鼻腔鼻窦内翻性乳头状瘤的CT诊断

CT Diagnosis of Sinonasal Inverted Papilloma

目的:探讨鼻腔鼻窦内翻性乳头状瘤(SNIP)的CT特点及诊断价值。方法:回顾性分析48例经手术病理诊断为SNIP的临床手术病理及CT资料,结合文献讨论。结果:48例SNIP中,男性居多(62.5%),鼻塞、流涕为主要临床症状(100%),50%的患者涕中带血,31.25%的患者嗅觉减退,18.75%的患者嗅觉丧失,12.5%的患者6年内复发。SNIP主要为单侧发病(93.75%),病变最易累及同侧上颌窦(55.56%)。CT平扫SNIP均呈鼻腔鼻窦内软组织密度肿块,CT值(45.61±1.02)HU。受累窦腔内肿块完全充填者21例(43.75%),未完全充满窦腔者22例(45.83%),受累窦腔呈轻度膨胀性改变21例(43.75%),窦壁及鼻甲骨质吸收或破坏42例(87.5%),受累窦腔较健侧缩小7例(14.58%),局限于鼻腔呈息肉样改变2例(4.17%)。结论:SNIP具有一定的CT特点,术前CT检查对SNIP累及的部位、范围等可准确确定,可为手术治疗提供重要的参考依据。

Object： To study the value of CT in diagnosis of sinonasal inverted papilloma （SNIP）. Methods： 48 cases of SNIP proved by operation and pathology were reviewed retrospectively. Results： Among 48 cases of SNIP, male patients accounted for the majority （62.5%）. Rhinobyon and rhinorrhoea were main clinical symptoms （100%）, 50% of the patients were accompanied with blood in rhinorrhoea, 31.25% presented hyposmia, 18.75% presented anosmia, 12.5% had a relapse with postoperative 6 years. Among 48 cases, there were 45 cases of unilateral lesions （93.75%）. Lesions were most frequently involved ipsilateral maxillary sinus （55.56%）. CT plain scan of all SNIP cases showed nasal sinuses soft tissue density mass, and CT value was （45.61 ~ 1.02） HU. There were 21 cases of lumps completely filling with involved sinus cavity （43.75%）, and 22 cases of lumps incompletely filling with involved sinus cavity （45.83%）. In addition, 21 cases of involved sinus cavities presented mild expansion changes （43.75%）, 42 cases presented bone absorption or damage of sinus wall and turbinate （87.5%）, 7 cases presented affected sinus cavity smaller than the normal-side sinus cavity （14.58%）, and 2 cases were limited to nasal polyploidy changes （4.17%）. Conclusions： SNIP has a certain CT characteristics, and preoperative CT examination can accurately determine SNIP-involved position and range and can provide an important reference basis for surgical treatment.