自发性脑脊液鼻漏定位诊断的影像学征象分析
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湘雅医院

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Imaging sign analysis of localization diagnosis of spontaneous cerebrospinal fluid rhinorrheaZhang Hua 1 Xing Lijun 2 Gao Kelei 1 Xie Zhihai 1 Zhang Junyi 1? Fan Ruohao 1 Wang Fengjun 1 Xie Shumin 1 Jiang Weihong1
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Xiangya Hospital, Central South University

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    摘要:目的:通过总结自发性脑脊液鼻漏患者的影像学直接征象和间接征象,为脑脊液鼻漏修补术前漏点的影像学定位诊断提供依据。方法:回顾性分析2017年1月~2021年年3月中南大学湘雅医院耳鼻咽喉科诊治的48例患者的临床资料,所有患者术前行鼻窦颅底HRCT和MRI水成像检查。术前分析其影像学直接征象和间接征象,并结合术中情况证实其漏点位置。结果:48例患者术前经影像学漏点判断并经手术证实漏点位于筛板20例(41.7%),蝶窦外侧隐窝16例(33.3%),筛顶8例(16.6%),额窦后壁2例(4.2%),斜坡2例(4.2%)。研究发现不同区域的自发性脑脊液鼻漏直接征象和间接征象存在明显不同,间接征象如左右侧不对称,引流通道水肿,窦腔黏膜增厚和积液征可以用于寻找漏点。漏口在影像学上根据直接征象颅底骨质缺损的诊断符合率为66.7%,而联合应用CT与MRI水成像根据直接征象和间接征象联合应用的诊断符合率为100%。结论:自发性脑脊液鼻漏患者影像学的间接征象对于术前准确判断漏点具有重要价值。

    Abstract:

    Abstract: Objective: To summarize the direct and indirect imaging signs of patients with spontaneous cerebrospinal fluid rhinorrhea, so as to provide basis for the imaging localization diagnosis of leakage points before cerebrospinal fluid rhinorrhea repair. Methods: The clinical data of 48 patients diagnosed and treated in the Department of Otorhinolaryngology, Xiangya Hospital, Central South University from January 2017 to March 2021 were analyzed retrospectively. All patients underwent HRCT and MRI of nasal sinus and skull base before operation. The direct and indirect imaging signs were analyzed before operation, and the location of the leakage point was confirmed in combination with the intraoperative situation. Results: The leak points of 48 patients were determined by imaging and confirmed by operation. The leak points were located in cribriform plate in 20 cases (41.7%), lateral recess of sphenoid sinus in 16 cases (33.3%), the ethmoid roof in 8 cases (16.6%), posterior wall of frontal sinus in 2 cases (4.2%) and clivus of skull basein 2 cases (4.2%). The study found that the direct signs and indirect signs of spontaneous cerebrospinal fluid rhinorrhea in different regions were significantly different. Indirect signs such as left-right asymmetry, drainage channel edema, sinus mucosal thickening and effusion signs could be used to find the leak point. The diagnostic coincidence rate of the leak according to the direct signs of skull base bone defect in imaging was 66.7%, while the combination of CT and MRI was used to image the leakage points according to the combination of direct signs and indirect signs, the diagnostic coincidence rate was 100%. Conclusion: The indirect imaging signs of patients with spontaneous cerebrospinal fluid rhinorrhea are of great value for accurately judging the leakage point before operation.

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  • 收稿日期:2021-12-16
  • 最后修改日期:2022-02-14
  • 录用日期:2022-02-15
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