32例鼻腔副鼻窦恶性肿瘤CT诊断

CT DIAGNOSIS OF PRIMARY MALIGNANT TUMOURS OF NASAL CAVITY AND PARANASAL SINUS

目的：探讨鼻腔副鼻窦ＣＴ检查方法和肿瘤的形态、密度、窦壁骨质破坏、周围脂肪层侵犯、窦腔外软组织肿块等征象在鼻腔副鼻窦恶性肿瘤中的诊断作用。方法：对经病理证实的鼻腔副鼻窦恶性肿瘤３２例和良性肿物１３９例的ＣＴ表现，逐项对比观察分析，统计学处理。结果：冠状位ＣＴ扫描显示１５例恶性肿瘤破坏２５个窦腔骨壁；２０例腔外软组织肿块累及２３个相邻部位。轴位扫描发现骨壁受累１２例，有２０个侧壁骨质显示破坏，１５个腔外肿块累及１８个相邻结构。恶性组和良性组突出于窦腔外的软组织肿块（７１９％／５０％）、窦壁骨质侵蚀性破坏（５９４％／１４４％）、肿瘤对窦腔周围脂肪层的侵犯消失（５６３％／１３７％）的差异有显著性（均Ｐ＜０．０５），而软组织肿块形态不规则和密度不均匀，２组间无显著差异（Ｐ＞００５）。结论：鼻腔副鼻窦腔外软组织肿块、侵蚀性骨质破坏和对窦壁周围脂肪层的侵犯消失，是诊断鼻腔副鼻窦恶性肿瘤的可靠征象。

Objective:To determine the value of mass shape and density,bone destruction,neighbor fat tissue invasion,and soft tissue mass outside the sinus in diagnosing primary malignant tumours of nasal cavity and paranasal sinus.Methods:The CT findings of 32 malignant and l39 benign tumours pathologically proven were analyzed and were compared statistically.Results:Twenty bone erosion in l5 patients and 23 soft tissue mass outsids the sinus in 20 patients were demonstrated with coronal CT scan. Axial CT detected 20 bone destruction in l2 patients and l8 soft tissue mass outsids the sinus in l5 patients.In comparison of malignant and bonign groups, the difference of soft tissue mass outside the sinus(71 9%/5 0%)and bone erosion(59 4%/14 4%),as well as neighbor fat tissue invasion(56 3%/13 7%)were significant( P <0 05),but without significant difference between irregular shape and heterodensity of tumour were not significant( P >0 05).Conclusion:The mass outside the sinus,bone erosion and neighbor fat tissue erosion were reliable criteria in diagnosing malignant tumour.Corona1 scan was better than axial scan in demonstrating anatomic structure and tumour invasion.