Paranasal Sinuses and Adjacent Spaces.ppt 2
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Paranasal Sinuses and Adjacent Spaces
by Laurie Loevner and Jennifer Bradshaw
Radiology department of the University of Pennsylvania, USA and the radiology department the Medical Centre Alkmaar, the Netherlands Publicationdate:25-2-2009 副鼻窦和邻近结构
Role of CT
• CT is of value for determining anatomic landmarks and variants. This information is of vital importance to the ENT-surgeon. In addition, we need it to identify erosive processes and acquired developmental deficiencies of the bone. CT对于鼻腔鼻窦来说主要用于判定解剖标 志和变异。这些信息对于耳鼻喉科医生是 非常重要的。此外，我们还需判断病变对 骨质的破坏以及骨的各种发育不良。
• Role of CT and MRI
* * * * * * * * * * * * * * Signal characteristics of secretions 黏液的信号特征 Pseudo-pneumatized sinus 假性气化的窦腔 Enhancement 增强 Brain abscess Mucocele Orbital Cellulitis and Abscess Complication of FESS (Functional endoscopic sinus surgery ) Encephalocele Mucocele Inverted papilloma Malignant tumors of the sinonasal tract Meningioma Keratocyst Silent sinus
•
Allergic fungal sinusitis - unenhanced CT
• On the left another, more characteristic, example of allergic fungal sinusitis.There is bilateral opacification of the nasal cavities, usually a sign of an inflammatory process or polyps.Note the concentric lamellated appearance of alternating hyper- and hypodensity in the maxillary sinusses. The hyperdensity is due to inspissated secretions and fungal elements. The hypodensity reflects cysts, mucosal disease, and granulation tissue.In the ethmoidal region some of the hyper-density reflects periostitis and neoosteogenesis along the septae. • 这是一个非常典型的过敏性真菌性鼻窦炎的病例。双侧鼻腔浑浊，通常提示 炎症或息肉。需要注意观察的是在上颌窦内可以看到高低密度同心层状排列 的征象。那么这里的高密度主要是由浓缩的黏液和真菌组成。 低密度反映的 是囊肿，粘膜疾病和肉芽组织。筛窦内的一些高密度还可以反映骨膜炎和沿 着鼻中隔的新生骨形成。
• CT is also excellent for determining whether there is intraorbital extension of sino-nasal disease in the ventral 2/3 of the orbit.When pathology approaches the orbital apex, an MRI study is necessary to assess spread to the cavernous sinus and intracranial compartment. CT is performed without contrast medium. If additional imaging he next step. • CT也同样对于判断位于眼眶内侧3分之2的鼻腔鼻窦病变对眶内是否有侵犯 非常有帮助。如果病变侵犯眶尖，那么需要进行MRI检查，以判断病变向海 绵窦以及颅内腔的播散。
• The real value of unenhanced CT is the following: if you see an opacified sinus with hyperdense contents, it is usually a sign of benign disease. Tumor is not hyper-dense. The hyperdensity is due to one or a combination of the following: inspissated secretions fungus blood 非增强CT的真正诊断价值在于：如果浑浊的窦腔内出现更高 密度影，那么这个病变通常是良性的。肿瘤的密度不会很高。 CT上的这种更高密度影主要由以下组成：浓缩的黏液；真菌； 血液。
• •
The signal intensity of sinus secretions depends on the protein content 不同蛋白含量导致信号不同
• MRI is also useful for determining invasion of the skull base. Involvement of the skull base is seen as replacement of the high signal of the fatty marrow on T1WI by hypointense signal of the tumor. Also look for foraminal extension, whether by perineural spread or direct invasion of the tumor. MRI is also the study of choice for detecting intracranial extension of sinonasal disease. • MRI 同样对于判断鼻腔鼻窦病变对颅底的侵犯非常有帮助。 信号改变主要表现为：T1上颅底诸骨髓腔内脂肪的高信号 被肿瘤的低信号取代。也可以观察肿瘤沿着颅底孔道的播 散，不论是沿着神经还是直接侵犯。MRI同样也是判断鼻 腔鼻窦病变颅内侵犯的首选。
• Role of CT and MRI
* * * * * * * * * * * * * * Signal characteristics of secretions 黏液的信号特征 Pseudo-pneumatized sinus 假性气化的窦腔 Enhancement 增强 Brain abscess Mucocele Orbital Cellulitis and Abscess Complication of FESS (Functional endoscopic sinus surgery ) Encephalocele Mucocele Inverted papilloma Malignant tumors of the sinonasal tract Meningioma Keratocyst Silent sinus
Pseudo-pneumatized sinus 假性气腔
• Complications of Sinusitis
• Tumor and tumorlike lesions
• Fibro-osseous Lesions
* * * Fibrous dysplasia Osteitis Osteoma
• Monitoring response to therapy
• Complications of Sinusitis
• Tumor and tumorlike lesions
• Fibro-osseous Lesions
* * * Fibrous dysplasia Osteitis Osteoma
• Monitoring response to therapy
• • • • •
• On the left you see a case that was initially interpreted as a tumor. The hyperdensity is a good prognostic sign, indicating a benign process. This is an example of allergic fungal sinusitis. Usually it is more anteriorly located. • 这是一张非增强的CT。我们最初认为是一个肿瘤。在右侧后 组筛窦、双侧蝶筛隐窝、蝶窦和斜坡的病变内我们发现了更 高密度影。这种更高密度影提示这可能是一个良性病变。最 后证实这是一个过敏性真菌性鼻窦炎，通常位置靠前，这个 病变靠后一些。
Signal characteristics of secretions
• MRI is extremely helpful in complicated sinonasal disease. MRI can discern secretions and mucosa from masses. When you understand the signal characteristics, you are readily able to distinguish soft tissues masses from inspissated secretions. The signal intensity of secretions can vary and mainly depends on the ratio of water to protein and the viscosity. Different protein contents result in different signal intensities on T1 and T2W-images. Fungus usually has a high protein content of more than 28% and can mimic an aerated sinus because it is low on T1- and T2WI. You need CT to make the distinction! • 黏液的特征：MRI对于复杂的鼻腔鼻窦病变是非常有帮助的。MRI可 以区分肿瘤与粘液、粘膜。如果掌握了黏液的信号特征，那么是可以 将软组织肿块与浓缩黏液进行区分的。 • 黏液的信号可以多样，主要取决于水和蛋白质的比例以及粘滞度。 • 不同的蛋白成分可以导致黏液在T1和T2上信号的不同。 • 真菌的蛋白含量通常超过28%，因此在T1和T2上信号非常低，是鼻 窦腔看上去像含气的空腔。此时，需要做的是建议CT。
Paranasal Sinuses and Adjacent Spaces
by Laurie Loevner and Jennifer Bradshaw
Radiology department of the University of Pennsylvania, USA and the radiology department the Medical Centre Alkmaar, the Netherlands Publicationdate:25-2-2009 副鼻窦和邻近结构
Role of CT
• CT is of value for determining anatomic landmarks and variants. This information is of vital importance to the ENT-surgeon. In addition, we need it to identify erosive processes and acquired developmental deficiencies of the bone. CT对于鼻腔鼻窦来说主要用于判定解剖标 志和变异。这些信息对于耳鼻喉科医生是 非常重要的。此外，我们还需判断病变对 骨质的破坏以及骨的各种发育不良。
• Role of CT and MRI
* * * * * * * * * * * * * * Signal characteristics of secretions 黏液的信号特征 Pseudo-pneumatized sinus 假性气化的窦腔 Enhancement 增强 Brain abscess Mucocele Orbital Cellulitis and Abscess Complication of FESS (Functional endoscopic sinus surgery ) Encephalocele Mucocele Inverted papilloma Malignant tumors of the sinonasal tract Meningioma Keratocyst Silent sinus
•
Allergic fungal sinusitis - unenhanced CT
• On the left another, more characteristic, example of allergic fungal sinusitis.There is bilateral opacification of the nasal cavities, usually a sign of an inflammatory process or polyps.Note the concentric lamellated appearance of alternating hyper- and hypodensity in the maxillary sinusses. The hyperdensity is due to inspissated secretions and fungal elements. The hypodensity reflects cysts, mucosal disease, and granulation tissue.In the ethmoidal region some of the hyper-density reflects periostitis and neoosteogenesis along the septae. • 这是一个非常典型的过敏性真菌性鼻窦炎的病例。双侧鼻腔浑浊，通常提示 炎症或息肉。需要注意观察的是在上颌窦内可以看到高低密度同心层状排列 的征象。那么这里的高密度主要是由浓缩的黏液和真菌组成。 低密度反映的 是囊肿，粘膜疾病和肉芽组织。筛窦内的一些高密度还可以反映骨膜炎和沿 着鼻中隔的新生骨形成。
• CT is also excellent for determining whether there is intraorbital extension of sino-nasal disease in the ventral 2/3 of the orbit.When pathology approaches the orbital apex, an MRI study is necessary to assess spread to the cavernous sinus and intracranial compartment. CT is performed without contrast medium. If additional imaging he next step. • CT也同样对于判断位于眼眶内侧3分之2的鼻腔鼻窦病变对眶内是否有侵犯 非常有帮助。如果病变侵犯眶尖，那么需要进行MRI检查，以判断病变向海 绵窦以及颅内腔的播散。
• The real value of unenhanced CT is the following: if you see an opacified sinus with hyperdense contents, it is usually a sign of benign disease. Tumor is not hyper-dense. The hyperdensity is due to one or a combination of the following: inspissated secretions fungus blood 非增强CT的真正诊断价值在于：如果浑浊的窦腔内出现更高 密度影，那么这个病变通常是良性的。肿瘤的密度不会很高。 CT上的这种更高密度影主要由以下组成：浓缩的黏液；真菌； 血液。
• •
The signal intensity of sinus secretions depends on the protein content 不同蛋白含量导致信号不同
• MRI is also useful for determining invasion of the skull base. Involvement of the skull base is seen as replacement of the high signal of the fatty marrow on T1WI by hypointense signal of the tumor. Also look for foraminal extension, whether by perineural spread or direct invasion of the tumor. MRI is also the study of choice for detecting intracranial extension of sinonasal disease. • MRI 同样对于判断鼻腔鼻窦病变对颅底的侵犯非常有帮助。 信号改变主要表现为：T1上颅底诸骨髓腔内脂肪的高信号 被肿瘤的低信号取代。也可以观察肿瘤沿着颅底孔道的播 散，不论是沿着神经还是直接侵犯。MRI同样也是判断鼻 腔鼻窦病变颅内侵犯的首选。
• Role of CT and MRI
* * * * * * * * * * * * * * Signal characteristics of secretions 黏液的信号特征 Pseudo-pneumatized sinus 假性气化的窦腔 Enhancement 增强 Brain abscess Mucocele Orbital Cellulitis and Abscess Complication of FESS (Functional endoscopic sinus surgery ) Encephalocele Mucocele Inverted papilloma Malignant tumors of the sinonasal tract Meningioma Keratocyst Silent sinus
Pseudo-pneumatized sinus 假性气腔
• Complications of Sinusitis
• Tumor and tumorlike lesions
• Fibro-osseous Lesions
* * * Fibrous dysplasia Osteitis Osteoma
• Monitoring response to therapy
• Complications of Sinusitis
• Tumor and tumorlike lesions
• Fibro-osseous Lesions
* * * Fibrous dysplasia Osteitis Osteoma
• Monitoring response to therapy
• • • • •
• On the left you see a case that was initially interpreted as a tumor. The hyperdensity is a good prognostic sign, indicating a benign process. This is an example of allergic fungal sinusitis. Usually it is more anteriorly located. • 这是一张非增强的CT。我们最初认为是一个肿瘤。在右侧后 组筛窦、双侧蝶筛隐窝、蝶窦和斜坡的病变内我们发现了更 高密度影。这种更高密度影提示这可能是一个良性病变。最 后证实这是一个过敏性真菌性鼻窦炎，通常位置靠前，这个 病变靠后一些。
Signal characteristics of secretions
• MRI is extremely helpful in complicated sinonasal disease. MRI can discern secretions and mucosa from masses. When you understand the signal characteristics, you are readily able to distinguish soft tissues masses from inspissated secretions. The signal intensity of secretions can vary and mainly depends on the ratio of water to protein and the viscosity. Different protein contents result in different signal intensities on T1 and T2W-images. Fungus usually has a high protein content of more than 28% and can mimic an aerated sinus because it is low on T1- and T2WI. You need CT to make the distinction! • 黏液的特征：MRI对于复杂的鼻腔鼻窦病变是非常有帮助的。MRI可 以区分肿瘤与粘液、粘膜。如果掌握了黏液的信号特征，那么是可以 将软组织肿块与浓缩黏液进行区分的。 • 黏液的信号可以多样，主要取决于水和蛋白质的比例以及粘滞度。 • 不同的蛋白成分可以导致黏液在T1和T2上信号的不同。 • 真菌的蛋白含量通常超过28%，因此在T1和T2上信号非常低，是鼻 窦腔看上去像含气的空腔。此时，需要做的是建议CT。