摘要
目的 探讨CT及MRI在鼻腔鼻窦 内翻性乳头状瘤(sinoasal and nasal inverted papilloma,SNIP)临床诊断中 的应用价值。方法 回顾性分析我科2012 年6月至2015年11月期间行手术病理确 诊的SNIP患者100例,术前均有CT及MRI 检查,比较CT、MRI、CT结合MRI诊断与 病理诊断的符合率,并分析CT、MRI的 影像诊断特点。结果 100例SNIP中起源 于上颌窦27例,筛窦22例,额窦16例, 鼻甲15例,窦口鼻道复合体8例,蝶窦7 例,不能确认起源5例;CT与MRI诊断的 分期符合率为98.0%,明显高于单独CT 或MRI的诊断符合率94.0%、96.0%;CT 表现:单侧鼻腔鼻窦软组织病变,骨炎 症出现率为63.0%(63/100),与起源部 位一致率64.6%(42/65),9例出现眶纸 板或前颅底骨质破坏,与恶变有关,MRI 表现:97例出现脑回征,86例准确预测 起源部位(准确率86.0%)。结论 CT联合 MRI检查可全面显示SNIP的范围及其与周 围软组织的界线,有助于术前肿瘤临床 分期以及肿瘤起源的准确评估,从而更 有利于实现早期诊断、早期治疗。
Objective To investigate the clinical value of CT and MRI in the diagnosis of sinoasal and nasal inverted papilloma (SNIP). Methods A retrospective analysis of 100 cases of SNIP confirmed by surgical pathology in our department from June 2012 to November 2015 who had preoperative CT and MRI, and the CT, MRI diagnostic accordance rate were compared with pathological diagnosis. The CT, MRI diagnostic imaging characteristics were analyzed. Results 27 cases of SNIP origins in the maxillary sinus, 22 and 16 cases in ethmoid and frontal sinus respectively, 15 cases in turbinate and 8 in ostiomeatal complex, 7 cases in sphenoid sinus, the origin of 5 cases remains unknown; CT and MRI diagnosis installments in line with the rate of 98.0% was significantly higher than CT or MRI diagnosis rate of 94.0%, 96.0%; CT manifestations: unilateral nasal sinus soft tissue lesions, bone inflammation occurred was 63.0% (63/100), and the site of origin concordance rate 64.6% (42/65), 9 cases of the orbital or skull base bone destruction, and malignant transformation, MRI findings: 97 cases occurred gyrus syndrome, 86 cases to accurately predict the site of origin (86.0% accuracy). Conclusion CT combined with MRI examination can show the full scope and SNIP and soft tissue boundaries contribute to tumor clinical stage and accurate preoperative assessment of tumor origin, and thus more conducive to early diagnosis and early treatment.
【关键词】CT;MRI;鼻腔鼻窦内翻性乳 头状瘤(SNIP);诊断;价值
【中图分类号】R765.2
【文献标识码】A
【DOI】10.3969/j.issn.1672- 5131.2017.10.011
前言
SNIP为一种鼻腔鼻窦较常见的上皮源性良性肿瘤,在男性中年人 群中发病率较高,病变部位多发生于鼻腔外侧壁、上颌窦及筛窦部 位,为所有鼻腔肿瘤的0.4%~4.7%[1]。SNIP虽为一种良性肿瘤,但具 有侵袭破坏性、复发性及恶变性特点,可破坏周围解剖结构及骨质重 塑,目前多采用手术切除法治疗SNIP,单切除不彻底、肿瘤残留等容 易增加复发率,因而术前详细检查、判断临床分期、肿瘤起源及是否 合并恶恶变对制定合理手术方案,彻底根除SNIP具有重要意义[2]。研 究认为乳状头瘤占位效应明显,肿瘤多沿中鼻道的自然孔生长,邻近 的鼻甲、钩突及筛窦间隔常有增生硬化,而CT增强扫描病灶强化明 显,MRI为SNIP诊断的另一辅助手段,其中脑回征为一个稳定、可信赖 的影响学特征,可较好鉴别SNIP恶性肿瘤与炎症性病变,但CT与MRI 联合对SNIP的诊断价值目前研究较少[3-4]。本文选取我科2012年6月至 2015年11月期间行手术病理确诊的SNIP患者100例,回顾性分析CT及 MRI在SNIP临床诊断中的应用价值,现报道如下。
中国CT和MRI杂志
第15卷, 第 10 期
2017年10月
相关文章