性真菌球的CT特征是不易累及筛窦，钙化多见且多位于病变中心部；非曲霉菌性真菌球的CT特征为易累及筛窦，钙化少见，多位于病变周边部。Objective To evaluate CT characteristics of fungal ball in paranasal sinus caused by different fungi and to enhance differential diagnosis. Methods CT resuhs and clinical data of 74 patients with fungal ball arising from the paranasal sinuses proved by histopathology from 2007 to 2009 were analyzed retrospectively. The CT characteristics of fungal ball in paranasal sinus caused by different fungi were compared using χ^2 test with P 〈 0. 05 considered statistically significant. Results Among 74 mycotic pathogenic agents, aspergillus was found in 58 cases （including 36 cases with aspergillus flavus, 15 cases with aspergillus fumigatus and 7 with aspergillus versicolor）, the others including 5 cases with penicillium, 6 cases with schizophyllum commune, and 5 cases with scedosporium apiospermum. There were significant differences in the number of sinus involved （single sinus involvement was seen in 29 cases caused by aspergillus group and 2 cases caused by non-aspergillus-group, respectively, with χ^2 = 7. 245,P = 0. 007 ）, the incidence of fungus ball in ethmoid sinus [ 39. 7% （23/58） of cases caused by aspergillus group and 81.3% （13/16） of cases caused by non-aspergillus-group, respectively, with χ^2 = 8. 685 ,P = 0. 003 ] and calcification （40 of 58 cases caused by aspergillus group and 5 of 16 cases caused by non-aspergillus-group, respectively, with χ^2 = 7. 485, P = 0. 006 ）, the location of calcification （ 26 of 40 cases with central calcification and 14 of 40 cases with peripheral calcification in cases caused by aspergillus group, while all of 5 cases caused by non-aspergillus-group with peripheral calcification, χ^2 = 7. 697, P = 0. 006）. However, there was no significant difference in the incidence of bilateral lesions （χ^2 = 1. 002, P = 0. 317 ）, maxillarysinus involvement （ χ^2 = 0. 020, P = 0. 888 ）, sphenoidal sinus involvement （χ^2 = 0. 704, P = 0. 401 ）, frontal sinus involvement （ χ^2 = 0. 126, P = O. 723 ）, bony sclerosis （ χ^2 = 2. 024, P = O.

关 键 词：鼻窦 真菌 体层摄影术 X线计算机 

分 类 号：R763[医药卫生—耳鼻咽喉科]