鼻腔鼻窦出血坏死性息肉的CT和MRI影像学特征分析

Analysis of CT and MRI Imaging Features of Sinonasal Organized Hematoma

目的:分析鼻腔鼻窦出血坏死性息肉(SOH)患者的CT和MRI影像学表现。方法:收集19例经病理证实为SOH患者的CT和MRI影像学资料,评估的图像特征包括CT上病变的位置、大小、边缘、鼻窦骨壁的变化,以及MRI上的信号强度和增强模式。结果:影像学上病变最大直径为2~4.3 cm(平均3.2 cm),形状为分叶状、块状或结节状。它们位于鼻腔(n=2)、上颌窦(n=3)或鼻腔及上颌窦(n=14),所有病例均为单侧,左侧有12例,右侧有7例。病变呈膨胀性,2例出现局部浸润性边缘,4例出现鼻泪管破坏。所有病变在CT扫描中均为等密度病变或密度不均匀,未发现钙化。MRI上的信号强度为混合性,所有病变在T2WI上表现为不均匀信号,肿块在T2WI图像上可观察到肿块边缘低信号,增强MRI显示病变呈不规则结节状或分叶状强化,也可表现为斑片状强化。病变位于上颌窦者均可观察到上颌窦内侧壁膨胀性骨质破坏,主要以上颌窦口为中心,患者均表现为鼻窦阻塞性炎症。结论:CT结合MRI的特征性影像学表现,对诊断SOH有重要意义。

Objective:To analysis the CT and MRI imaging features of sinonasal organized hematoma(SOH).Methods:The CT and MR imaging data of 19 patients with SOH diagnosed by pathology were analyzed,including location,size,margin and changes in the bone wall of sinuses on CT,and signal intensity and enhancement pattern on MRI.Results:The maximum diameter of the lesion on imaging was 2 to 4.3 cm(average 3.2 cm)with lobulated,massive or nodular in shape.They were located in the nasal cavity(n=2),maxillary sinus(n=3)or nasal cavity and maxillary sinus(n=14).All cases were unilateral,with 12 on the left and 7 on the right.The lesions were expansive,2 cases had local invasive margins and 4 cases had nasolacrimal duct destruction.All lesions were equally or uneven dense on CT scans,without calcification.The signal intensity on MRI was mixed.All lesions showed uneven signal on T2WI.The T2WI image of the tumor showed low signal at the edge of the tumor.Enhanced MRI of all lesions were performed as irregular nodules,or lobulated enhancement,or patchy enhancement.The expanded bone destruction in the medial wall of the maxillary sinus could be observed in the lesions located in the maxillary sinus,mainly centered at maxillary sinus ostium.All patients presented with obstructive sinus inflammation.Conclusion:The characteristic findings of CT combined with MRI may be of great significance for the diagnosis of SOH.