真菌性鼻窦炎的CT影像学特征分析

Diagnosis of fungal sinusitis with computer tomography

目的总结真菌性鼻窦炎的CT影像学特点并初步探讨真菌性鼻窦炎CT诊断要点。方法观察和记录143例病理确诊的真菌性鼻窦炎患者的鼻窦,比较慢性侵袭性真菌性鼻窦炎和非侵袭性真菌性鼻窦炎（真菌球和变应性真菌性鼻窦炎）的CT影像学特点。结果单窦病变125例,最多见为上颌窦,其次是蝶窦、筛窦;127例（89%）病变鼻窦内不均匀不透光区,101例（71%）病变膨入临近鼻窦或鼻腔;97例（68%）软组织窗位鼻窦内可见CT值80~160Hu的钙化斑（点）。慢性侵袭性真菌性鼻窦炎多窦病变比例高于非侵袭性真菌性鼻窦炎。结论真菌性鼻窦炎的CT特征有单窦病变;病变鼻窦内不均匀的不透光区,病变常膨入临近鼻窦或鼻腔;软组织窗位鼻窦内可见的钙化斑;可有鼻窦骨质压迫性破坏。其中以鼻窦病变内钙化斑最具特异性。早期慢性侵袭性真菌性鼻窦炎的CT特征与非侵袭性真菌性鼻窦炎较相似,但其多窦病变比例较高。

Objective To summarize the computer tomography（CT） characteristics of fungal sinusitis and discuss the diagnostic main points of it with CT examination.Methods The CT characteristics of 143 cases of fungal sinusitis including 23 chronic invasive fungal sinusitis（CIFS）,118 fungal balls and 2 allergic fungal sinusitis diagnosed by histological examinations were observed and analyzed.Results One hundred and twenty-five cases were single sinus lesion and the most commonly infected sinus was the maxillary sinus,followed by the sphenoid sinus and ethmoid sinus.Complete or subtotal heterogeneous opacities of the infected sinus were found in 127 cases,and 97 cases had calcification spots or in the soft tissue window. Compared with non-invasive fungal sinusitis,CIFS had more multi-sinus infected cases with more range of bone lesion area.Conclusions There are four main points for the diagnosis of fungal sinusitis with CT imaging.A single sinus is involved.Complete or subtotal heterogeneous opacity of the infected sinus may expand into the adjacent sinus or nasal cavity in some cases.In the soft tissue window,there are always calcification spots with the CT value between 80 Hu and 160 Hu.Bone destruction may occur in some cases.Among the above,the calcification spot is the mostly specific.Compared with noninvasive fungal sinusitis,CIFS is more likely to infect more sinuses.