摘要目的 回顾单侧上颌窦病变CT及MRI表现,并与术中及术后病理比较,探讨MRI及CT检查在单侧上颌窦病变诊断及鉴别诊断中的作用.方法 选择34例经鼻内镜手术及术后病理确诊的单侧上颌窦及鼻腔病变患者的CT及MRI影像资料,分析CT及MRI影像对单侧上颌窦病变的诊断价值.结果 34例单侧上颌窦病变(伴或不伴同侧鼻腔受累)CT表现:单侧上颌窦内软组织影中见点片状高密度影,伴窦壁骨质增厚5例次；伴上颌窦自然口扩大11例次；伴鼻腔外侧壁骨质破坏2例次；窦内软组织影边缘为弧形骨壳样高密度影,伴含牙影1例次；仅表现为窦内软组织密度影14例次.MRI表现:31例患者T1 WI病变表现为略低信号,真菌球内部部分信号缺失.增强MRI表现:鼻窦炎、囊肿及后鼻孔息肉病变内部无增强,边缘信号线性增强；出血坏死性息肉、内翻性乳头状瘤及恶性肿瘤内部分别有强、中等及轻微不均匀强化,呈现不同程度“脑回征”.T2WI像:鼻窦炎、真菌球、后鼻孔息肉病变为略高或高信号,边缘为较高信号；囊肿信号则随蛋白含量增高而降低.出血坏死性息肉、内翻性乳头状瘤均为不同程度混杂信号.结论 CT及MRI检查对于单侧上颌窦病变的诊断具有重要意义.CT结合增强MRI分析比单纯依靠CT扫描更具鉴别诊断价值.

abstractsObjective To study the CT and MRI findings of lesions in unilateral maxillary sinus,and to compare the effect of CT and MRI in the differential diagnosis of lesions in unilateral maxillary sinus.Methods Retrospective analysis of CT and contract-enhanced MRI imaging data from 34 patients with lesions in unilateral maxillary sinus which were diagnosed by endoscopic sinus surgery and postoperative pathology.The CT and contract-enhanced MRI's value in the differential diagnosis in lesions in unilateral maxillary sinus was analysed.Results All 34 patients had unilateral maxillary sinus lesions.On CT:soft tissue density shadow in the unilateral maxillary sinus was found in all 34 cases.Five cases showed spot high density with thickening bone in the maxillary sinus wall.Eleven cases showed expansion of the opening of maxillary sinuses.Two cases showed broken lateral wall of nasal cavity.One case showed soft tissue density shadow in the maxillary sinus with curve edge with high density shadow which had a tooth shadow in it.Other 14 cases showed only soft density shadow in the maxillary sinuses.On MRI:all 34 cases revealed lower signals on T1WI compared to gray matter.Little loss signal were found in the inner of the maxillary sinus fungal balls on T1WI.Enhanced MR imaging showed no enhanced in nasal sinusitis,sinus cysts and polyp of posterior naris.Inhomogenous enhancing and "the cerebral convolution sign" were found in the hemorrhagic and necrotic nasal polyp,the nasal inverted papilloma and the malignant tumor cases.Higher signals were seen in the nasal sinusitis,fungal balls and the polyp of posterior naris cases on T2WI.Inhomogenous signal with different levels were found in the hemorrhagic and necrotic nasal polyp,the nasal inverted papilloma and the malignant tumor cases on T2WI.Conclusions CT and MRI examination are important in the diagnosis of the unilateral maxillary sinus lesions.Both CT and MRI had more differential diagnostic value in the unilateral maxillary sinus lesions than only CT used.