儿童急性鼻窦炎颅眶并发症的CT和MRI表现  

CT and MRI Features of Orbitocranial Complications Secondary to Pediatric Acute Sinusitis

作　　者：王永哲[1] 杨本涛[1] 鲜军舫[1] 陈光利[1] 燕飞[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《临床放射学杂志》2016年第3期338-341,共4页Journal of Clinical Radiology

摘　　要：目的探讨儿童急性鼻窦炎颅眶并发症的CT和MRI表现,提高对其影像学表现的认识。方法回顾性分析26例经临床证实的儿童急性鼻窦炎颅眶并发症的影像资料,16例行CT平扫检查,所有病例均行MRI检查。结果 26例患者中眼眶并发症23例,颅内并发症3例。根据Chandler对儿童急性鼻窦炎眼眶并发症的分型,眶隔前蜂窝织炎2例,CT表现为眼睑、面颊部肿胀,MRI肿胀的软组织T_1WI呈等信号,T_2WI呈高信号,眶隔后肌锥内外间隙清晰;眶隔后蜂窝织炎5例,CT表现为眼睑、面颊部肿胀并眶隔后肌锥内外间隙模糊不清,MRI炎性水肿组织表现为T_1WI呈等信号,T_2WI呈高信号,肌锥内外间隙脂肪信号存在,增强后,病变累及范围内有强化;骨膜下脓肿16例,CT表现为眼眶内下象限肌锥外间隙软组织密度影,多呈梭形,11例眼眶内壁、下壁骨质有不同程度破坏,MRI表现为T_1WI低信号,T_2WI高信号,增强后脓肿壁明显强化。儿童急性鼻窦炎颅内并发症主要为脑膜炎及硬膜下脓肿,CT表现为前颅底、额部颅板下新月形低密度影,MRI脓腔T_1WI低信号,T_2WI高信号,增强扫描脓肿内外壁均明显强化,脑表面见脑沟回样强化。结论 CT和MRI的联合检查可明确儿童急性鼻窦炎颅眶并发症的类型、范围、部位,对临床治疗方案的制定以及随访观察具有重要的指导意义。Objective To study the CT and MRI features of orbitocranial complications secondary to pediatric acute si- nusitis and raise the recognition of its imaging findings. Methods Orbitocranial complications secondary to pediatric a- cute sinusitis in 26 cases proven by clinical treatment were analyzed retrospectively. CT was performed in 16 cases, MRI in all 26 cases. Results The 26 cases comprised of 23 orbital complications and 3 intracranial complications. Cases with orbital complications were assessed according to Chandler＇s classification. Two cases with pre-septal cellulitis： CT only dis- played the swelling on the eyelid and face, which showed isointensity on MR TI WI and hyperintensity on T2 WI without post-septal extension; five cases with post-septal cellulitis ： there was swelhng on the eyelid and face with blurred post-sep- tal fat space was seen on CT. MR] showed inflammatory edema in the intraconal and extraconal fat space, the involved ex- tent of inflammation revealed marked enhancement after the injection of contrast. Sixteen cases with subperiosteal abscess ： the lesion showed soft tissue density with a fusiform shape located in the medial or inferior extraconal space. Medial and in- ferior orbital walls were eroded in 11 cases. The abscess demonstrated low signal intensity on T^WI and high signal intensity on T2WI, the strongly enhanced abscess wall was revealed on contrast enhanced MRI. The intracranial complications in 3 cases included meningitis and subdural empyema. The subdural empyema showed crescentic hypodenstiy in the anterior skull base and frontal part. Lesions demonstrated hypointensity on T, WI and hyperintensity on T2WI. The peripheral marked enhancement was seen on contrast enhanced MRI. Conclusion It is of important significance for the combined examination of MRI and CT in clinical treatment and follow-up observation for the correct evaluation of orbitocranial compli- cations secondary to pediatric acute sinusitis.

关 键 词：急性鼻窦炎 并发症 蜂窝织炎 体层摄影术 X线计算机 磁共振成像 

分 类 号：R765.41[医药卫生—耳鼻咽喉科] R816.92[医药卫生—临床医学]