额隐窝区域多排螺旋CT的影像学观察

Spiral computed tomographic analysis of frontal recess regions

目的通过观察正常额隐窝区域的 CT 影像学特征,加深对额隐窝区域部分重要解剖标志的认识。方法选择49例(98侧)无额窦疾病症状且额隐窝区域无病变表现的患者,对头部行16排螺旋 CT 扫描(螺距0.562,扫描层厚0.625mm,层距0.3mm),然后在图像工作站上进行冠状位、矢状位和水平位图像重建(层厚0.625mm,窗宽+2000HU,窗位+200HU)。观察 CT 影像上鼻丘气房、钩突上端附着点、终末隐窝、额气房、筛泡上气房、额泡气房和额窦内间隔气房等解剖标志的出现比率。结果鼻丘气房的出现率为94%(92/98)。钩突前上部参与构成鼻丘气房的内壁、上壁、下壁和后壁,后上部向上可有单一附着点(65%,64/98)或两个附着点(35%,34/98)。钩突后上端的单一附着点主要位于眶纸板(53%,52/98),也可附着于中鼻甲(9%)或颅底(3%)。钩突后上部的两个附着点主要附着于眶纸板和颅底(24%),也可附着于眶纸板和中鼻甲(10%),仅1侧(1%)附着于颅底和中鼻甲。87%(85/98)的钩突后上端在眶纸板上有附着点,与眶纸板接合部的下方形成终末隐窝。额气房的出现率为33%(32/98),其中Ⅰ型最多见(23%)、Ⅱ型(2%)和Ⅲ型(7%)少见,未见Ⅳ型额气房。筛泡上气房、额泡气房和额窦间隔气房的出现率分别为31%、7%和14%。结论多排螺旋 CT 实现了单次扫描、多平面(多角度)、多参数重复成像,为有效地辨认额隐窝区域复杂的局部解剖特征提供了有益的帮助。

Objective The purpose of the study was to determine the prevalence of frontal recess cells in Chinese patients who did not have frontal sinus disease related symptoms. Methods Forty-nine Chinese patients without frontal sinus disease symptoms were undergone spiral computed tomography （CT）. Then multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation. Results The prevalence of agger nasi cell was 94% （92/98）. Sixty-four uneinate processes （65%, 64/98 ） had one superior attachment for each uneinate process, the other thirty-four uneinate processes （35% , 34/98 ） had two superior attachments for each uncinate process. The uncinate process＇ single superior attachment into the surrounding structures was identified to have the following distribution： 53% （52/98） to the lamina papyraeea, 9% （9/98） to the middle turbinate, 3% （3/98） to the skull base. Most of the uneinate process＇ two superior attachments were either into the lamina papyraeea and the skull base （24% , 23/98 ） or into the lamina papyraeea and the middle turbinate （ 10%, 10/98 ）. Only one uneinate process （1%） superiorly attached to the skull base and the middle turbinate. The prevalence of reeessus terminalis was 87 % （ 85/98 ）. Of all the frontal cells identified in 32 sides （33 % ） of frontal recesses, the prevalence of type I , type Ⅱ , type Ⅲ and type Ⅳ cells were 23% （ 23 sides ） , 2% （2 sides）,7% （7 sides ） and 0% （0 side） respectively. Suprabnllar cell, frontal bullar cell and interfrontal septal cell were identified in 30 sides （31%）, 7 sides （7%） and 7 patients （14%） respectively. Conclusions The result characterized normal frontal recess pneumatization in Chinese. That, together with the variations of the uneinate process＇ superior attachment emphasized the roles of agger nasi cell and the uneinate process in endoscopic frontal sinus surgery.