真菌球型上颌窦炎98例影像学特征分析  

Radiologic characteristics of fungus ball maxillary sinusitis:an analysis of 98 cases

作　　者：冯燕军 王建宏[1] 闫素英[1] 李希平[1] 于玮[2] 商建峰[2] FENG Yanjun;WANG Jianhong;YAN Suying;LI Xiping;YU Wei;SHANG Jianfeng(Department of Otolaryngology Head and Neck Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,China;Department of Pathology,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,China)

机构地区：[1]首都医科大学附属北京安贞医院耳鼻咽喉头颈外科,北京100029 [2]首都医科大学附属北京安贞医院病理科,北京100029

出　　处：《中国耳鼻咽喉头颈外科》2021年第3期163-166,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨真菌球型上颌窦炎的影像学特征。方法回顾性分析98例经手术病理证实的真菌球型上颌窦炎患者的临床和CT、MRI影像学资料。所有患者均行鼻窦CT检查,其中20例行MRI检查。结果 CT显示上颌窦内或窦口鼻道复合体有典型钙化灶的钙化型76例(77.6%),非钙化型22例(22.4%)。上颌窦壁骨质增生72例(73.5%),其中钙化型56例,非钙化型16例(P>0.05)。骨质破坏46例(46.9%),其中钙化型31例,非钙化型15例(P<0.05)。伴发其他鼻腔鼻窦病变10例(10.2%),分别为鼻腔息肉7例、上颌窦出血坏死性息肉2例、上颌窦癌1例,术前CT未能准确识别。MRI检查20例,病变主体T1WI呈等信号为主,混杂少许高信号或低信号;T2WI呈明显高低不均匀的混杂信号,尤其是特征性低信号的真菌球周围环绕反差明显高信号带"岛征"最具特点。结论真菌球型上颌窦炎影像学表现多变。CT显示钙化灶和骨质增生具有较高的诊断价值,但应避免漏诊伴发疾病,MRI上T2WI呈现"岛征"有助于确诊。OBJECTIVE To investigate the radiographic characteristics of fugal ball maxillary sinusitis.METHODS Ninety-eight patients were reviewed who underwent endoscopic sinus surgery and pathologically proven as a maxillary fungal ball.All were subjected to preoperative computed tomography(CT) scan,and 20 patients were examined by magnetic resonance imaging(MRI).RESULTS CT showed 76 cases(77.6%) with typical calcifications in maxillary sinuses or the ostiomeatal complex and 22 non-calcification cases(22.4%).There were 72 cases(73.5%) with sinus wall hyper-osteogenesis,including 56 cases of calcification type and 16 cases of non-calcification type(P>0.05).Bone destructions were confirmed in 46 cases(46.9%),including 31 cases of calcification type and 15 cases of non-calcification type(P<0.05).There were 10 cases(10.2%) associated with concurrent sinonasal diseases,including 7 nasal polyps,2 maxillary hemorrhagic necrotizing polyps,and 1 maxillary carcinoma.MRI examination of 20 cases revealed that the primary lesions appeared isointense on T1-weighted images mixed with little area of hyper or hypointense signal,and heterogeneous intense on T2-weighted images.Specifically,T2-weighted images showed the particular hypointense fungus ball surrounded dramatically high signal zone(the ’island sign’) was the most characteristic.CONCLUSION The imagingfeatures off ugal ball maxillary sinusitis are variable.Calcifications and hyper-osteogenesis on CT have high diagnostic value,but misdiagnosis of concomitant diseases should be avoided;The ’island sign’ on T2-weighted MR images is helpful to the final diagnosis.

关 键 词：真菌病 鼻窦炎 上颌窦炎 体层摄影术 X线计算机 磁共振成像 真菌球 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]