牙源性鼻窦炎的核磁共振成像特征及其与无钙化上颌窦真菌球的差异

Magnetic resonance imaging features of odontogenic sinusitis and its differences with maxillary sinus fungal ball without calcification

摘要:

目的分析牙源性鼻窦炎(OS)患者的核磁共振成像(MRI)特征及其与无钙化的上颌窦真菌球(MSFB)的区别。方法回顾性分析2019年1月—2021年5月收治住院行内镜鼻窦手术(ESS)治疗的OS及无钙化的MSFB患者的MRI影像资料，其中OS患者10例，MSFB患者11例，分析两组患者在T1WI、T2WI及T1WI增强时的差异。结果 OS在T1WI为不均质的等低信号，在T2WI为不均质的高信号，上颌窦各壁的信号均略高于中央区域。T1WI增强可见上颌窦各壁黏膜水肿增厚，呈“花环样”不均匀强化，局部呈乳头状突起，而中心为无强化的脓性分泌物。OS所致黏膜平均厚度(8.87±6.56) mm，显著高于真菌球所致的黏膜增厚[(4.34±3.24) mm](P＜0.05)。此外，上颌窦真菌球在T2WI时窦腔内可见特征性的顺磁性极低信号，且伴有下鼻道穹隆塌陷的比例(10/11)显著高于OS (1/10)(P＜0.05)。结论 OS的MRI特征性表现是上颌窦黏膜高度水肿、分层强化和花环征以及窦腔内充满脓性分泌物。相对于无钙化的MSFB，OS上颌窦口处的下鼻道穹隆多数完好无塌陷。

Abstract:

Objective To investigate the characteristics of magnetic resonance imaging (MRI) of patients with odontogenic sinusitis (OS) and the differences from maxillary sinus fungal ball (MSFB) without calcification. Methods A retrospective analysis was conducted on the MRI data of patients with OS and MSFB who were hospitalized and underwent endoscopic sinus surgery (ESS) in our department from January 2019 to May 2021. Ten OS patients and 11 MSFB patients were included. The differences between the two groups of patients in T1WI, T2WI and T1WI enhancement (T1WI+C) were analyzed. Results MRI of OS patients showed heterogeneous hypointense signals in T1WI, and heterogeneous hyperintense signals in T2WI. The signals of each wall of maxillary sinus were slightly higher than those of the central region. In T1WI+C, the mucous membranes of each wall of the maxillary sinus were edematous and thickened, presenting an uneven enhancement in a “wreath-like” pattern with local papillary protrusions, while the center showed purulent secretions without enhancement. The average mucosal thickness caused by OS was (8.87±6.56)mm, which was significantly higher than that caused by fungal ball [(4.34±3.24)mm] (P＜0.05). The maxillary fungal ball showed characteristic paramagnetic extremely low signals in the sinus cavity at T2WI. The proportion of collapse of inferior meatus dome in MSFB (10/11) was significantly higher than that of OS (1/10) (P<0.05). Conclusions The characteristic manifestations of MRI of OS are severe edema of the maxillary sinus mucosa, stratified enhancement and wreath-like sign, as well as purulent secretions filling the sinus cavity. Compared with the MSFB without calcification, the inferior meatus dome at the maxillary sinus ostium in OS is mostly intact without collapse.