鼻窦CT及MRI检查在单侧良性蝶窦病变中的临床应用

The clinical application of sinus CT and MRI in unilateral benign sphenoid sinus lesions

目的回顾分析单侧良性蝶窦病变在CT及MRI中的影像学表现,探讨在临床中的应用价值。方法分析21例单侧良性蝶窦病变且经鼻内镜手术及术后病理证实的住院患者的影像学特征。结果 21例单侧良性蝶窦病变中,囊肿7例,CT表现为蝶窦内圆形或卵圆形较均匀软组织密度影,蝶窦腔膨胀性改变者可伴有骨质吸收变薄,MRI表现为长T1和长T2不规则球形信号影;真菌性病变8例,CT表现为蝶窦内不规则点片状钙化斑或云絮状密度增高影,呈毛玻璃样改变,MRI表现为蝶窦内混杂信号,炎症片状渗出呈高信号,真菌结节呈T2WI低信号;脑脊液鼻漏3例,CT表现为蝶窦内单纯软组织密度影,MRI表现为脑脊液高信号影与鼻窦内高信号液体影之间有线状高信号影相连,其他组织(脑组织、鼻黏膜)呈低信号;内翻性乳头状瘤3例,CT表现为蝶窦内软组织密度影,密度欠均匀,MRI表现为肿物有不均匀强化,呈现条索样或不同程度"脑回征"。结论 CT可以较好地显示病变周围的骨质改变,MRI能更清楚地显示病变侵袭范围,两者结合可为单侧良性蝶窦病变诊断及临床治疗提供更全面的影像信息。CT结合增强MRI分析比单纯依靠CT扫描更具鉴别诊断价值。

Objective To discuss the clinical application value through retrospective analysis of the CT and MRI imaging findings of unilateral benign sphenoid sinus lesions. Methods The imaging characteristics of 21 inpatients were analyzed who had had nasal endoscopic surgery and whose unilateral benign sphenoid sinus lesions had been pathologically proved. Results Of the 21 cases of unilateral benign sphenoid sinus lesions,there are 7 cases of cyst. CT manifestations： circular or ovoid soft tissue opacity with relatively homogeneous density in sphenoid sinus. The cases with sphenoid sinus cavity expansion may be accompanied by bone absorption attenuation. MRI manifestations： long T1 and long T2 irregular spherical signal shadow; 8 cases of fungal disease. CT manifestations： in sphenoid sinus,there are irregular patchy calcification spots or puffy-cloud density increase,ground-glass opacity in change. MRI manifestations： in sphenoid sinus,there are mixed signals,inflammation flake effusion in high signal,fungi the nodules are lowT2 WI signal; 3 cases of cerebrospinal fluid rhinorrhea,CT manifestations： pure soft tissue density in sphenoid sinus,MRI manifestations： there is linear high signal shadowbetween cerebrospinal fluid high signal shadowand high signal liquid film in sinuses. other organizations（ brain tissue,nasal mucous membrane） has lowsignal; 3 cases of inverting papilloma,CT manifestations： soft tissue density shadowwith heterogeneous density in sphenoid sinus. MRI manifestations： Neoplasm has uneven reinforcement,presenting a sample or a different degree of ＂gyrus＂sign. Conclusion CT can showbone changes around the lesions very well. MRI can showthe invaded range by lesions more clearly. A combination of both CT and MRI can provide more comprehensive imaging information for diagnosis and clinical treatment of unilateral benign sphenoid sinus lesions. CT combined with enhanced magnetic resonance imaging（ MRI） analysis is more valuable in differential diagnosis than merely depending on CT scan.