【作者】 张岚；

【导师】 丁长伟；

【作者基本信息】 中国医科大学 ， 影像医学与核医学， 2022， 硕士

【摘要】 目的:探讨计算机断层扫描(Computed tomography,CT)、磁共振成像(Magnetic resonance imaging,MRI)常规序列及扩散加权(Diffusion weighted image,DWI)序列对FBS的诊断价值,提高术前诊断率。方法:前瞻性收集37例FBS患者与另40例鼻窦占位患者,均在术前4周进行CT扫描,术前2周进行常规MRI平扫及增强、DWI序列扫描,以临床病理为诊断金标准,纳入研究进行回顾性分析。观察病变的位置,钙化情况,窦壁骨质改变,以及MRI平扫信号强度,增强扫描强化方式,并避开病灶边缘区域划取最大范围层面的感兴趣区(Region of interest,ROI)测量表观扩散系数(Apparent diffusion coefficient,ADC)数值,筛选出存在组间差异的因素,进行logistic回归试验,根据有意义的诊断指标画出受试者工作特征(Receiver operating characteristic,ROC)曲线,确定诊断阈值,评价诊断效能。结果:FBS好发于单侧上颌窦(28/37),29例FBS于CT见钙化及稍高密度影,22例伴受累窦壁骨质增生硬化,6例伴骨质破坏。FBS于TI加权成像(T1-weighted image,T1WI)表现为低、等或高信号,T2加权成像(T2-weighted image,T2WI)37例全为极低信号,周围窦腔内充满不同信号的炎性积液,增强后环形明显强化鼻窦粘膜包绕不强化的FB及其周围液体并可突入鼻腔,并鼻窦粘膜下囊肿。在收集的在b值等于600s/mm~2时,FBS在DWI上信号多以低信号混杂少许高信号为主,缺乏特异性。在各组征象中,进行统计分析得出CT中的钙化及稍高密度影、上颌窦分布、骨质增生硬化与MRI序列中T2WI极低信号、增强扫描无强化有组间意义;DWI信号没有组间差异,FBS的ADC均值不能与其他鼻窦良性占位病变的相区别,所得数值没有统计学差异,但能与恶性占位相区别(P<0.05)。在有统计学意义的的诊断征象中,T2WI序列上极低信号区是最有价值的诊断征象,灵敏度100%,特异度为92.5%。其中病灶位于上颌窦内、软组织内稍高密度影及钙化、骨质增生硬化是FBS的独立危险因素,T2WI极低信号和增强扫描不强化的特点有助于鉴别FB及其他鼻窦内占位。根据多征象联合诊断ROC曲线结果,钙化是FBS最具特征性的CT征象,对于无钙化的FBS,联合骨质增生硬化及上颌窦内分布能够提高诊断特异度及准确性。结论:对于有统计学意义的单一诊断征象而言,T2WI极低信号影最有价值,灵敏度及特异度高,但在独立危险因素中,钙化是FBS最具特征性的CT征象,对于有钙化的FBS患者多征象联合诊断灵敏度、特异度及诊断的准确率都存在不同程度下降,但对于无钙化的FBS,窦壁骨质增生硬化及病变位于上颌窦内可作为无钙化FBS补充诊断征象。FBS的DWI的表现以及ADC均值对于FBS的鉴别诊断具有一定价值,同时MRI能更好地显示真菌球的部位、范围及周围炎症情况,对于其诊断和治疗有重要意义。更多还原

【Abstract】 Objective:To determine the diagnostic value of computed tomography(CT),magnetic resonance image(MRI)conventional sequences and diffusion weighted image(DWI)sequence of fungus ball rhino-sinusitis(FBS)improves the preoperative diagnostic accuracy.Method:Prospective collecting thirty-seven patients with FBS and forty patients with occupation in rhino-sinus which will be confirmed by surgical pathology to perform CT scan in four weeks before surgery and MRI conventional sequences plain and contrast enhancement scan,DWI scan in two weeks before surgery,were included into research for retrospective analysis.The location of lesion,calcification,the adjacent to the sinus wall bone,and the signals in MRI plain scan,enhancement extent in MRI contrast enhancement scan are observed.The apparent diffusion coefficient(ADC)values were measured in the region of interest(ROI)in the largest occupation area slice avoiding the edges of lesion.Factors with inter-group difference will be selected for logistic regression analysis.According to the statistical significant diagnostic index,the receiver operator characteristic curve(ROC curve)will be generated to confirmed the diagnosis threshold value and to evaluate diagnostic efficacy.Result:FBS usually occurs in unilateral maxillary sinus(28/37),29 of FBS had calcification and high density tissue on CT,22 with hyper-plasia and sclerosis of involved sinus bone,and 6 with destruction of bone.T1-weighted image(T1WI)showed low,equal or high signal,and all of 37 FBS T2-weighted image(T2WI)showed extremely low signal.The peripheral sinus cavity was filled with Inflammatory fluid of different signal,and the obviously enhanced sinus mucosa wrapped non-enhanced fungus ball(FB)as well as surrounding effusion,which may protruded into nasal cavity,following wiht paranasal sinus mucosa cyst.On b=600 mm/s~2,the singnal of fungus ball rhino-sinusitis in diffusion weighted imaging is mainly low signal mixed little high signal and lack of specificity.According to statistical analysis,calcification and soft tissues with high density lesion,located in maxillary sinus,hyper-plasia and sclerosis of bone in CT images,and extreme low signal in T2-weighted image(T2WI),non-enhance in contrast images have statistical significance,the DWI signal has none of inter group difference,there is no statistical significance between the FB and other benign occupying lesions on average of ADC,however,there is exact difference between the benign and malignant tissue(P<0.05).Among the single diagnosis feature of statistical significance,the extreme low signal in T2WI is the best for differ fungus ball from other lesion,the sensitivity,specificity is 100%,92.5%.Among these signs for diagnosis,soft tissues had high density and calcification in the soft tissue,adjacent to the sinus wall bone hyper-plasia and sclerosis and lesion located in the maxillary sinus are the independent risk sign for FBS.Among all the significant diagnosis sign,According to ROC curve of multi-sign diagnosis,calcification is the best characteristic feature of FBS on CT,for FBS without calcification,combined hyperostosis and sclerosis of sinus wall and the lesion located in maxillary sinus can improve the sensitivity and accuracy of diagnosis.Conclusion:Among the single diagnosis feature of statistical significance,extremely low signal in T2WI is the most valuable sign.Among the independent risk sign,calcification is the best characteristic feature of FBS on CT,but for FBS without calcification,the hyperostosis and sclerosis of sinus wall and the lesion located in maxillary sinus can be used as a supplementary diagnostic sign for FBS without calcification,MRI should be used as an auxiliary diagnosis.The MRI enhance scan and DWI examination images have certain features for the differential diagnosis of FBS,meanwhile MRI can better shows the location,extent an adjacent inflammation of the fungus ball,being of high value in the diagnosis and therapy.更多还原