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上颌窦炎性假瘤的CT和MRI表现

Features of inflammatory pseudotumor in the maxillary sinus on CT and MRI

摘要:

目的 分析上颌窦炎性假瘤的CT和MRI表现.方法 回顾性分析8例经组织学证实的上颌窦炎性假瘤的CT(8例)、MRI(7例)资料,并分析其中3例MR动态增强扫描的时间-信号强度曲线(TIC).结果 病变位于左侧2例,右侧6例;病变均呈不规则形,边界清楚5例、模糊3例,最大径平均51 mm(29~72 mm).CT表现:与脑实质比较,平扫6例呈等密度,2例呈略低密度,2例增强后呈中度强化;受累窦壁骨质吸收、破坏,残端骨质伴有硬化.MRI表现:T_1 WI呈低信号2例、等信号5例;T_2 WI呈不均匀低信号6例、等信号1例;增强后病变呈不均匀轻度强化2例、中度强化5例;3例动态增强扫描的TIC均为持续上升型.病变累及同侧鼻腔6例、颞下窝和翼腭窝4例、眼眶4例及面颊部3例,MRI更清楚、准确显示窦外蔓延的范围.结论 骨质破坏伴有残存骨质硬化、T_2 WI呈较低信号是上颌窦炎性假瘤较特征性表现;CT和MRI联合使用能够对该病的诊断、治疗及随访提供更全面的信息.

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Objective To explore the features of inflammatory pseudotumor in the maxillary sinus on CT and MRI.Methods The CT and MRI data of 8 patients with histology-proven inflammatory pseudotumor in the maxillary sinus were retrospectively analyzed.All 8 patients underwent CT scans and 7 of them also underwent MRI examinations.In addition, the time-intensity curve (TIC) of dynamic contrast-enhanced (DCE)MR imaging were analyzed in 3 patients.Results Two cases had lesions in the left maxillary sinus, while the others showed lesions in the right maxillary sinus.All the lesions showed irregular shape with well-defined margins in 5 cases and hazy margins in 3 cases.The mean maximum diameter of the lesions was 51 mm (ranged from 29 mm to72 mm).On non-enhanced CT, the lesions were isodense to gray matter in 6 and slightly hypodense in 1 patients.Only 2 patients had post-contrast CT with moderate enhancement of their lesions.The lesions caused adjacent bony absorption and destruction with residual bony sclerosis.On MR T_1 WI, inflammatory pseudotumor showed hypointense in 2 patients and isointense in 5 cases in relative to gray matter.On T_2 WI, the lesions revealed inhomogeneous hypointense in 6 patients and isointense in 1 patients.Inflammatory pseudotumor showed heterogeneously slight contrast enhancement in 2 cases and moderate enhancement in 5 cases.The TIC showed a steady enhancement pattern in 3 patients.The lesions extended to nasal cavity in 6 cases, pterygopalatine fossa and infratemporal fossa in 4, orbit in 4, and cheek in 3 cases.Six patients underwent follow-up for 2-5 years after surgery and 2 of them were found to have recurrence.In comparison to CT, MRI was proved to show the extent of the lesions more clearly.Conclusions Bony destruction with sclerosis and hypointense signal on MR T_2 WI are typical manifestations of inflammatory pseudotumor in the maxillary sinus.Combined CT and MRI can provide clinicians with more comprehensive information for the diagnosis, therapy, and follow-up of these lesions.

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