额窦引流通道内气房的影像学研究

Multiplayer Spiral Computed Tomographic Analysis of Cells in Frontal Drainage System

【目的】应用多层螺旋CT(MSCT)和Advantage Windows 4.1(AW4.1)影像工作站对额窦引流通道的相关气房进行影像学研究。【方法】采用4层螺旋CT对65例成人,30例正常成人(无额窦炎组)及35例额窦炎患者(额窦炎组)的额窦引流通道行水平位薄层扫描后用Advantage Windows 4.1(AW4.1)影像工作站进行冠状位、矢状位重建,动态分析和比较两组额窦引流通道内出现的相关气房。【结果】①额隐窝内出现的相关气房(无额窦炎组出现率/额窦炎组出现率):终末气房(23.7%/45.5%),前筛气房(15.3%/31.8%),鼻丘气房(13.5%/28.8%);②额窦内出现的相关气房:额气房(22%/42.4%),眶上气房(25.4%/33.3%),额窦中隔气房(20%/27.3%)。两组间额窦引流通道内出现并影响额窦通气引流功能的部分气房(终末气房、前筛气房、鼻丘气房和额气房)出现率的差异有显著性。【结论】采用MSCT和AW4.1工作站能对额窦引流通道的病变和解剖情况做出准确、合理的术前评估,对额窦微创手术方案的制定和术中指导具有一定的临床指导意义。此外,额窦引流通道解剖结构复杂多变,部分额周气房的过度发育可能是额窦引流通道阻塞导致额窦炎的主要原因之一。

[Objective] To study the imageological characteristics of related cells in frontal drainage system with multilayer spiral computed tomographic （MSCT） and Advantage Windows 4.1 （AW 4.1） software. [Methods] Axial lamellate computed tomography scans of frontal drainage system were firstly performed with four layers spiral CT, and coronal, sagittal sections then reconstructed with AW 4.1 software on 65 adults, both frontal sinusitis group （35 cases,66 sides） and control group （30 cases, 59 sides）. Related cells in frontal drainage system were studied and compared dynamically. [Results] （1）Cells in frontal recess： The existence of terminal cells was 45.5% in frontal sinusitis group and 23.7% in control; anterior ethmoid cell 31.8% and 15.3%; agger nasi ceils 28.8% and 13.5%. （2）Cells in frontal sinus： for perifrontal cells there were 42.4% and 22%, respectively; superaorbital cells 33,3% and 25.4%; intersinus septal cells 27.3% and 20%. There was significant difference in frequency of cells in frontal drainage system between sinusitis group and control group, including terminal cell, anterior ethmoid cell, agger nasi cells, and perifrontal cells. [Conclusions ] AW 4. 1 software and MSCT are helpful in preoperative anatomical evaluation for minimum invasive frontal sinus operations and play a guidance role in selection of operation schedule and clinical surgery. Cells in frontal drainage system are complex and various. Over development of some cells arroud frontal sinus leading to obstruction of frontal drainage system may accounts for frontal sinusitis.