上颌窦出血坏死性息肉的CT和MRI特点

doi:10.6040/j.issn.1673-3770.0.2018.135

摘要/Abstract

摘要： 目的探讨上颌窦出血坏死性息肉的CT和MRI特点,提高术前诊断准确率。方法回顾复习近3年收治的14例上颌窦出血坏死性息肉患者的影像学资料,分析总结其术前鼻窦CT和MRI的特点并讨论其与相似疾病的鉴别要点。结果上颌窦出血坏死性息肉CT主要表现为单侧上颌窦膨胀性病变,常突入中鼻道,可伴有上颌窦多个骨壁的破坏。MRI表现为T₁WI等信号、T₂WI高信号为主的混杂信号,T₂上的高信号病变主体被低信号包绕或分割。T₁WI增强上则表现为特征性的“胚胎样”结构。部分病例CT表现与一部分真菌性鼻窦炎、内翻乳头状瘤以及上颌窦癌有相似之处。但这些病的MRI表现各异,可资鉴别。结论相较于单一的鼻窦CT检查,CT结合MR影像可提供更多的诊断信息以提高上颌窦出血坏死性息肉的术前诊断准确性,有助于术前预估内镜下手术方案,有利于与患者沟通病情。

关键词: 内翻乳头状瘤, 出血, 上颌窦肿瘤, 上颌窦, 息肉

Abstract: Objective To improve the accuracy of preoperative diagnosis by determining the computed tomography(CT)and magnetic resonance imaging(MRI)features of maxillary hemorrhagic necrotizing polyps. Methods We retrospectively reviewed 14 cases of maxillary hemorrhagic necrotizing polyps diagnosed and operated in the last 3 years. We studied the CT and MR images of these patients and determined the imaging features of the disease and the key points for differential diagnosis. Results The main features observed on CT imaging included an expansive lesion that led to bone destruction and a soft tissue mass extending to the middle meatus. The main portion of the lesion had intermediate signal intensity on T₁-weighted imaging(T₁WI)and high signal intensity on T₂WI, surrounded or divided by bands or strips of low signal intensity on T₂WI. The “embryo sign” on enhanced T₁WI is a unique feature of the disease. Some cases have similar CT imaging features to those of fungal sinusitis, inverted papilloma, and maxillary carcinoma. However, these diseases have different features on MRI, which can provide more information for differential diagnosis. Conclusion Compared with CT alone, combined CT and MRI can provide more information on maxillary hemorrhagic necrotizing polyps to enable surgeons to make a more accurate diagnosis before surgery. It is useful in the planning of endoscopic surgery and communicating with patients.

Key words: Maxillary sinus, Inverted papilloma, Hemorrhage, Maxillary sinus neoplasm, Polyps

中图分类号:

R765.23

查洋,吕威,亓放,王晓巍,高志强. 上颌窦出血坏死性息肉的CT和MRI特点[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 37-42.

ZHA Yang, LÜ Wei, QI Fang, WANG Xiaowei, GAO Zhiqiang. Computed tomography and magnetic resonance imaging features of maxillary hemorrhagic necrotizing polyps[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 37-42.

参考文献

[1] Pang W, Hu L, Wang H, et al. Organized hematoma: an analysis of 84 cases with emphasis on difficult prediction and favorable management[J]. Otolaryngol Head Neck Surg, 2016, 154(4):626-633.
[2] Choi SJ, Seo ST, Rha K, et al. Sinonasal organized hematoma: clinical features of seventeen cases and a systematic review[J]. Laryngoscope, 2015, 125(9):2027-2033.
[3] Kim JS, Oh JS, Kwon SH. The increasing incidence of paranasal organizing hematoma: a 20-year experience of 23 cases at a single center[J]. Rhinology, 2016, 54(2):176-182.
[4] 董怿,周兵,王成硕,等. CT与MRI检查对单侧上颌窦病变的诊断价值[J]. 中华耳鼻咽喉头颈外科杂志,2013,48(11):895-900. DONG Yi, ZHOU Bing, WANG Chengshuo, et al. CT and MRI diagnosis of lesions in unilateral maxillary sinus[J]. Chin J Otorhinolaryngol Head Neck Surg, 2013, 48(11):895-900.
[5] 索方方. 上颌窦鼻腔出血坏死性鼻息肉的CT诊断价值[J].罕少疾病杂志, 2017,24(2):1-2,5. SUO Fangfang. The diagnostic value of CT in hemorrhagic and necrotic polyps of maxillary sinus and nasal cavity[J]. J Rare Uncom Diseas, 2017, 24(2):1-2,5
[6] Hur J, Kim JK, Byun JS, et al. Imaging characteristics of sinonasal organized hematoma[J]. Acta Radiol, 2015, 56(8):955-959.
[7] Kim EY, Kim HJ, Chung SK, et al. Sinonasal organized hematoma: CT and MR imaging findings[J]. AJNR Am J Neuroradiol, 2008, 29(6):1204-1208.
[8] Ginat DT, Moonis G. Case 217: sinonasal organized hematoma[J]. Radiology, 2015, 275(2):613-616.
[9] 汪韦平,曹志伟. 上颌窦出血性息肉的影像学分析[J]. 临床耳鼻咽喉头颈外科杂志,2017, 31(15):1164-1167,1173. WANG Weiping, CAO Zhiwei. Radiographic analysis for infarcted angiomatous polyps in maxillary sinus[J]. J Clin Otorhinolaryngol Head Neck Surg, 2017, 31(15):1164-1167,1173.
[10] 李毅敏,詹阿来,黄庆文. HRCT及MRI对鼻腔-副鼻窦出血坏死性息肉及内翻性乳头状瘤的鉴别诊断价值[J]. 医学影像学杂志,2016,26(6):967-971. LI Yimin, ZHAN Alai, HUANG Qingwen. The value of differential diagnosis between inverted papilloma and hemorrhagic necrotic nasal polyps in nasal cavity and sinus by HRCT and MRI[J]. J Med Imag, 2016, 26(6):967-971.

相关文章 15

[1]	冯思聪,于晓岚,娄丹. 基于囊泡组织Ki67、GM-CSF表达评估Messerklinger中鼻甲成形术对慢性鼻-鼻窦炎合并鼻息肉的效果[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 31-39.
[2]	刘迪,谢应恒,朱斌,马霖,关兵,王莹,曹清,焦成,严齐,孙海勇,马伟. 不同性别未成年人鼻出血与环境气象因素相关性及滞后效应[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 47-54.
[3]	张家齐,袁野,洪陈,顾敏,程雷,陆美萍. 基于孟德尔随机化的肠道菌群与慢性鼻窦炎鼻息肉的因果关系及代谢物中介研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 49-60.
[4]	曾琪璎,朱华明,关建,吴红敏,叶海波,易红良. 双极电凝镊应用于治疗Shamblin Ⅲ 型颈动脉体瘤6例[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 70-76.
[5]	张广玲,陈兴雪,武天义,孙占伟,王卫卫,李世超,王广科. Tespa1在慢性鼻窦炎伴鼻息肉中的表达及作用研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 35-42.
[6]	曹正勇,李小波. 慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 43-50.
[7]	王坛,王晶,李燕子,卜苓南,杨淑娟. 下咽纤维血管性息肉1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 121-125.
[8]	郭翔,马永强,伊海金. 突发性聋磁共振检查的现状与进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 140-144.
[9]	王文晴,张丹,朱梦迪,王路阳,杨培培,孙思思,张秋敏,周慧. 慢性鼻窦炎伴鼻息肉复发手术时临床及组织病理学特征变化[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 46-53.
[10]	王奥维,时文杰. CRSwNP中医证型与TFH细胞相关因子的相关性研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 54-60.
[11]	张婕,尼玛吉宗,徐小东,周菁,刘建敏,罗依蕤,杜进涛,巴罗. 藏红花素在嗜酸性慢性鼻窦炎伴鼻息肉中调控2型炎症反应的研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 61-67.
[12]	王登茂,温鑫,耿江桥,张光远,刘晓峰. 儿童咽鼓管毛息肉合并鼻咽部错构瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 105-109.
[13]	石忠刚,蔡晓岚,李学忠,张立强,冯昕. 上颌骨囊肿并内翻性乳头状瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 123-129.
[14]	肖哲,张胜娟,赵子琦,兴辰,李成泉,刘志强. Ultra Q:YAG激光治疗黄斑部视网膜前出血17例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 130-135.
[15]	张韵秋,任秀敏,徐鸥,董金辉,王建星. 奥马珠单抗靶向治疗慢性鼻窦炎伴鼻息肉的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 136-140.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed