鼻窦真菌球术前MRI征象分析

Preoperative diagnostic value of magnetic resonance imaging for fungal ball of nasal sinuses

目的：探讨鼻窦真菌球（FB）的磁共振成像（MRI）征象与病理特点，为手术治疗提供参考。方法收集2013年12月至2015年12月经手术病理证实的27例鼻窦真菌球患者的临床资料，对磁共振影像资料进行回顾性分析。27例鼻窦真菌球患者中男14例，女13例，年龄49～86岁，平均57．6岁，病程6个月至5年。27例患者术前均进行1．5T 高场强磁共振的平扫及增强扫描，采用功能性鼻内镜手术彻底切除病灶。结果以上颌窦发病为主，其中单侧92％（25／27），双侧4％（1／27），其次蝶窦发病4％（1／27），FB 位于窦腔中央；FB T1WI 等信号（与脑白质比较），T2WI 低信号，DWI（b 值＝1000）呈高低混杂信号，Gd-DTPA 增强无强化；周围增厚黏膜 T1WI 等信号、T2WI 高信号，环状明显强化。27例病例组织病理学切片均找到缠绕的真菌菌丝，证实为 FB；FB 病理基础为真菌丝含锰（顺磁性物质），其次 FB 有磷酸钙和硫酸钙等物质，因磁敏感效应 T2WI 呈低信号、DWI 高低混杂信号改变。结论MRI 征象能反应 FB 的病理组织学特点，具有重要的诊断和鉴别诊断价值，能为患者手术治疗提供重要的影像学依据。

Objective To investigate the magnetic resonance imaging （MRI）features and pathologic characteristics of the fungal ball （FB）of the nasal sinuses,for the purpose to provide reference for surgical treatment.Methods The MRI data of 27 patients of nasal sinuses who were diagnosed by surgical pathology were retrospectively analyzed.Of 27 patients,there were 14 male and 13 female,aged from 49 to 86,anverage age 57.6,with course of disease from 6 months to 5 years.All patients preoperatively recieved 1.5 T high field strength mri scan and enhanced scan and functional nasal endoscopic surgical radical resection lesions.Results Maxillary sinus disease,which unilateral 92%（25 /27）,bilateral 4% （1 /27）,sphenoid sinus disease 4%（1 /27）,FB was located in the sinus cavity central.FB isointense signal （com-pared with the white matter of the brain）,hypointense on T2WI,DWI （b value =1000）was mixed high and low signal,Gd DTPA enhanced no enhancement,with around mucosal thickening isointense signal,high signal intensity on T2WI,ring enhancement.The histopathology slices of 27 cases were found wrapped fungal hyphae,which confirmed for FB.The pathological basis of FB was fungal silk containing manganese （paramagnetic substances）,FB calcium phosphate and calcium sulfate and other substances,due to the magnetic susceptibility effect of T2WI was low signal,DWI high and low mixed signal changes.Conclusion MRI can reflect the histopathological characteristics of FB,and it is of great value in diagnosis and differential diagnosis,as well as providing important imaging evidence for patients undergoing surgical treatment.