应用多层螺旋CT观察窦口鼻道复合体区炎性病变与影像学特征
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摘要
窦口鼻道复合体(Ostiomeatal Complex,OMC)是鼻科学近年来比较新兴解剖学名词。主要在中鼻甲(middle turbinate)、中鼻道(middle meatus)及附近区域解剖结构,是以筛漏斗为中心的附近区域,包括:筛漏斗、钩突、筛泡、半月裂、中鼻道、中鼻甲、前组筛房、额窦口及上颌窦自然开口等一系列结构。鼻窦的炎性病变多发生于此区域。本研究主要目的是通过对窦口鼻道复合体炎性病变的影像学观察,加深对窦口鼻道复合体炎性病变影像学特征的认识,提高对窦口鼻道复合体的炎性病变影像诊断水平。
本研究收集了150例经临床证实的鼻窦炎患者,全部采用德国SIEMENS公司生产的Sensatian 16型多层螺旋CT扫描仪,进行常规扫描和使用CT工作站行多平面重建(Multipliate Plane Reconstruction,MPR)图像两种方法对OMC区炎性病变进行观察,比较两种方法在显示炎性病变方面的优劣。通过对比研究发现MPR方法在显示微小软组织病变及小的窦壁骨质改变,尤其在显示窦壁骨质增生硬化和窦壁骨质吸收破坏方面具有非常明显的优势。
结果表明多层螺旋CT扫描中MPR重建图像能清晰的显示OMC区的炎性病变的大小、侵及范围及周围毗邻关系,是临床医生正确认识鼻窦炎影像特征和避免FESS手术治疗并发症,必不可少的检查方法。
Ostiomeatal complex (OMC) is a relatively new nasal anatomy term in recent years, which mainly refers to the middle turbinate, the middle meatus and the nearby anatomical structure, as the center to ethmoidal infundibulum, including the ethmoidal infundibulum, semilunar hiatus, uncinate process, ethmoid bulla, middle turbinate, first group paranasal sinus aperture and a series of related structures. Sinus inflammatory disease often occurr in this region. It was first proposed by Naumann as an anatomy of a concept with with popular agreement of many medical professionors. Then Stammberger suggessed that paranasal nasal sinus infection always occurred in nasal cavity, the middle meatus ethmoidal infundibulum and the narrow area neighboring middle meatus-OMC theory in 1986. But the theory didn’t receive wide attention, because of the restrict of the science ,technology and economic condition level, the influence of the traditional concept to today surgical treatment ,the low requisition of life quality , and other factors. In the last 10 years, endoscopic sinus surgery and endoscopy equipment improved and matured, particularly Functional Endoscopic Sinus Surgery(FESS) developed and widespread, following the development of country economics and the improvement of people living standards.More and more nose branch doctor gradually realize the close relationship between OMC sinusitis abnormal structure and pathological changes and the incidence of sinusitis,and realize the importance of OMC in emergement of sinusitis.
Now imaging examination has always been a major means of clinical inspection before endoscopic sinus surgery, because of pain-free, micromesh, convenience and close to the entities anatomy. It is the main method of first choice to evaluate the OMC anatomical variations, making sure the lacation and region of lesion. But due to complicated OMC complex structure,deep location, too many overlapping of X-ray film and unclear layer, it is difficult to get detailed image of OMC structure and soft tissue condition. Now high-field MRI can clearly show the abmormality of OMC region. But its high cost and long examine time limit MRI application. The new examin method-multipliate plane reconstruction(MPR) by multislice helical CT scan can clearly shows the OMC lesions, the neighbouring structure and the anatomical structure variation.Its the reconstruction of coronal images is similar to or better than conventional coronal scan images, and can show clearly the structure (such as the ethmoid, transsphenoidal) which endoscope can not reach.
The purpose of this study is to deepen the understanding of ostiomeatal complex inflammatory disease imaging features, and to improve the imaging diagnostic level of ostiomeatal complex inflammatory disease, through the imaging observation of OMC.
Materials and methods: This study collected 150 cases of clinically proved sinusitis over a year. All the patients received conventional scaning without reconstruction and interval reconstruction of 1.0mm after that by the German SIEMENS Sensatian 16 of the multi-slice helical CT scanner. All the data were sent to CT workstations to do MPR, mainly coronal view. Image analysis was based in the cross-sectional image and adjust direction to get the best visual image, for better observing OMC inflammatory lesions and the surrounding area adjacent. Because nasal cavity and nasal sinus distribut in paires, and function independently, this study analyzes by "side" to compare the value of conventional CT scan and MPR in assess OMC inflammatory lesions.
Results:(1) OMC is a complex, which refers to the anatomical structures as the center to ethmoidal infundibulum, including the ethmoidal infundibulum, semilunar hiatus, uncinate process, ethmoid bulla, middle turbinate, first group paranasal sinus aperture and a series of related structures. MPR images is able to show clearly OMC anatomical variations, besides the region and extent of OMC lesions and sinus bone wall from all directions. (2) We found that sinus mucosal thickening (230:203), sinus polyps (184:156), sinus bone hyperplasia sclerosis (95:60), sinus bone absorption destruction (106:71) and gas-liquid plane in sinus (49:35) were the image feature of OMC inflammatory lesions, which were seen both in conventional CT scan and MPR. But MPR displayed OMC lesions more detailed than conventional CT scan, (P<0.05).
Conclusion: (1) multi-slice helical CT scan reconstruction of the MPR images can show very clearly the region and the extent of OMC inflammatory lesions and the surrounding structures. (2) Because MPR technology is superior to conventional CT scanning in displaying sinus mucosal thickening , sinus polyps , sinus bone hyperplasia sclerosis , sinus bone absorption destruction and gas-liquid plane in sinus, so we should take MPR images, when checking nasal sinusal inflammatory disease, or before FESS sinus surgery or conventional surgery, particularly those OMC diseases involving anatomical variaties.
In a word, multi-slice helical CT scan reconstruction of the MPR images can clearly show the OMC lesions. It is a necessary tool for clinical doctors to knew he condition of OMC lesions and prevent beforehand FESS sinus surgery complication.
本研究收集了150例经临床证实的鼻窦炎患者,全部采用德国SIEMENS公司生产的Sensatian 16型多层螺旋CT扫描仪,进行常规扫描和使用CT工作站行多平面重建(Multipliate Plane Reconstruction,MPR)图像两种方法对OMC区炎性病变进行观察,比较两种方法在显示炎性病变方面的优劣。通过对比研究发现MPR方法在显示微小软组织病变及小的窦壁骨质改变,尤其在显示窦壁骨质增生硬化和窦壁骨质吸收破坏方面具有非常明显的优势。
结果表明多层螺旋CT扫描中MPR重建图像能清晰的显示OMC区的炎性病变的大小、侵及范围及周围毗邻关系,是临床医生正确认识鼻窦炎影像特征和避免FESS手术治疗并发症,必不可少的检查方法。
Ostiomeatal complex (OMC) is a relatively new nasal anatomy term in recent years, which mainly refers to the middle turbinate, the middle meatus and the nearby anatomical structure, as the center to ethmoidal infundibulum, including the ethmoidal infundibulum, semilunar hiatus, uncinate process, ethmoid bulla, middle turbinate, first group paranasal sinus aperture and a series of related structures. Sinus inflammatory disease often occurr in this region. It was first proposed by Naumann as an anatomy of a concept with with popular agreement of many medical professionors. Then Stammberger suggessed that paranasal nasal sinus infection always occurred in nasal cavity, the middle meatus ethmoidal infundibulum and the narrow area neighboring middle meatus-OMC theory in 1986. But the theory didn’t receive wide attention, because of the restrict of the science ,technology and economic condition level, the influence of the traditional concept to today surgical treatment ,the low requisition of life quality , and other factors. In the last 10 years, endoscopic sinus surgery and endoscopy equipment improved and matured, particularly Functional Endoscopic Sinus Surgery(FESS) developed and widespread, following the development of country economics and the improvement of people living standards.More and more nose branch doctor gradually realize the close relationship between OMC sinusitis abnormal structure and pathological changes and the incidence of sinusitis,and realize the importance of OMC in emergement of sinusitis.
Now imaging examination has always been a major means of clinical inspection before endoscopic sinus surgery, because of pain-free, micromesh, convenience and close to the entities anatomy. It is the main method of first choice to evaluate the OMC anatomical variations, making sure the lacation and region of lesion. But due to complicated OMC complex structure,deep location, too many overlapping of X-ray film and unclear layer, it is difficult to get detailed image of OMC structure and soft tissue condition. Now high-field MRI can clearly show the abmormality of OMC region. But its high cost and long examine time limit MRI application. The new examin method-multipliate plane reconstruction(MPR) by multislice helical CT scan can clearly shows the OMC lesions, the neighbouring structure and the anatomical structure variation.Its the reconstruction of coronal images is similar to or better than conventional coronal scan images, and can show clearly the structure (such as the ethmoid, transsphenoidal) which endoscope can not reach.
The purpose of this study is to deepen the understanding of ostiomeatal complex inflammatory disease imaging features, and to improve the imaging diagnostic level of ostiomeatal complex inflammatory disease, through the imaging observation of OMC.
Materials and methods: This study collected 150 cases of clinically proved sinusitis over a year. All the patients received conventional scaning without reconstruction and interval reconstruction of 1.0mm after that by the German SIEMENS Sensatian 16 of the multi-slice helical CT scanner. All the data were sent to CT workstations to do MPR, mainly coronal view. Image analysis was based in the cross-sectional image and adjust direction to get the best visual image, for better observing OMC inflammatory lesions and the surrounding area adjacent. Because nasal cavity and nasal sinus distribut in paires, and function independently, this study analyzes by "side" to compare the value of conventional CT scan and MPR in assess OMC inflammatory lesions.
Results:(1) OMC is a complex, which refers to the anatomical structures as the center to ethmoidal infundibulum, including the ethmoidal infundibulum, semilunar hiatus, uncinate process, ethmoid bulla, middle turbinate, first group paranasal sinus aperture and a series of related structures. MPR images is able to show clearly OMC anatomical variations, besides the region and extent of OMC lesions and sinus bone wall from all directions. (2) We found that sinus mucosal thickening (230:203), sinus polyps (184:156), sinus bone hyperplasia sclerosis (95:60), sinus bone absorption destruction (106:71) and gas-liquid plane in sinus (49:35) were the image feature of OMC inflammatory lesions, which were seen both in conventional CT scan and MPR. But MPR displayed OMC lesions more detailed than conventional CT scan, (P<0.05).
Conclusion: (1) multi-slice helical CT scan reconstruction of the MPR images can show very clearly the region and the extent of OMC inflammatory lesions and the surrounding structures. (2) Because MPR technology is superior to conventional CT scanning in displaying sinus mucosal thickening , sinus polyps , sinus bone hyperplasia sclerosis , sinus bone absorption destruction and gas-liquid plane in sinus, so we should take MPR images, when checking nasal sinusal inflammatory disease, or before FESS sinus surgery or conventional surgery, particularly those OMC diseases involving anatomical variaties.
In a word, multi-slice helical CT scan reconstruction of the MPR images can clearly show the OMC lesions. It is a necessary tool for clinical doctors to knew he condition of OMC lesions and prevent beforehand FESS sinus surgery complication.
引文
[1]Naumann H.Pathogische anatomic der chronicschen Rhinitis and sinnusistisin:Proceedings vin international congress of Oto-Rhino Laryngology[M].Amsterdan:Excerp Med Foudation,1965,80:123
[2]Stammberger H.Endoscopic endonasal surgery:Concepts in treatment orecurring rhinosinusitis.Part1:Anatomic and pathologic considerations Otolayngol Head Neck Surg,1986,94:143
[3]Messeklinger W·Background and evolution of endoscopic sinus surgery·ENT J,1994,73:451-455·
[4]张小伯,王忠植,正确认识慢性鼻窦炎的传统手术和内窥镜鼻窦手术,中华耳鼻咽喉科杂志,1998,33(1):52-54
[5]韩德民,中国鼻内镜外科 20 年发展历程的思考,中华耳鼻咽喉头颈外科杂志 2005,40,10,721-724
[6] 孔维佳 , 周梁 , 许庚等 , 耳鼻咽喉头颈外科学 , 人民卫生出版社2005,1:64-66,94-95,98-99,101,102-104,117
[7]Zinreich SJ.Paranasal sinus imaging[J].Otolaryngal Head Neck Surg,1990,103:863
[8]Beakm E, Teresi L .Lufkin R, et al. MR of the paranasal sinuses. Surg Radiol Anat,1990,12:203.
[9]李松柏,徐克,多层螺旋 CT 临床诊断实践图谱,人民军医出版社,2004,1:3,5,35
[10]Zinreich SJ, Kenedy DW,Rosenbaum AE,et al.Paranasal sinuses:CT imaging requirements for endoscopic surgery [J]Radiology,1987,163:769
[11]周伟明,李惠民,刘光华.窦口鼻道复合体 CT 扫描三维重建技术[J].中国医学计算机成像杂志,2000,6(3):205
[12]雍军,张华.CT 仿真内镜在鼻腔、鼻窦疾病中应用[J]。国际耳鼻咽喉头颈外科杂志,2006,30(2):105-108
[13]Han P, PirsigW, Ilgen F, et al.Virtual endoscopy of the nasal cavity in comparison with fiberop tic endoscopy. [J] . Eur Arch Otorhinolaryngol, 2000, 257 (10) : 578
[14]宣秀芸,于进志等,鼻窦炎的细菌学特点及药敏观察,哈尔滨医药,1991,02:3-4
[15]Gilani S, Norbash AM,Ringi H,et al.Virtral endoscopy of the paranasal sinuses using perspective volume rendered helical sinus computed tomography[J].Laryngoscope,1997,107(1):25-29
[16]Stammberger HR, Kennedy DW.Paranasal Sinuses:anatomic terminologyand nomenclature.The Anatomic Terminology Group.Ann Otol RhinoLarygol Suppl,1995,167:7-16
[17]Bolger WE,Butzin CA,Parson DS.Paranasal sinus bony anatomic variations and mucosal abnormalities:CT analysis for endoscopic sinussurgery[J].Laryngoscope,1991,101:56-64
[18]Laine FJ, Smoker WRK.The ostiomeateal unit and endoscopic surgery:Anatomy variations,and imaging findings in imflammatory disease[J].Am J Roentgenal,1992,159:849-857
[19]朱俭,温志波,段承祥,吕桃珍.鼻窦解剖变异的 CT 观察.头颈部放射学,2005,24(5):395-399
[20]Bolger WE,Woodruf WW Jr,Morehead J,etal.Marxillary sinus hypoplasia: Classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg,1997,103:759-765
[21]Shankar L,Evans K,Hawke M,etal.The role of anatomic variants of the ostiomeatal complex and paranasal sinuses In:Shankar L,Evans K,HawkeM,etal.An atlas of imaging of the paranasal sinuses.London: Martin Dunits Press,1994,73:275
[22]May M.Complex paranasal sinus anatomy simplified for the surgeon.Opera Tech Otol Head Neck Surgery,1991,2:214-217
[23]张革化,李源,曾转萍, 真菌性鼻-鼻窦炎发病相关因素及临床特征分析,中华耳鼻喉头颈外科杂志,2006,41(3),163-166
[24]贾永忠,殷明德,真菌性鼻窦炎的临床及 CT 特征,临床耳鼻喉科杂志,1999,13(7),313-314
[25]刘贤,张革化,许庚等.CT 扫描分析窦口鼻道复合体解剖变异在鼻窦炎发病中的意义.中华耳鼻咽喉科杂志,1999,34(3):143
[26]雷雨萌.鼻窦冠状位 CT 扫描在鼻内镜鼻窦手术中的应用价值.医学理论与实践,2005,1(18):58.
[27]杨智云,蒋爱云,杨旭峰,等,螺旋 CT 三维重建在鼻科的临床应用.影像诊断与介入放射学,2005,1(10):129-131.
[28]郭文臣,赵斗贵,王石嵩,等.浅谈多层与单层螺旋 CT 的应用区别.上海医学影像杂志,2002,2(11):147.
[29]朱云翔,何亚奇,高起学,等.螺旋 CT 多层面重建矢状位图像对鼻内镜鼻窦手术的价值.中华耳鼻咽喉科杂志,2003,3(38):233-234.
[30]罗德红,梁颖,吴宁等,头颈部肿瘤多层螺旋 CT 冠状面多平面重建与常规扫描图像的对比研究.中华放射学杂志,2003,37,10,917-921
[31]刘亚群,王鲁仲,马晓峰.窦口鼻窦复合体 HRCT 扫描及其临床应用[J].中国医学影像学杂志,2000,8(5):331
[32]郑晓林,王承缘,肖明,鼻腔鼻窦炎性病变的 CT 分析,临床放射学杂志,1994,13(3),141-145
[33]许庚,李源.功能性内窥镜鼻窦外科.中华耳鼻咽喉科杂志,1995,30:119
[34]张承志,欧阳天昭,丁良新, 鼻腔和鼻窦炎性病变的 CT 表现及分型,中国医学计算机成像杂志,2006,12(1),20-22
[35]钟兴,李恒国,齐玲俊,鼻腔和鼻窦炎性疾患的 CT 分析,临床放射学杂志,2000,19(8),481-483
[36]张承志,李静,丁良新,鼻腔和鼻窦炎性病变相关性 CT 探讨,实用放射学杂志,2006,22(2),247-249
[2]Stammberger H.Endoscopic endonasal surgery:Concepts in treatment orecurring rhinosinusitis.Part1:Anatomic and pathologic considerations Otolayngol Head Neck Surg,1986,94:143
[3]Messeklinger W·Background and evolution of endoscopic sinus surgery·ENT J,1994,73:451-455·
[4]张小伯,王忠植,正确认识慢性鼻窦炎的传统手术和内窥镜鼻窦手术,中华耳鼻咽喉科杂志,1998,33(1):52-54
[5]韩德民,中国鼻内镜外科 20 年发展历程的思考,中华耳鼻咽喉头颈外科杂志 2005,40,10,721-724
[6] 孔维佳 , 周梁 , 许庚等 , 耳鼻咽喉头颈外科学 , 人民卫生出版社2005,1:64-66,94-95,98-99,101,102-104,117
[7]Zinreich SJ.Paranasal sinus imaging[J].Otolaryngal Head Neck Surg,1990,103:863
[8]Beakm E, Teresi L .Lufkin R, et al. MR of the paranasal sinuses. Surg Radiol Anat,1990,12:203.
[9]李松柏,徐克,多层螺旋 CT 临床诊断实践图谱,人民军医出版社,2004,1:3,5,35
[10]Zinreich SJ, Kenedy DW,Rosenbaum AE,et al.Paranasal sinuses:CT imaging requirements for endoscopic surgery [J]Radiology,1987,163:769
[11]周伟明,李惠民,刘光华.窦口鼻道复合体 CT 扫描三维重建技术[J].中国医学计算机成像杂志,2000,6(3):205
[12]雍军,张华.CT 仿真内镜在鼻腔、鼻窦疾病中应用[J]。国际耳鼻咽喉头颈外科杂志,2006,30(2):105-108
[13]Han P, PirsigW, Ilgen F, et al.Virtual endoscopy of the nasal cavity in comparison with fiberop tic endoscopy. [J] . Eur Arch Otorhinolaryngol, 2000, 257 (10) : 578
[14]宣秀芸,于进志等,鼻窦炎的细菌学特点及药敏观察,哈尔滨医药,1991,02:3-4
[15]Gilani S, Norbash AM,Ringi H,et al.Virtral endoscopy of the paranasal sinuses using perspective volume rendered helical sinus computed tomography[J].Laryngoscope,1997,107(1):25-29
[16]Stammberger HR, Kennedy DW.Paranasal Sinuses:anatomic terminologyand nomenclature.The Anatomic Terminology Group.Ann Otol RhinoLarygol Suppl,1995,167:7-16
[17]Bolger WE,Butzin CA,Parson DS.Paranasal sinus bony anatomic variations and mucosal abnormalities:CT analysis for endoscopic sinussurgery[J].Laryngoscope,1991,101:56-64
[18]Laine FJ, Smoker WRK.The ostiomeateal unit and endoscopic surgery:Anatomy variations,and imaging findings in imflammatory disease[J].Am J Roentgenal,1992,159:849-857
[19]朱俭,温志波,段承祥,吕桃珍.鼻窦解剖变异的 CT 观察.头颈部放射学,2005,24(5):395-399
[20]Bolger WE,Woodruf WW Jr,Morehead J,etal.Marxillary sinus hypoplasia: Classification and description of associated uncinate process hypoplasia. Otolaryngol Head Neck Surg,1997,103:759-765
[21]Shankar L,Evans K,Hawke M,etal.The role of anatomic variants of the ostiomeatal complex and paranasal sinuses In:Shankar L,Evans K,HawkeM,etal.An atlas of imaging of the paranasal sinuses.London: Martin Dunits Press,1994,73:275
[22]May M.Complex paranasal sinus anatomy simplified for the surgeon.Opera Tech Otol Head Neck Surgery,1991,2:214-217
[23]张革化,李源,曾转萍, 真菌性鼻-鼻窦炎发病相关因素及临床特征分析,中华耳鼻喉头颈外科杂志,2006,41(3),163-166
[24]贾永忠,殷明德,真菌性鼻窦炎的临床及 CT 特征,临床耳鼻喉科杂志,1999,13(7),313-314
[25]刘贤,张革化,许庚等.CT 扫描分析窦口鼻道复合体解剖变异在鼻窦炎发病中的意义.中华耳鼻咽喉科杂志,1999,34(3):143
[26]雷雨萌.鼻窦冠状位 CT 扫描在鼻内镜鼻窦手术中的应用价值.医学理论与实践,2005,1(18):58.
[27]杨智云,蒋爱云,杨旭峰,等,螺旋 CT 三维重建在鼻科的临床应用.影像诊断与介入放射学,2005,1(10):129-131.
[28]郭文臣,赵斗贵,王石嵩,等.浅谈多层与单层螺旋 CT 的应用区别.上海医学影像杂志,2002,2(11):147.
[29]朱云翔,何亚奇,高起学,等.螺旋 CT 多层面重建矢状位图像对鼻内镜鼻窦手术的价值.中华耳鼻咽喉科杂志,2003,3(38):233-234.
[30]罗德红,梁颖,吴宁等,头颈部肿瘤多层螺旋 CT 冠状面多平面重建与常规扫描图像的对比研究.中华放射学杂志,2003,37,10,917-921
[31]刘亚群,王鲁仲,马晓峰.窦口鼻窦复合体 HRCT 扫描及其临床应用[J].中国医学影像学杂志,2000,8(5):331
[32]郑晓林,王承缘,肖明,鼻腔鼻窦炎性病变的 CT 分析,临床放射学杂志,1994,13(3),141-145
[33]许庚,李源.功能性内窥镜鼻窦外科.中华耳鼻咽喉科杂志,1995,30:119
[34]张承志,欧阳天昭,丁良新, 鼻腔和鼻窦炎性病变的 CT 表现及分型,中国医学计算机成像杂志,2006,12(1),20-22
[35]钟兴,李恒国,齐玲俊,鼻腔和鼻窦炎性疾患的 CT 分析,临床放射学杂志,2000,19(8),481-483
[36]张承志,李静,丁良新,鼻腔和鼻窦炎性病变相关性 CT 探讨,实用放射学杂志,2006,22(2),247-249