慢性侵袭性真菌性鼻窦炎的CT和MRI诊断

CT and MRI diagnosis of chronic invasive fungal sinusitis

目的探讨慢性侵袭性真菌性鼻窦炎的CT和MRI表现及诊断价值。方法回顾性分析经手术、组织病理学证实的10例慢性侵袭性真菌性鼻窦炎的影像学资料。结果慢性侵袭性真菌性鼻窦炎发生于蝶窦5例,上颌窦3例,筛窦2例。CT表现:受累窦腔内充以软组织影,其中1例伴斑点状钙化;窦壁骨质破坏,同时伴周围骨质增生肥厚。MRI表现:T1WI为低信号(与脑实质比较,以下相同)2例,等信号7例;T2WI信号不均匀,7例以低信号为主,2例以高信号为主;增强后病变明显强化。侵犯邻近结构:眼眶9例,其中6例累及眶尖区,可见不规则软组织肿块影,与邻近眼外肌分界不清楚,7例包绕视神经;6例侵犯海绵窦,可见形态不一的软组织影;脑膜增厚、强化5例,3例侵犯脑实质,表现为水肿1例,肉芽肿2例;4例侵犯翼腭窝及颞下窝;3例鼻咽部软组织增厚;2例上颌神经和1例下颌神经明显增粗、强化;3例面颊部软组织肿胀;1例硬腭骨质破坏。结论窦壁骨质破坏伴硬化、MRT2WI低信号、易侵犯眶尖及海绵窦为本病特征性影像学表现。结合CT和MRI2种检查方法能够对本病的诊断、鉴别和治疗提供更可靠的信息。

Objective To study the CT and MR! features of chronic invasive fungal sinusitis and to assess their diagnostic value. Methods CT and MRI findings of ten cases of chronic invasive fungal sinusitis verified by histopathology and surgery were analyzed retrospectively. Results Out of 10 patients,the lesion of chronic invasive fungal sinusitis occured from sphenoid sinus in 5, from maxillary sinus in 3,and from ethmoidal sinus in 2. On CT scans, the affected sinuses were filled with soft tissues. Punctate calcification was seen in only one case. The bony sinus walls showed destruction with bony sclerosis and thickening in all 10 cases. On MR imaging, the lesions showed hypointense signal in 2 cases and isointense signal in 7 cases with respect to that of the brain on T1WI. On T2WI, 7 cases showed chiefly hypointense singal and chiefly hyperintense singal in 2 cases. Marked postcontrast enhancement was evident. The lesion extended into the orbit in 9 cases. The lesions invaded cavernous sinus in 6 cases. Meningeal thickening and enhancement were found in 5 cases. The lesion invaded pterygopalatine fossa and infratemporal fossa in 4 cases. The soft tissue in nasopharyngeal region was thickened in 3 cases. The maxillary nerve and mandibular nerve revealed marked thickening and enhancement in 2 cases and 1 case respectively. Swelling of the anterior periantral soft tissue was found in 3 cases and massive bony erosion of hard palate in 1 case.Conclusion Destruction of bony sinus wall with sclerosis ,hypointense signal on MR T2WI and invasion of orbital apex and cavernous sinus are typical imaging signs of chronic invasive fungal sinusitis. Both CT and MRI can provide accurate information for diagnosis, differential diagnosis and therapy of chronic invasive fungal sinusitis.