鼻部病變影像學(xué)檢查路徑及分析思路

1、鼻部病變影像學(xué)檢查路徑及分析思路 1內(nèi) 容影像學(xué)檢查方法病變影像學(xué)檢查路徑分析思路新技術(shù)應(yīng)用2影像學(xué)檢查方法X線平片體層攝影超聲CTMRIPET-CT3影像學(xué)檢查方法CT骨質(zhì)分辨率高最常用的方法價(jià)值定位和定性診斷內(nèi)窺鏡手術(shù)路徑圖4HRCT-routine procedurescanning (reformatting )techniquehigh Kvbone algorithm reconstructionmargin enhancement section thickness 2 mmsmall FOVWW/WL 2000/200HU axial, coronal and sagittal

2、 planes5鼻竇CT質(zhì)控 重組斷面基線范圍窗技術(shù)MPR圖像數(shù)量照片總數(shù)骨（D）軟組織（B）層厚間距橫斷面聽眶下線額竇頂部至硬腭2000/200 2.03.0243冠狀面垂直硬腭額竇前部至蝶竇后部2000/200 2.03.024矢狀面平行中正中矢狀面包括兩側(cè)上頜竇外側(cè)緣2000/200 2.03.0246鼻竇橫斷位7鼻竇冠狀位8鼻竇矢狀位9normal CT images10影像學(xué)檢查方法MRI軟組織分辨率高較常用檢查方法價(jià)值病變大小侵犯范圍浸潤骨髓神經(jīng)累及定性診斷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影像學(xué)檢查方法PET-CT療效評價(jià)17影像學(xué)檢查路徑CT為首選方法MRI為補(bǔ)充方法PET-CT為后選方法簡單化、最優(yōu)化及合理化18常見鼻部病變外傷炎癥息肉腫瘤19（一）外傷CT為首選檢查方法準(zhǔn)確認(rèn)識(shí)解剖結(jié)構(gòu)診斷報(bào)告描述全面注意并發(fā)癥的發(fā)生20 鼻頜縫21顱骨標(biāo)本大體解剖及雙側(cè)鼻骨孔 顱骨標(biāo)本CT掃描后VR重組像22橫斷面圖像及冠狀面圖像診斷為鼻骨骨折 VR圖像證實(shí)為鼻骨孔 23 鼻骨骨折上頜骨額突骨折24fracture？252627（二）炎癥細(xì)菌性炎癥真菌性炎癥肉芽腫性病變28細(xì)菌性炎癥CT常規(guī)檢查方法分期骨質(zhì)改變

5、29acute sinusitis30acute sinusitis3132 chronic sinusitis33odontogenic sinusitis34 mucocele35mucocele36mucocele37bilateral mucoceles38真菌性炎癥CT首先檢查方法MRI補(bǔ)充檢查方法該類炎癥發(fā)病率高注意該類炎癥分型掌握各型影像學(xué)特點(diǎn)39 fungus ball40 41fungus ball42 AFS43 AFS44 CIFS4546 AFFS47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(diǎn)首先確定炎性病變可選用排除診斷法48 WG4950 WG5

6、1rhinoscleroma52tuberculosis53 EAF54（三）息肉屬于常見、多發(fā)病影像學(xué)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55 nasal polyp 56antrochoanal polyp 5750s150s250s出血、漸進(jìn)性強(qiáng)化征hemorrhagic necrotic polyp 58olfactory neuroblastoma 59（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60骨源性腫瘤的檢查路徑主要靠CT診斷MRI可作為補(bǔ)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軟組織起源腫瘤檢查路徑CT和M

8、RI聯(lián)合使用 CT平掃M(jìn)RI平掃+增強(qiáng)PET-CT應(yīng)適時(shí)選擇80分析思路定位良、惡性判別骨質(zhì)組織學(xué)性質(zhì)推斷密度信號(hào)臨床重視惡性腫瘤分期加強(qiáng)療后影像學(xué)隨訪81fat accumulation82F/43鼻出血10余日紫紅色腫塊隨心率搏動(dòng)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