新型冠状病毒感染后长期嗅觉障碍患者嗅裂的CT影像学表现

CT imaging features of olfactory cleft in patients with persistent olfactory dysfunction following COVID-19 infection

目的 观察新型冠状病毒感染后长期嗅觉障碍患者嗅裂的CT影像学表现,探讨嗅裂混浊程度CT比值评分法对此类患者嗅觉功能的评估价值。方法 回顾性分析中日友好医院嗅觉味觉障碍诊疗中心2023年1~7月期间接诊的新冠感染后长期嗅觉障碍患者30例,行嗅觉视觉模拟量表(VAS)评分、T&T嗅觉计嗅觉觉察阈和识别阈测试评分;再行鼻窦CT薄层扫描,精确测量嗅裂长度、宽度和高度,测定嗅裂长度、宽度和高度最大值与嗅裂长度、宽度和高度的比值,采用新的评分法评估嗅裂混浊程度;然后,将嗅裂CT评分值与嗅觉功能测试结果进行相关性分析。结果 鼻窦CT结果显示,90%患者存在不同程度嗅裂混浊。相关性分析显示,患者嗅觉VAS评分与T&T嗅觉察觉阈值相关性无统计学意义(P>0.05),嗅裂宽度与嗅觉VAS评分显示正相关(r=0.370,P=0.044);T&T嗅觉察觉阈值与嗅裂混浊程度CT比值评分法中,嗅裂混浊长度分值、宽度分值、总分值均存在正相关(r=0.398、0.376、0.377,P=0.029、0.041、0.040),差异有统计学意义(P<0.05)。结论 结果提示,嗅裂炎可能是新冠病毒感染后长期嗅觉障碍的重要原因。嗅裂混浊程度CT比值评分法可作为新冠病毒感染后长期嗅觉障碍患者嗅觉功能的影像学评价指标。

Objective To observe the imaging features in olfactory cleft on sinus CT images among patients with persistent olfactory dysfunction following COVID-19 infection to explore the practical value of olfactory cleft opacity scoring to evaluate the status of olfactory function among this kind of patients.Methods A retrospective analysis was conducted among 30 patients with persistent olfactory dysfunction following COVID-19 infection,diagnosed in the Clinic of Smell and Taste Disorders of China-Japan Friendship Hospital during the period of Jan.2023 to Jul.2023.Their olfactory function was evaluated by use of the scores of visual analogue scaling(VAS) and T&T smell test scores,including both of olfactory detection threshold and recognition threshold.All the patients underwent thin slice CT scanning of sinuses,with the maximums of length,width and height of the olfactory cleft measured accurately on CT images and a newly established scoring method used to evaluated the opacity of olfactory cleft on the images.Then,a correlating analysis was made on the association of opacity score in olfactory cleft with the determined values from olfactory function tests.Results As shown on the CT images,90% cases with persistent olfactory dysfunction following COVID-19 infection showed various degrees of opacity in olfactory cleft.As the results of correlating analysis,there was no marked significance in the difference of VAS score with the detection threshold of T&T smell test(P>0.05),while the width of olfactory cleft showed a positive correlation with olfactory VAS score(r=0.370,P=0.044),and T&T olfactory perception threshold held positive correlations with the length and width as well as the total score of opacity in olfactory cleft as evaluated by ratios of scores on CT images(r=0.398,0.376,0.377,P=0.029,0.041,0.040) as well,with obviously statistical significance(P<0.05).Conclusion The results suggested that olfactory cleft inflammation might be the most important one of the associated pathological factors with persistent olfactory dysfunction following COVID-19 infection.Furthermore,scoring method of CT ratio on the opacity of olfactory cleft can be used as an imaging index for the evaluation of olfactory function in such patients.