鼻部病變影像學檢查路徑及分析思路-楊本濤

1、鼻部病變影像學檢查路徑及分析思路,首都醫(yī)科大學附屬北京同仁醫(yī)院楊本濤,內 容,影像學檢查方法病變影像學檢查路徑分析思路新技術應用,影像學檢查方法,X線平片體層攝影超聲CTMRIPET-CT,影像學檢查方法,CT骨質分辨率高最常用的方法價值定位和定性診斷內窺鏡手術路徑圖,HRCT-routine procedure,scanning (reformatting )techniquehigh Kvbon

2、e algorithm reconstructionmargin enhancement section thickness 2 mmsmall FOVWW/WL 2000/200HU axial, coronal and sagittal planes,鼻竇CT質控,鼻竇橫斷位,鼻竇冠狀位,鼻竇矢狀位,normal CT images,影像學檢查方法,MRI軟組織分辨率高較常用檢查方法價值病變大小侵犯范圍浸潤

3、骨髓神經(jīng)累及定性診斷,MRI scanning procedure,pre-enhanced axial and coronal T1WI and axial T2WI post-enhanced axial, coronal, and sagittal T1WIAdd frequency-selective fat saturation in the post-contrast axial or coronal plane

4、,T1WI: TR/TE 500–600/10–15msT2WI: TR/TE 3500–4000/120–130 msNEX 2–4,echo train length 11–27, matrix 256×256FOV 18×18 cmsection thickness 4-5 mm intersection gap 0.5 mm,MR cisternography,DCE-MRI,DWI,影像學檢查

5、方法,PET-CT療效評價,影像學檢查路徑,CT為首選方法MRI為補充方法PET-CT為后選方法,簡單化、最優(yōu)化及合理化,,常見鼻部病變,外傷炎癥息肉腫瘤,（一）外傷,CT為首選檢查方法準確認識解剖結構診斷報告描述全面注意并發(fā)癥的發(fā)生,,鼻頜縫,,,,,,,顱骨標本大體解剖及雙側鼻骨孔,顱骨標本CT掃描后VR重組像,橫斷面圖像及冠狀面圖像診斷為鼻骨骨折,VR圖像證實為鼻骨孔,,,,,,鼻骨骨折,上頜骨額突骨折,frac

6、ture？,,,（二）炎癥,細菌性炎癥真菌性炎癥肉芽腫性病變,細菌性炎癥,CT常規(guī)檢查方法分期骨質改變,acute sinusitis,,,,acute sinusitis,,chronic sinusitis,odontogenic sinusitis,mucocele,mucocele,mucocele,bilateral mucoceles,真菌性炎癥,CT首先檢查方法MRI補充檢查方法該類炎癥發(fā)病率高注意該類炎癥

7、分型掌握各型影像學特點,fungus ball,,fungus ball,AFS,AFS,CIFS,AFFS,肉芽腫炎癥,CT、MRI聯(lián)合使用該類炎癥為少見病著重掌握診斷要點首先確定炎性病變可選用排除診斷法,WG,WG,rhinoscleroma,tuberculosis,EAF,（三）息肉,屬于常見、多發(fā)病影像學能判別類型常見息肉：CT首選上頜竇-后鼻孔息肉：CT首先出血壞死性息肉：MRI最佳注意與真菌炎、腫瘤鑒別

8、,nasal polyp,antrochoanal polyp,出血、漸進性強化征,hemorrhagic necrotic polyp,olfactory neuroblastoma,（四）腫瘤,分類軟組織起源骨組織起源合理選擇檢查方法定位診斷定性診斷腫瘤分期,骨源性腫瘤的檢查路徑,主要靠CT診斷MRI可作為補充,,osteoma,osteoma,Gardner syndrome,OF,,OF with ABC,ost

9、eosarcoma,osteosarcoma,,chondrosarcoma,chondrosarcoma,chondrosarcoma,metastatic tumor,,metastatic tumor,,M/59 yrs vision loss of the right eye,metastatic tumor,,fibrous dysplasia,fibrous dysplasia,Albright syndrome,LC

10、H,2007－5－21,2007－8－20,軟組織起源腫瘤檢查路徑,CT和MRI聯(lián)合使用 CT平掃MRI平掃+增強PET-CT應適時選擇,分析思路,定位良、惡性判別骨質組織學性質推斷密度信號臨床重視惡性腫瘤分期加強療后影像學隨訪,fat accumulation,F/43鼻出血10余日紫紅色腫塊隨心率搏動,,,,meningoencephalocele,IP,,IP,IP transformation,cap

11、illary hemangioma,cavernoushemangioma,,angiofibroma,,angiofibroma,angiofibroma,SCC,SCC,SCC,ACC,,melanoma,olfactory neuroblastoma,olfactory neuroblastoma,2003-12-22,2004-4-2,NK/T lymphoma,,NK/T lymphoma,metastatic tumor,

12、,,ON pretreatment,postreatment,,F/38ACC8 years of postsurgery,2010-4-8,,F/26SCC2 months ofpostsurgery,2010-5-13,2010-5-18,2010-6-7,2010-6-23,2010-6-26,2010-6-25,2010-8-3,總 結,熟練掌握解剖結構了解檢查方法優(yōu)勢明確影像檢查路徑優(yōu)化各種掃描技術具有良好