Analysis of imaging features and treatment strategies of unilateral maxillary sinus and nasal diseases
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摘要: 目的: 回顾单侧上颌窦鼻腔病变影像学表现及治疗方案的选择和实施情况,探讨鼻科常见单侧病变的影像学特征,分析影像学表现对此类病变的治疗策略选择的指导意义。方法: 选择64例单侧上颌窦及鼻腔病变CT及增强MRI影像学资料,观察并记录影像学表现和手术方案的设计和实施情况,总结影像学特征,分析其对治疗策略选择的指导意义。结果: 64例单侧上颌窦鼻腔病变,CT表现为大致均匀的软组织密度影。在全部良性病变中,上颌窦壁骨质破坏、骨质不连续9例(18.4%,9/49);骨质增生17例(34.7%,17/49);在全部恶性病变中,可见骨质破坏14例(93.3%,14/15)。MRI T1WI像表现为大致均匀的等信号影。增强后的T1像不同性质的病变表现为具有各自特征的影像学表现。根据CT及增强MRI影像学表现,设计治疗方案分为5型。实际实施与计划符合率为90.5%,有4例术中临时更改手术方式。结论: 对于单侧病变,术前增强MRI与CT检查应共同列为常规检查。CT对于骨质观察清晰,可对肿物性质、生发中心等情况做出初步判断;增强MRI可对病变范围、血供及其与周围组织关系提供更加丰富准确的信息。结合术前影像学资料,可以为单侧病变的手术方案和治疗策略提供依据。Abstract: Objective: To analyze the imaging features of unilateral maxillary sinus nasal lesions and the selection of treatment strategies based on imaging findings for these lesions.Method: The CT and enhanced MRI data of 64 cases of unilateral maxillary sinus and nasal lesions were selected. The imaging findings and surgery approach were observed and recorded. To summarize the imaging characteristics and analyze the choice of treatment strategy.Result: All 64 Unilateral maxillary sinus nasal lesions presented a roughly uniform soft tissue density shadow on CT. In all benign lesions, there were 9 cases manifested maxillary sinus wall bone destruction and bone discontinuity(18.4%,9/49); There were 17 cases of bone hyperplasia (34.7%,17/49).Bone destruction was observed in 14 cases of all malignant lesions (93.3%, 14/15). The appearance is approximately uniform signal shadow on MRI T1WI images. The lesions with different properties of the enhanced T1 images showed the imaging manifestations with their own characteristics. According to the CT and enhanced MRI images, the designed treatment plan was divided into 5 types. The coincidence rate of operation and plan was 90.5%,there were 4 cases of temporary modification in operation.Conclusion: For unilateral lesions, preoperative enhanced MRI and CT scan should be included as routine examination. CT is clear for bone observation, and can be the nature of tumor and germinal center. Enhanced MRI can provide more accurate information on the lesion scope, blood supply and the relationship between mass and surrounding tissues. Combined with the preoperative imaging data, it can provide the basis for the operation plan and treatment strategy of unilateral lesions.
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Key words:
- unilateral lesion /
- paranasal sinus neoplasms /
- imaging /
- nasal endoscopic surgery
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