先天性梨状窝瘘的影像特征  

Comparative imaging studies of congenital pyriform sinus fistula

作　　者：梁璐[1,2] 陈良嗣[1] 周正根[3] 张贝[1] 黄舒玲[1] 许咪咪[1] 罗小宁[1] 卢仲明[1] 张思毅[1] 

机构地区：[1]广东省医学科学院广东省人民医院耳鼻咽喉头颈外科,广州510080 [2]南方医科大学第二临床学院,广州510515 [3]广东省医学科学院广东省人民医院放射科

出　　处：《中华放射学杂志》2016年第3期196-200,共5页Chinese Journal of Radiology

基　　金：“十二五”国家科技支撑计划（2013BAI07B00）

摘　　要：目的探讨先天性梨状窝瘘（CPSF）的影像特征。方法回顾性分析2007年1月至2014年12月，经手术和病理证实的80例CPSF患者的临床及术前影像检查资料。影像检查项目包括下咽造影（BSX）、CT、MRI中的至少一项。63例行BSX检查；42例行CT平扫及增强扫描，其中40例在行BSX检查后即行CT扫描；32例行MRI平扫及增强扫描。根据年龄将患者分为低龄组（≤14岁）和大龄组（〉14岁），并根据炎症表现分为炎症期和静止期。观察CPSF患者的BSX、CT、MRI表现，并计算不同影像检查的阳性率。采用x。检验比较低龄组与大龄组、炎症期与静止期患者各种检查诊断阳性率的差异。结果63例行BSX检查的患者中，35例可见梨状窝窦道形成，9例可见梨状窝瘘管形成。BSX检查的诊断阳性率为74．6％（47／63）。低龄组和大龄组患者的BSX诊断阳性率分别为46．2％（12／26）、94．6％（35／37），炎症组和静止组间患者的BSX诊断阳性率分别为52．9％（9／17）、82．6％（38／46），差异均有统计学意义（χ2值分别为18．911、5．766，P值均〈0．05）。CT检查的阳性率为85．7％（36142）。BSX联合CT的诊断阳性率为87．5％（35140）。MRI诊断的阳性率为84．4％（27／32）。CPSF在CT和MRI上，表现为颈部窦道和（或）瘘管形成，环甲关节内侧、下缘或甲状腺上极组织内含气腔隙，甲状腺形态改变，颈部炎性改变等。低龄组和大龄组间、炎症组和静止组间CT、MRI诊断阳性率的差异均无统计学意义（P均〉0．05）。结论BSX可作为疑似CPSF静止期的初筛手段，检出率受年龄及是否有炎症影响。CT和MRl可提供CPSF诊断的直接和间接信息。BSX联合CT可提高诊断阳性率。Objective To investigate the image features of congenital pyriform sinus fistula （CPSF）. Methods We retrospectively analyzed the clinical features and preoperative images of 80 patients with confirmed diagnosis of CPSF by surgical and pathological outcome in Guangdong general hospital from January 2007 to December 2014. At least one of the following imaging examinations were performed for all the patients, including Barium swallow X-ray （BSX）, CT and MRI. Among them, 63 patients were examined with BSX, while 42 patients underwent plain and enhanced CT scans, wherein 40 of them were exanimated shortly after BSX. Thirty-two patients underwent plain and enhanced MRI scans. Patients were divided into two groups according to their age, young age group （≤14 years old） and older age group （〉14 years old）. Furthermore, they were also grouped based on inflammatory or quiescent stage clinically. The images of BSX, CT, and MRI from the patients were analyzed and the positive diagnostic rates （PDR） between groups were compared by using χ2 tests. Results For the patients examined with BSX, sinuses in 35 of 63 were depicted from pyriform and fistulas in 9 of 63 were depicted h-ore the pyriform. The overall PDR of BSX was 74.6% （47/63）,wherein 46.2% （12/26） in young age group, 94.6% （35/37） in older age group, 52.9% （9/17） in inflammatory stage group ,and 82.6% （38/46）in quiescent stage group. The inter-group differences were statistically significant （χ2 were 18.911 and 5.766,both P〈O.05）. The PDR of CPSF with CT was 85.7% （36/42）, MRI was 84.4%（27/32）, BSX＋CT was 87.5% （35/40）. The courses of fistula or sinus were showed on CT and MRI. The presence of air bubbles at the inferomedial edge of cricothyroid joints or around the upper lobe of the thyroid gland, the changes of the morphology of thyroid grand as well as the inflammatory change along the fistula region were detected much clearly on CT and MRI. There was no statistical difference between CT and MRI grou

关 键 词：先天畸形 体层摄影术 X线计算机 磁共振成像 先天性梨状窝瘘 下咽 造影 

分 类 号：R762[医药卫生—耳鼻咽喉科] R816.96[医药卫生—临床医学]