HRCT及MRI对鼻腔-副鼻窦出血坏死性息肉及内翻性乳头状瘤的鉴别诊断价值  

The value of differential diagnosis between inverted papilloma and hemorrhagic necrotic nasal polyps in nasal cavity and sinus by HRCT and MRI

作　　者：李毅敏[1] 詹阿来[1] 黄庆文[1] 

机构地区：[1]福建医科大学附属漳州市医院影像科,福建漳州363000

出　　处：《医学影像学杂志》2016年第6期967-971,共5页Journal of Medical Imaging

摘　　要：目的探讨HRCT及MRI在鼻腔-副鼻窦出血坏死性鼻息肉及内翻性乳头状瘤鉴别诊断中的价值。方法对经手术病理证实的54例内翻性乳头状瘤及22例出血坏死性鼻息肉患者的一般资料、临床表现、HRCT及MRI影像资料进行回顾性分析。结果出血坏死性鼻息肉的发病年龄低于内翻性乳头状瘤(P<0.05)。生长方式上,部分出血坏死性鼻息肉表现为膨胀性生长,而内翻性乳头状瘤则无此特点。病灶周围局部骨质破坏是内翻性乳头状瘤恶变的重要提示。在CT平扫上,出血坏死性鼻息肉密度高于内翻性乳头状瘤(P<0.05),出血坏死性鼻息肉CT增强各期表现为渐进性强化,而内翻性乳头状瘤强化峰值出现于实质期,延迟期强化减低。MRI上出血坏死性鼻息肉中的出血成分表现为T1WI高信号,T2WI低信号,增强后表现为结节状明显不均匀强化,内翻性乳头状瘤表现为片状相对均匀强化。结论出血坏死性鼻息肉及内翻性乳头状瘤的影像学表现有一定区别,HRCT增强扫描及MRI在两者的鉴别诊断上有重要意义。Objective To inverstigate the value of differential diagnosis between inverted papilloma and hemorrhagic necrotic nasal polyps in nasal cavity and sinus by HRCT and MRI. Methods General information,clinical manifestation,HRCT and MRI findings of 54 patients with inverted papilloma and 22 patients with hemorrhagic necrotic nasal polyp confirmed by surgically and pathologically were analyzed retrospectively. Results The onset age of hemorrhagic necrotic nasal polyps was younger than inverted papilloma（ P〈0. 05）. Hemorrhagic necrotic nasal polyps showed extensive growth in mode of growth,and inverted papilloma without this feature. Local bone destruction surrounding lesions was an important characteristic for malignant transformation of inverted papilloma. On noncontrast CT scan,the density of hemorrhagic necrotic nasal polyps was higher than inverted papilloma（ P〈0. 05）. On contrast-enhanced CT,hemorrhagic necrotic nasal polyps showed progressive enhancement,and inverted papilloma showed strengthening peak appeared in nephrographic phase,then enhanced degree was reduced in delayed phase. On MRI scan,bleeding component in hemorrhagic necrotic nasal polyps appeared hyperintense in T1 WI and hypointense in T2 WI. On contrast-enhanced MR,hemorrhagic necrotic nasal polyps showed nodular enhancement and inverted papilloma showed relative homogenous enhancement. Conclusion Inverted papilloma and hemorrhagic necrotic nasal polyps were demonstrated a certain distinction on imaging findings,contrast-enhanced HRCT and MRI scanning have great value in differential diagnosis.

关 键 词：内翻性乳头状瘤 出血坏死性鼻息肉 体层摄影术 X线计算机 磁共振成像 

分 类 号：R739.62[医药卫生—肿瘤] R445[医药卫生—临床医学]