CT和MRI对鼻腔鼻窦内翻性乳头状瘤的诊断价值

Value of CT and MRI in the diagnosis of sinonasal inverted papilloma

目的分析鼻腔鼻窦内翻性乳头状瘤的CT和MRI表现,探讨其诊断价值。方法回顾37例经病理证实的鼻腔鼻窦内翻性乳头状瘤的CT和MRI影像,并与术中所见、术后病理及随访结果比较。结果 37例中,起源于上颌窦10例,筛窦8例,额窦6例,鼻甲6例,窦口鼻道复合体3例,蝶窦1例,不能确认起源3例。CT表现:单侧鼻腔鼻窦软组织病变,骨炎征的出现率为62.16%,与起源部位一致的72.00%,3例出现眶纸板或前颅底骨质破坏,与恶变相关。MRI表现:36例出现脑回征,根据脑回征逆向回溯法,32例准确预测起源部位。结论 CT与MRI相结合,对于判断鼻腔鼻窦内翻性乳头状瘤的起源、范围及是否合并恶变更具有诊断价值。

OBJECTIVE To investigate the CT and MRI findings of sinonasal inverted papilloma so as to promote the diagnostic accuracy.METHODS All of the 37 cases of sinonasal inverted papilloma(SNIP) were confirmed by pathology.Both MRI and CT scans were performed preoperatively and were analyzed retrospectively for each of the patients.RESULTS The lesion originated from the maxillary sinus in 10 cases,the frontal sinus in 6cases,the turbinate in 6 cases,ostiomeatalcomples(OMC)in 3 cases,the sphenoid sinus in 1 case,and uncertain or multifocal origins in 3 cases.Previous sinonasal operations were undertaken in 13 patients and 3 cases were associated with malignant change.Analysis of CT images revealed osteitis sign in 23 patients,hyperostosis or osteolysis in37 patients.Surgical evaluation revealed that the location of osteitis coincided with the actual tumor attachment site(18/25,72.00%).Bony destruction or extension into the anterior cranial fossa and orbital paperacea in 3cases was associated with malignant change.Convoluted cerebriform pattern(CCP) in MRI was present in(36/37,97.30%) patients.For 32 patients,the SNIP originating site predicted by MRI was confirmed by operation(32/36,88.89%).Focal loss of CCP in 3 cases may be an indicator of coexistent malignancy.CONCLUSION It is the best choice to evaluate the SNIP by combining MRI and CT preoperatively.This may facilitate accurate and complete excision of SNIP and possibly lead to low recurrence.