鼻部病变影像学检查路径及分析思路

1、鼻部病变影像学检查路径及分析思路 1内 容影像学检查方法病变影像学检查路径分析思路新技术应用2影像学检查方法X线平片体层摄影超声CTMRIPET-CT3影像学检查方法CT骨质分辨率高最常用的方法价值定位和定性诊断内窥镜手术路径图4HRCT-routine procedurescanning (reformatting )techniquehigh Kvbone algorithm reconstructionmargin enhancement section thickness 2 mmsmall FOVWW/WL 2000/200HU axial, coronal and sagittal

2、 planes5鼻窦CT质控 重组断面基线范围窗技术MPR图像数量照片总数骨（D）软组织（B）层厚间距横断面听眶下线额窦顶部至硬腭2000/200 2.03.0243冠状面垂直硬腭额窦前部至蝶窦后部2000/200 2.03.024矢状面平行中正中矢状面包括两侧上颌窦外侧缘2000/200 2.03.0246鼻窦横断位7鼻窦冠状位8鼻窦矢状位9normal CT images10影像学检查方法MRI软组织分辨率高较常用检查方法价值病变大小侵犯范围浸润骨髓神经累及定性诊断11MRI scanning procedurepre-enhanced axial and coronal T1WI and

3、 axial T2WI post-enhanced axial, coronal, and sagittal T1WIAdd frequency-selective fat saturation in the post-contrast axial or coronal planeT1WI: TR/TE 500600/1015msT2WI: TR/TE 35004000/120130 msNEX 24,echo train length 1127, matrix 256256FOV 1818 cmsection thickness 4-5 mm intersection gap 0.5 mm1

4、213MR cisternography 14 DCE-MRI15 DWI16影像学检查方法PET-CT疗效评价17影像学检查路径CT为首选方法MRI为补充方法PET-CT为后选方法简单化、最优化及合理化18常见鼻部病变外伤炎症息肉肿瘤19（一）外伤CT为首选检查方法准确认识解剖结构诊断报告描述全面注意并发症的发生20 鼻颌缝21颅骨标本大体解剖及双侧鼻骨孔 颅骨标本CT扫描后VR重组像22横断面图像及冠状面图像诊断为鼻骨骨折 VR图像证实为鼻骨孔 23 鼻骨骨折上颌骨额突骨折24fracture？252627（二）炎症细菌性炎症真菌性炎症肉芽肿性病变28细菌性炎症CT常规检查方法分期骨质改变

5、29acute sinusitis30acute sinusitis3132 chronic sinusitis33odontogenic sinusitis34 mucocele35mucocele36mucocele37bilateral mucoceles38真菌性炎症CT首先检查方法MRI补充检查方法该类炎症发病率高注意该类炎症分型掌握各型影像学特点39 fungus ball40 41fungus ball42 AFS43 AFS44 CIFS4546 AFFS47肉芽肿炎症CT、MRI联合使用该类炎症为少见病着重掌握诊断要点首先确定炎性病变可选用排除诊断法48 WG4950 WG5

6、1rhinoscleroma52tuberculosis53 EAF54（三）息肉属于常见、多发病影像学能判别类型常见息肉：CT首选上颌窦-后鼻孔息肉：CT首先出血坏死性息肉：MRI最佳注意与真菌炎、肿瘤鉴别55 nasal polyp 56antrochoanal polyp 5750s150s250s出血、渐进性强化征hemorrhagic necrotic polyp 58olfactory neuroblastoma 59（四）肿瘤分类软组织起源骨组织起源合理选择检查方法定位诊断定性诊断肿瘤分期60骨源性肿瘤的检查路径主要靠CT诊断MRI可作为补充61 osteoma62osteoma

7、63Gardner syndrome64OF65OF with ABC66osteosarcoma67osteosarcoma68chondrosarcoma69chondrosarcoma70chondrosarcoma71metastatic tumor72metastatic tumor73 M/59 yrs vision loss of the right eye74metastatic tumor75 fibrous dysplasia76fibrous dysplasia77Albright syndrome78 LCH2007521200782079软组织起源肿瘤检查路径CT和M

8、RI联合使用 CT平扫MRI平扫+增强PET-CT应适时选择80分析思路定位良、恶性判别骨质组织学性质推断密度信号临床重视恶性肿瘤分期加强疗后影像学随访81fat accumulation82F/43鼻出血10余日紫红色肿块随心率搏动83 meningoencephalocele84IP85IP86 IP transformation87 capillary hemangioma88cavernoushemangioma89angiofibroma90angiofibroma91angiofibroma92SCC93SCC94SCC95ACC9697melanoma98olfactory neuroblastoma 99olfactory neuroblastoma 100101 2003-12-22 2004-4-2NK/T lymphoma102NK/T lymphoma103metastatic tumor104ON pretreatmentpostreatment105F/38ACC8 years of postsurgery106 2010-4-8F/26SCC2 months ofpostsurgery