鼻腔鼻窦内翻性乳头状瘤的影像学分析

Imaging Findings of Sinonasal Inverted Papillomas

目的分析鼻内翻性乳头状瘤(IP)的CT和MRI表现。方法搜集术前经MRI诊断为IP 22例患者的临床、影像及病理资料,对其影像学表现进行回顾性分析。结果 19例术后病理为IP,3例为鼻息肉。19例IP中,6例发生于上颌窦与窦口中鼻道复合体之间,呈"哑铃形";11例病变位于筛窦与鼻腔,形态不规则;1例位于上颌窦内壁缺损处,呈结节状;1例局限于上颌窦腔黏膜,呈"线状"。19例患者,12例在T_2WI、17例在增强T_1WI呈规则的"栅栏"状表现;线状等信号或线状强化1例;病变局部呈不规则栅栏状改变1例。4例时间-信号强度曲线(TIC)呈速升缓降型。3例鼻息肉均位于鼻腔与上颌窦之间,病变通过上颌窦口区,局部黏膜聚集。22例中,17例术前行CT检查,9例CT表现有骨质吸收、变薄不完整;3例表现局限性骨质增生硬化,5例骨质未见改变。结论MRI对诊断IP和评估病变的范围具有重要作用。CT对观察病变部位的骨质有重要意义。

Objective To analyze the CT and MRI findings of sinonasal inverted papillomas. Methods 22 cases of inverted papillomas diagnosed by MRI were collected,the imaging and general data were studied,and the imaging features were analyzed retrospectively. Clinical history,CT and MRI images and pathological results from 22 cases of inverted papillomas pre-operatively diagnosed by MRI were collected,and the imaging features were analyzed retrospectively. Results19 cases of inverted papillomas and 3 cases of nasal polyps were confirmed pathologically. 6 cases of inverted papillomas occurred in the maxillary sinus and the sinus orifice in the nasal complex region displayed a ＂dumbbell shaped＂contour.11 cases were located in the ethmoid sinus and nasal cavity were they had an irregular shape; 1 case was located in the inner wall of the maxillary sinus represented as nodular mass,and 1 case was confined to the maxillary sinus mucosa represented as ＂linear＂mucous thickening. 12 cases of inverted papillomas showed regular fence-like pattern on T_2-weighted images,and 17 cases showed the regular fence-like pattern on contrast-enhanced T_1-weighted images. 1 case of sinonasal inverted papilloma revealed linear and isointense signal on T_2-weighted images and linear enhancement on contrast-enhanced T_1-weighted images. 1 case showed irregular fence-like pattern changes. The time-intensity curve（ TIC） of dynamic contrast enhancement of MRI showed rapid enhancement and slow wash-out type in 4 cases. CT manifestations of 9 cases represented bone resorption,thinning and disruption,3 cases showed localized bone sclerosis,and 5 cases showed no bone changes. Conclusion MRI plays an important role in the diagnosis of sinonasal inverted papillomas,and CT is helpful to observe bone changes.