CT中骨质变化对鼻腔鼻窦内翻性乳头状瘤的诊断价值

Diagnostic value of osseous diversity on CT to sinonasal inverted papilloma

目的评估鼻腔鼻窦内翻性乳头状瘤的CT影像中骨质变化与肿瘤根蒂部位之间的关系。方法对28例鼻腔鼻窦内翻性乳头状瘤CT中的骨质变化进行分析，并与鼻内镜术中发现的肿瘤根蒂部位进行对比，研究骨质变化与肿瘤根蒂部位之间的关系。结果28例患者中的22例有骨质密度增加、增厚的骨增生影像表现，其中有20例骨增生部位与肿瘤的根蒂部位一致，一致性达71．4％，提示根据骨增生部位可预计肿瘤的根蒂部位。2例骨增生与肿瘤根蒂不一致者，1例根蒂位于钩突，CT表现为中鼻甲前端骨增生；另1例根蒂位于上鼻甲，CT表现为钩突的骨增生。28例中9例CT有气泡征，21例有骨质破坏，19例有骨移位，肿瘤生长产生的压力，可导致不同的骨质破坏或移位表现，根据骨质破坏的部位及移位的方向可大致判断肿瘤的来源。结论鼻腔鼻窦内翻性乳头状瘤的肿瘤根蒂部位与CT影像中的骨增生有较高的一致性，根据骨质破坏或移位也可间接辨别肿瘤的来源，有助于术前评估和制定手术计划。

Objective To evaluate the CT characteristics of osseous diversity in patients with sinonasal inverted papilloma （SIP） and to correlate these characteristics with the origins of tumors. Methods Sinonasal CT images of 28 patients were reviewed retrospectively to detect areas within which there was focal hyperostosis. The correlation between the sites on the CT scans within which there was osseous diversity and the origin of the tumors in the surgery was analyzed. Results Surgical evaluation of 22 lesions with focal hyperostosis in CT images revealed that 20 of these lesions coincided with the actual origin of tumor. The focal hyperostosis on CT images corresponded to the actual tumor origin in 71.4% of cases. It denotes the origin of SIP could be predicted from the focal hyperostosis site. The origin of the other 2 cases were disaccored with the focal hyperostosis site, one case had the origin of uncinate process but hyperostosis of anterior middle turbinate, another case had the origin of superior turhiuate but hyperostosis of uncinate process. Nine lesions of 28 patients had air sign, 21 lesions had bone absorption and destruction and 19 lesions had bone displacement in CT images. The pressure from tumor growth can induce varied bone destruction and displacement, the source of SIP can be estimated by the bone destruction site and displacement direction. Conclusions There has a relatively high concordance between the origin of the SIP and focal hyperostosis on CT, The source of SIP could be discerned indirectly by bone destruction and displacement, these conduce to assess the disease before surgery and make perninent operation.