鼻窦炎相关颅内眼眶并发症CT表现及危险因素分析

Analysis of CT findings and risk factors for orbital and intracranial complications associated with sinusitis

目的探讨鼻窦炎相关的眼眶及颅内并发症的CT征象及发生的危险因素。方法收集因鼻部症状或怀疑有鼻窦炎而来放射科行鼻窦CT检查的鼻窦炎患者194例,其中有眼眶或颅内并发症患者39例,无并发症患者155例,分析并发症发生的相关危险因素及并发症的CT征象。结果并发症组和非并发症组的小于18岁的未成年人、急性鼻窦炎、男性、额窦炎、筛窦炎、发病至入院时间、Lund-Mackay评分分别为66.67%比16.78%、84.62%比30.97%、74.36%比47.1%、79.49%比25.81%、89.74%比43.87%、20.46±7.45比13.45±8.46、10.82±4.01比6.86±3.92,并发症组指标明显高于非并发症组,组间比较有统计学差异(P<0.05)。对上述单因素分析有统计学差异的变量进行多因素Logistic回归分析显示,筛窦炎、额窦炎、小于18岁、急性鼻窦炎、延迟入院规范治疗有统计学差异(P<0.05),是鼻窦炎眼眶或颅脑并发症发生的危险因素,男性、Lund-Mackay评分则没有统计学差异(P>0.05)。并发症主要有眼眶脓肿、眼眶骨膜下脓肿、眼眶蜂窝织炎,均表现为眼眶内异常密度;眶周蜂窝织炎表现为眼眶周围软组织肿胀和密度增加;硬膜下和硬膜外脓肿表现为颅内轴外形态不同的液体聚集;脑炎和脓肿表现为脑实质低密度区域和液体聚集;Pott’s肿表现为额骨前方的骨膜下液性密度聚集伴前额部软组织肿胀。结论未能及时规范治疗的儿童急性筛窦或额窦炎患者是发生眼眶或颅脑并发症的高危人群;CT扫描能为鼻窦炎并发症的诊断提供可靠的依据。

Objective To explore the CT findings and risk factors of orbital and intracranial complications associated with paranasal sinusitis.Methods 194 patients who came to the radiology department for CT scanning of paranasal sinuses due to nasal symptoms or suspected paranasal sinusitis were collected.There were 39 patients with orbital or intracranial complications and 155 patients without complications.The risk factors of complications and CT findings of complications were analyzed.Results In the complication group versus the non-complication group,the percentages of minors under 18 years of age,male gender,acute sinusitis,frontal sinusitis,ethmoid sinusitis,the time from onset to admission(days)and Lund-Mackay score(points),were 66.67%vs.16.78%,84.62%vs.30.97%,74.36%vs.47.1%,79.49%vs.25.81%,89.74%vs.43.87%,20.46±7.45 vs.13.45±8.46,and 10.82±4.01 vs.6.86±3.92,respectively.The indicators in the complication group were significantly higher than those in the non-complication group,with a significant difference between groups(P<0.05).Multivariate logistic regression analysis was conducted on the variables with statistically significant differences in the above univariate analysis.The results showed that ethmoid sinusitis,frontal sinusitis,minors younger than 18 years of age,acute sinusitis,and delayed admission were all significant risk factors for the occurrence of orbital or intracranial complications of sinusitis(P<0.05).However,there was no significant difference in male or Lund-Mackay score(P>0.05).The main CT manifestations of complications include orbital abscess,subperiosteal abscess of the orbit,and orbital cellulitis,which present as abnormal density within the orbit;periorbital cellulitis is characterized by soft tissue swelling and increased density around the orbit;subdural and epidural abscesses are characterized by extra-axial fluid collections with different shapes,while encephalitis and brain abscesses present as low-density lesions or fluid attenuation in the brain parenchyma;Pott’s puffy tumor is characterized by a subperiosteal fluid collection and swelling of the soft tissue in the frontal region of the skull.Conclusion Children with acute ethmoid or frontal sinusitis who fail to receive timely standardized treatment are at high risk for orbital or cranial complications;CT scanning can provide reliable basis for the diagnosis of complications of sinusitis.