单侧良性蝶窦病变的CT及MRI影像表现特点分析

CT and MRI Features of Unilateral Benign Sphenoid Sinus Lesions

目的分析单侧良性蝶窦病变的CT及MRI影像表现特点。方法回顾性分析2017年5月至2018年5月我院耳鼻喉科诊治的20例鼻内镜手术后病理证实单侧良性蝶窦病变患者临床资料,均行CT及MRI检查,评估其影像学特征。结果 20例单侧良性蝶窦病变患者中,7例为蝶窦囊肿,CT见蝶窦内呈圆形/卵圆形密度均匀的软组织密度影,其中蝶窦腔膨胀者骨质吸收减少,MRI呈长T1、长T2不规则球形影;7例为真菌性蝶窦炎,CT见其蝶窦内呈不规则点片状钙化斑、云絮状影,毛玻璃样改变,MRI见蝶窦内混杂信号,炎症片状渗出影,真菌结节T2WI低信号;4例为蝶窦脑脊液鼻漏,CT发现蝶窦中单纯软组织密度影,MRI上有线状高信号影将脑脊液高信号影及鼻窦内高信号液体影相连,脑组织、鼻黏膜呈明显低信号;内翻性乳头状瘤2例,CT见蝶窦中软组织不均匀密度影,MRI上肿物不均匀强化,条索样或"脑回征"。结论 CT及MRI可为单侧良性蝶窦病变的诊断及治疗提供全面影像信息,其中CT对病变周围骨质改变、MRI对病变侵袭范围分别有较好显示效果,两者联合对病变有较高的鉴别价值。

Objective To analyze the CT and MRI features of unilateral benign sphenoid sinus lesions. Methods The clinical data of 20 patients with unilateral benign sphenoid sinus lesions which confirmed by endoscopic sinus surgery in otolaryngology department of the hospital from May 2017 to May 2018 were analyzed retrospectively. All patients were examined by CT and MRI and the imaging features were evaluated. Results Of the 20 patients with unilateral benign sphenoid sinus lesions, 7 cases were sphenoid sinus cysts. CT showed sphenoid sinus with round/oval shape homogeneous soft tissue density lesions. The bone absorption of patients with sphenoid sinus expansion decreased. MRI showed long T1 and long T2 irregular spheroidals. There were 7 cases of fungal sphenoid sinusitis, and CT showed irregular patchy calcification and cloud-like shadow in the sphenoid sinus and ground-glass-like changes. MRI showed mixed signals in the sphenoid sinus and inflammatory patchy exudation shadow. Fungal nodules showed low signal on T2 WI. There were 4 cases of sphenoid sinus cerebrospinal fluid rhinorrhea. CT found simple soft tissue density in the sphenoid sinus, while MR images show linear hypersignal shadow connecting CSF hypersignal shadow and sinusoid hypersignal liquid shadow. Brain tissues and nasal mucosa showed low signals. There were 2 cases of inverting papillomas. CT showed inhomogeneous density in soft tissues of the sphenoid sinus while MRI showed inhomogeneous enhancement of the tumor, strip-like or gyrus sign. Conclusion CT and MRI can provide comprehensive imaging information for the diagnosis and treatment of unilateral benign sphenoid sinus disease, in which CT has better effect on the changes of bone around the disease and MRI has better effect on the invasion range of the disease, and the combination of them has higher differential value for the disease.