本文選題：鼻腔鼻竇炎　切入點：真菌　出處：《中國醫(yī)學(xué)計算機(jī)成像雜志》2017年02期

【摘要】：目的:通過分析慢性侵襲性真菌性鼻腔鼻竇炎(CIFR)的影像學(xué)表現(xiàn),提高本病的診斷率。方法:回顧性分析經(jīng)病理證實的16例CIFR的臨床和影像資料,16例均行CT檢查(10例平掃,6例增強(qiáng)掃描),其中5例行MRI平掃及增強(qiáng)檢查(3例加擴(kuò)散加權(quán)成像)。結(jié)果:(1)部位:發(fā)生于上頜竇者7例,蝶竇5例,篩竇3例,上鼻道1例。(2)CT表現(xiàn):竇腔內(nèi)軟組織影,CT平掃中等或稍低密度,6例病灶內(nèi)有鈣化,增強(qiáng)掃描后呈不均勻強(qiáng)化;骨質(zhì)增生硬化或伴吸收破壞各7例,單純骨質(zhì)吸收破壞2例。(3)MRI表現(xiàn):T1WI等信號,T2WI等或低信號,增強(qiáng)后明顯不均勻強(qiáng)化,擴(kuò)散受限,平均表觀擴(kuò)散系數(shù)值(ADC)為0.516±0.128(×10-3mm2/s)。(4)鄰近結(jié)構(gòu)侵犯:侵犯眼眶6例,其中眶尖區(qū)5例,眶底1例;眶下裂區(qū)5例;海綿竇及翼腭窩各4例;顳下窩及鼻咽頂各3例;上頜神經(jīng)3例;視神經(jīng)2例;腦膜和顳葉各1例。結(jié)論:CT可顯示病灶內(nèi)鈣化及周圍骨質(zhì)受累情況,常規(guī)MRI聯(lián)合DWI對明確本病診斷提供更多的信息。
[Abstract]:Objective: to improve the diagnostic rate of chronic invasive fungal sinusitis by analyzing the imaging findings of CIFR.Methods: the clinical and imaging data of 16 cases of CIFR proved by pathology were retrospectively analyzed. Ct scans were performed in 10 cases and plain scan in 6 cases, of which 5 cases were performed with MRI plain scan and 3 cases with diffusion-weighted imaging.Results: the lesions occurred in 7 cases of maxillary sinus, 5 cases of sphenoid sinus, 3 cases of ethmoid sinus and 1 case of superior nasal canal.There were 7 cases of osteogenesis sclerosis and 7 cases of resorption destruction, 2 cases of simple bone resorption and destruction of bone, and 2 cases of simple bone resorption. MRI showed iso-or hypointensity on T _ 1WI. After enhancement, the enhancement was not homogeneous and the diffusion was limited.The mean apparent diffusion coefficient was 0.516 鹵0.128 (脳 10-3mm ~ (-2) / s ~ (-1)), including 6 cases of orbital invasion, 5 cases of orbital apical region, 1 case of orbital floor, 5 cases of inferior orbital fissure area, 4 cases of cavernous sinus and pterygopalatine fossa, 3 cases of infratemporal fossa and 3 cases of nasopharyngeal roof, 3 cases of maxillary nerve, and 3 cases of infratemporal fossa and nasopharyngeal roof, respectively.There were 2 cases of optic nerve, 1 case of meningeal and 1 case of temporal lobe.Conclusion the calcification and the surrounding bone involvement in the lesions can be demonstrated by CT scan. Routine MRI combined with DWI can provide more information for the diagnosis of the disease.
【作者單位】： 復(fù)旦大學(xué)附屬金山醫(yī)院放射科;復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院放射科;復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院病理科;
【基金】：上海市醫(yī)學(xué)重點建設(shè)專科No.ZK2015A05~~
【分類號】：R445.2;R765;R816.96

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