鼻腔鼻窦内翻性乳头状瘤的CT征象及诊断

CT signs and diagnosis of sinonasal inverted papilloma

目的分析鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma,SNIP)的CT征象,提高其诊断准确性。方法回顾性分析73例经病理证实为鼻腔鼻窦内翻性乳头状瘤的资料及临床资料。结果 CT 73例SNIP中,起源于鼻甲13例,上颌窦24例,筛窦16例,钩突9例,蝶窦7例,额窦4例。SNIP在CT上均表现为鼻腔鼻窦内软组织肿块,沿窦腔或鼻道匍行生长,大多数(86.3%,63/73)密度均匀;59例(80.8%)出现骨质改变,表现为受压移位、吸收变薄或骨质增生、破坏;19例(26.0%)出现自然孔扩大。增强后呈明显不均匀强化67例(91.8%)。根据骨质变化预测病灶起源并与术中结果对照,诊断一致性达最佳(Kappa=0.835,95%CI为。结论 0.724~0.947)CT检查能清晰显示内翻性乳头状瘤的病变范围、累及部位,根据骨质变化预测肿瘤起源具有一定价值。

Objective To analyze the CT signs of sinonasal inverted papilloma（SNIP） so as to improve the diagnostic accuracy. The CT findings and clinical data of 73 cases with SNIP that have been confirmed by pathology were Methodsretrospectively analyzed. Results Of 73 cases with SNIP, 13 cases originated from turbinate, 24 cases originated from maxillary sinus, 16 cases originated from ethmoid sinus, 9 cases originated from uncinatus, 7 cases originated from sphenoid sinuses and 4 cases originated from frontal sinus. The CT findings of SNIP were all soft tissue mass in nose and sinuses, growing along the sinus cavity or the nasal tract and mostly homogeneous in density（86.3%, 63/73）; 59 cases（80.8%） showed bone changes, manifesting compressive displacement, attenuation or bone hyperplasia and destruction; and 19 cases（26.0%） had natural hole expansion. Additionally, 67 cases（67/73） showed heterogeneous density in enhanced scan. CT prediction in combination with the contrast with intraoperative results achieved the best consistency in the diagnosis（Kappa=0.835, 95% CI of 0.724-0.947）. Conclusion CT examination is a useful technology to demonstrate the lesion range of SNIP and involved sites. CT prediction of tumor origin based on bone changes is valuable for the diagnosis.