早期慢性侵袭性真菌性鼻鼻窦炎鼻窦CT特征及其诊断意义

Computer tomography characteristics of chronic invasive fungal rhinosinusitis in early stage

目的 :探讨早期慢性侵袭性真菌性鼻 鼻窦炎 (CIFRS)鼻窦CT特征及其诊断意义。方法 :以病理学诊断为依据 ,对 18例诊断为早期CIFRS的鼻窦CT影像学表现进行回顾性分析 ,并与 35例非侵袭性真菌性鼻 鼻窦炎 (NIFRS)进行比较。结果 :早期CIFRS鼻窦CT表现为 :14例 (77.8% )为单窦病变 ,多见于上颌窦 ,其次是蝶窦、筛窦 ;多窦病变为 4例 (2 2 .2 % ) ;病变鼻窦内表现为密度不均匀不透光影 ;单窦病变者窦腔均不同程度向邻近鼻窦、鼻腔或眼眶膨出 ;12例 (6 6 .7% )病变鼻窦内可见钙化斑或点 ,CT值为 80～ 16 0Hu ;7例 (38.9% )病变鼻窦显示窦壁骨质破坏 ,其中 2例同时有中鼻甲大部分破坏 ,1例同时有鼻中隔破坏。与NIFRS鼻窦CT比较 ,CIFRS多窦病变比例和骨质破坏比例较高 ,且破坏程度较大。结论 :早期CIFRS鼻窦CT表现病变多窦侵犯、病变鼻窦骨质破坏的机率略高 ,但总体特征与NIFRS基本相似 ,因此鼻窦CT对早期CIFRS的诊断无特异性意义。

Objective:To discuss the computer tomography (CT) characteristics of chronic invasive fungal rhinosinusitis in early stage and their diagnostic value.Method: The CT characteristics of 18 cases of chronic invasive fungal rhinosinusitis in early stage and 35 noninvasive fungal rhinosinusitis diagnosed with pathologic examination were retrospectively analyzed and compared. Result:On sinus CT scan of chronic invasive fungal rhinosinusitis in early stage, 78% (14/18) were single-sinus lesioned. The maxillary sinus was the most commonly lesioned sinus, followed by the sphenoid sinus and ethmoid sinus. 22%(4/18) were poly-sinus lesioned. All infected sinus showed complete or subtotal heterogeneous opacity. In 62% (12/18) cases the lesion expanded into the adjacent sinus or nasal cavity.78%(14/18)had calcification spots or points (CT number between 80 Hu and 160 Hu) in the soft tissue window. Bony destruction occurred in 6 cases (33%), in which lamina papyracea and middle turbinates were mostly destructed simultaneously each in 2 cases. Chronic invasive fungal rhinosinusitis had more poly-sinus lesioned cases and bony destructed cases than noninvasive fungal rhinosinusitis,and its bone lesion degree was higher too. Conclusion:Chronic invasive fungal rhinosinusitis in early stage has more poly-sinus lesioned cases and higher bony destruction ratio and degree. But its total CT characteristics are similar with noninvasive fungal rhinosinusitis.So sinus CT scan has no specific meaning in diagnosing of chronic invasive rhinosinusitis in early stage.