上颌窦出血坏死性息肉的CT和MRI特点  

Computed tomography and magnetic resonance imaging features of maxillary hemorrhagic necrotizing polyps

作　　者：查洋 吕威 亓放 王晓巍 高志强 ZHA Yang;LV Wei;QI Fang;WANG Xiaowei;GAO Zhiqiang(Department of Otolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China)

机构地区：[1]中国医学科学院/北京协和医院耳鼻咽喉头颈外科,北京100730

出　　处：《山东大学耳鼻喉眼学报》2018年第4期37-42,共6页Journal of Otolaryngology and Ophthalmology of Shandong University

摘　　要：目的探讨上颌窦出血坏死性息肉的CT和MRI特点,提高术前诊断准确率。方法回顾复习近3年收治的14例上颌窦出血坏死性息肉患者的影像学资料,分析总结其术前鼻窦CT和MRI的特点并讨论其与相似疾病的鉴别要点。结果上颌窦出血坏死性息肉CT主要表现为单侧上颌窦膨胀性病变,常突入中鼻道,可伴有上颌窦多个骨壁的破坏。MRI表现为T_1WI等信号、T2WI高信号为主的混杂信号,T2上的高信号病变主体被低信号包绕或分割。T_1WI增强上则表现为特征性的"胚胎样"结构。部分病例CT表现与一部分真菌性鼻窦炎、内翻乳头状瘤以及上颌窦癌有相似之处。但这些病的MRI表现各异,可资鉴别。结论相较于单一的鼻窦CT检查,CT结合MR影像可提供更多的诊断信息以提高上颌窦出血坏死性息肉的术前诊断准确性,有助于术前预估内镜下手术方案,有利于与患者沟通病情。Objective To improve the accuracy of preoperative diagnosis by determining the computed tomography（CT） and magnetic resonance imaging（MRI） features of maxillary hemorrhagic necrotizing polyps.Methods We retrospectively reviewed 14 cases of maxillary hemorrhagic necrotizing polyps diagnosed and operated in the last 3 years.We studied the CT and MR images of these patients and determined the imaging features of the disease and the key points for differential diagnosis.Results The main features observed on CT imaging included an expansive lesion that led to bone destruction and a soft tissue mass extending to the middle meatus.The main portion of the lesion had intermediate signal intensity on T1-weighted imaging（T_1WI） and high signal intensity on T_2WI,surrounded or divided by bands or strips of low signal intensity on T2 WI.The＂embryo sign＂on enhanced T_1WI is a unique feature of the disease.Some cases have similar CT imaging features to those of fungal sinusitis,inverted papilloma,and maxillary carcinoma.However,these diseases have different features on MRI,which can provide more information for differential diagnosis.Conclusion Compared with CT alone,combined CT and MRI can provide more information on maxillary hemorrhagic necrotizing polyps to enable surgeons to make a more accurate diagnosis before surgery.It is useful in the planning of endoscopic surgery and communicating with patients.

关 键 词：上颌窦 出血 息肉 内翻乳头状瘤 上颌窦肿瘤 

分 类 号：R765.23[医药卫生—耳鼻咽喉科]