MRI与多层螺旋CT诊断变应性真菌性鼻窦炎的临床价值

Clinical Value of MRI and Multi-slice Spiral CT in the Diagnosis of Allergic Fungal Sinusitis

【目的】比较MRI与多层螺旋CT诊断变应性真菌性鼻窦炎(AFRS)的临床价值。【方法】选取2017年1月至2021年6月咸阳市第一人民医院收治的84例疑似AFRS患者,所有患者均行MRI与多层螺旋CT检查,以病理诊断作为“金标准”。记录MRI与多层螺旋CT诊断结果,分析MRI与多层螺旋CT诊断AFRS的效能及一致性。【结果】84例疑似AFRS患者有80例经病理检查确诊为AFRS。多层螺旋CT诊断为AFRS有78例,显示53例患者累及上颌窦,36例上颌窦口开大,20例骨质增生硬化致窦腔缩小;19例气泡影残留,20例软组织密度显示条索状(或斑片状)的稍高密度影,呈特征性“毛玻璃样改变”(软组织窗中较明显),CT值为(96.84±8.06)HU,58例显示低密度软组织影充填,CT值为(34.54±5.79)HU;66例显示腔内密度不均、钙化;23例上颌窦壁骨质增生硬化,40例上颌窦壁骨质吸收破坏,8例筛窦下壁骨质吸收破坏,7例鼻中隔吸收、破坏。MRI诊断为AFRS有79例,T_(1)WI累及窦腔周围显示等或稍低信号,T_(2)WI呈现均匀或混杂高信号,STIR_longTE呈现稍高信号;T_(1)WI稍低信号、T_(2)WI低信号与CT钙化位置基本一致,并且T_(2)WI信号明显低于T_(1)WI。多层螺旋CT诊断AFRS的灵敏度、特异度分别为97.50%、100.00%,MRI诊断AFRS的灵敏度、特异度分别为98.75%、100.00%,两者比较差异无统计学意义(P>0.05)。病理诊断与多层螺旋CT、MRI诊断AFRS的一致性Kappa值分别为0.908、0.917,多层螺旋CT与MRI诊断的一致性Kappa值为0.901。【结论】多层螺旋CT、MRI诊断AFRS效能类似,CT可作为首选筛查AFRS的影像学方法,对于多层螺旋CT无法确诊的AFRS患者可辅助MRI诊断。

【Objective】To compare the clinical value of MRI and multi slice spiral CT in the diagnosis of allergic fungal sinusitis(AFRS).【Methods】A total of 84 patients with suspected AFRS admitted to our hospital from January 2017 to June 2021 were selected.All patients underwent MRI and multi-slice spiral CT examinations,using pathological diagnosis as the"gold standard".The diagnostic results of MRI and multi slice spiral CT were recorded,and the effectiveness and consistency of MRI and multi slice spiral CT in diagnosing AFRS were analyzed.【Results】Eighty out of 84 suspected AFRS patients were diagnosed as AFRS by pathological examination.Multi slice spiral CT diagnosed 78 cases of AFRS,showing 53 cases of maxillary sinus involvement,36 cases of maxillary sinus ostium enlargement,and 20 cases of bone hyperplasia and sclerosis causing sinus cavity narrowing;There were 19 cases of residual air bubbles,20 cases of soft tissue density showing a slightly higher density shadow in the form of strips(or patches),presenting a characteristic"ground glass like change"(more obvious in the soft tissue window),with a CT value of(96.84±8.06)HU,58 cases of low density soft tissue filling,with a CT value of(34.54±5.79)HU;66 cases showed uneven intraluminal density and calcification;There were 23 cases of hyperplasia and sclerosis of the maxillary sinus wall,40 cases of bone resorption and destruction of the maxillary sinus wall,8 cases of bone resorption and destruction of the inferior ethmoid sinus wall,and 7 cases of absorption and destruction of the nasal septum.There were 79 cases of AFRS diagnosed by MRI.T1WI showed equal or slightly lower signal intensity around the sinus cavity.T_(2)WI showed uniform or mixed high signal.STIR_LongTE presents a slightly higher signal;The slightly low signal on T_(1)WI and the low signal on T_(2)WI were basically consistent with the location of CT calcification,and the signal on T_(2)WI was significantly lower than that on T_(1)WI.The sensitivity and specificity of multi-slice spiral CT in the diagnosis of AFRS were 97.50%and 100.00%,respectively.The sensitivity and specificity of MRI in the diagnosis of AFRS were 98.75%and 100.00%,respectively.There was no statistically significant difference between the two(P>0.05).The consistency Kappa value between pathological diagnosis and multi-slice spiral CT and MRI diagnosis of AFRS was 0.908 and 0.917,respectively.The consistency Kappa value between multi-slice spiral CT and MRI diagnosis was 0.901.【Conclusion】Multislice spiral CT and MRI have similar diagnostic efficacy in AFRS.CT can be the first imaging method for screening AFRS,and can assist MRI in the diagnosis of AFRS patients who cannot be diagnosed with multislice spiral CT.