CT检查在真菌球型鼻窦炎术前诊断中的临床意义

Computed tomography-based preoperative diagnosis of fungal ball sinusitis

目的探讨CT检查在真菌球型鼻窦炎术前诊断中的临床意义。方法回顾性分析2019年1月~2020年12月术前CT检查判断为真菌球型鼻窦炎32例患者的病例资料,包括术前CT检查、术中所见和术后病理结果。所有患者入院后均行鼻窦CT平扫并重建,均行内镜鼻窦手术,术中观察鼻窦内黏膜肿胀、分泌物等情况,并与术前鼻窦CT影像学检查进行对比。结果30例患者术中检查和术后病理明确诊断为真菌性鼻窦炎,诊断准确率为93.7%。鼻窦CT检查可见鼻窦内钙化影27例;鼻窦内完全浑浊高密度影21例;部分浑浊且表面不规则的"土坷垃征"13例;鼻窦局部骨质增厚16例。另外2例患者术后病理诊断为上颌窦嗜酸细胞乳头状瘤1例、出血坏死性息肉1例。结论真菌球型鼻窦炎患者CT主要特征是鼻窦内软组织不均匀密度影,其内可见高密度钙化点;其次鼻窦内部分浑浊影,表面高低不平;骨质局部增生肥厚也是其体征性表现。单纯依靠CT检查结果诊断真菌球型鼻窦炎有误诊的可能。

Objective To investigate the computed tomography(CT)features of fungal ball sinusitis and evaluate their preoperative usefulness in differential diagnosis.Methods The CT scans of 32 patients preoperatively diagnosed with fungal ball sinusitis between January 2019 and December 2020 were retrospectively analyzed.The perioperative findings were compared with the preoperative CT findings.Histopathology and fungal smears were performed postoperatively.Results Of the 32 patients,30 were diagnosed with fungal ball sinusitis based on the perioperative findings and postoperative histopathology;the diagnostic accuracy was 93.7%.In these 30 patients,the CT characteristics included intralesional hyperdensity,calcification spots,irregular surfaces,and sclerosis of the lateral sinus wall.Among the two other patients,one was diagnosed with eosinophilic papilloma of the maxillary sinus and the other was pathologically diagnosed with hemorrhagic necrotizing polyps.Conclusion Intralesional hyperdensity with calcification spots is a specific CT feature of fungal ball sinusitis.Partial opacification with an irregular surface and bony sclerosis in the areas affected by sinusitis are also CT characteristics.There is a risk of misdiagnosis when diagnosis is based solely on CT examinations.