慢性侵袭性真菌性鼻腔鼻窦炎影像学表现  

Imaging Findings of Chronic Invasive Fungal Rhinosinusitis

作　　者：钟玉凤[1,2] 唐作华[2] 强金伟[1] 王纾宜[3] 钱雯[2] 肖泽彬[2] 王容[2] 

机构地区：[1]复旦大学附属金山医院放射科 [2]复旦大学附属眼耳鼻喉科医院放射科 [3]复旦大学附属眼耳鼻喉科医院病理科

出　　处：《中国医学计算机成像杂志》2017年第2期113-117,共5页Chinese Computed Medical Imaging

基　　金：上海市医学重点建设专科No.ZK2015A05~~

摘　　要：目的:通过分析慢性侵袭性真菌性鼻腔鼻窦炎(CIFR)的影像学表现,提高本病的诊断率。方法:回顾性分析经病理证实的16例CIFR的临床和影像资料,16例均行CT检查(10例平扫,6例增强扫描),其中5例行MRI平扫及增强检查(3例加扩散加权成像)。结果:(1)部位:发生于上颌窦者7例,蝶窦5例,筛窦3例,上鼻道1例。(2)CT表现:窦腔内软组织影,CT平扫中等或稍低密度,6例病灶内有钙化,增强扫描后呈不均匀强化;骨质增生硬化或伴吸收破坏各7例,单纯骨质吸收破坏2例。(3)MRI表现:T1WI等信号,T2WI等或低信号,增强后明显不均匀强化,扩散受限,平均表观扩散系数值(ADC)为0.516±0.128(×10-3mm2/s)。(4)邻近结构侵犯:侵犯眼眶6例,其中眶尖区5例,眶底1例;眶下裂区5例;海绵窦及翼腭窝各4例;颞下窝及鼻咽顶各3例;上颌神经3例;视神经2例;脑膜和颞叶各1例。结论:CT可显示病灶内钙化及周围骨质受累情况,常规MRI联合DWI对明确本病诊断提供更多的信息。Purpose： To analyze the imaging features of chronic invasive fungal rhinosinusitis and to improve the recognition and diagnosis of it. Methods： Sixteen cases of surgical and pathological result confirmed chronic invasive fungal rhinosinusitis （CIFR） were retrospectively analyzed. All patients underwent CT examination （10 plain scans and 6 enhanced scans）, and 5 cases underwent MRI plain scans and enhanced scans （3 cases with diffusion weighted imaging）. Results： （1） Location： Of 16 CIFR patients, the lesions occurred from maxillary sinus in 7, from sphenoid sinus in 5, from ethmoid sinus in 3 and from nasopharynx in 1 case. （2） CT findings： the affected sinuses were filled with soft tissues with medium or low density on CT plain scan and moderate and heterogeneous enhancement on enhanced scan. Calcifications were seen in 6 cases, simple sclerosis of sinus bone wall was seen in 7 cases, sclerosis with bone absorption in 7 cases and simple bone absorption and destruction in 2 cases. MRI findings： the lesion was iso-intensity on T1WI, iso- or hypo-intensity on T2WI with an avidly inhomogeneous enhancement and restricted diffusion. The average apparent diffusion coefficient （ADC） value was 0.516±0.128×10^-3mm2/s. （3） Invasion of adjacent structures：orbit was invaded the in 6 cases, including orbital apex in 5 cases and orbital floor in 1 case; interior orbital fissure in 5 cases; pterygopalatine fossa in 4 cases; infratemporal fossa in 3 cases; cavernous sinus in 4 cases; nasopharynx top in 3 cases; maxillary nerve in 3 cases; optic nerve in 2 cases; and dura and temporal lobe in 1 case, respectively. Conclusion： CT can clearly demonstrate the lesions of CIFR and the surrounding bone and calcification. MRI combined with DWI can provide more intbrmation for characterization of the lesions.

关 键 词：鼻腔鼻窦炎 真菌 侵袭性 体层摄影术 X线计算机 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]