副鼻竇和鄰近結(jié)構(gòu)

ParanasalSinusesandAdjacentSpaces

byLaurieLoevnerandJenniferBradshaw

RadiologydepartmentoftheUniversityofPennsylvania,USAandtheradiologydepartmenttheMedicalCentreAlkmaar,theNetherlandsPublicationdate:25-2-2021副鼻竇和鄰近結(jié)構(gòu)1精選pptRoleofCTandMRISignalcharacteristicsofsecretions黏液的信號(hào)特征Pseudo-pneumatizedsinus假性氣化的竇腔Enhancement增強(qiáng)ComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)TumorandtumorlikelesionsEncephaloceleMucoceleInvertedpapillomaMalignanttumorsofthesinonasaltractMeningiomaKeratocystSilentsinusFibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy2精選pptRoleofCT

CTisofvaluefordetermininganatomiclandmarksandvariants.ThisinformationisofvitalimportancetotheENT-surgeon.

Inaddition,weneedittoidentifyerosiveprocessesandacquireddevelopmentaldeficienciesofthebone.

CT對(duì)于鼻腔鼻竇來(lái)說(shuō)主要用于判定解剖標(biāo)志和變異。這些信息對(duì)于耳鼻喉科醫(yī)生是非常重要的。此外，我們還需判斷病變對(duì)骨質(zhì)的破壞以及骨的各種發(fā)育不良。

3精選pptCTisalsoexcellentfordeterminingwhetherthereisintraorbitalextensionofsino-nasaldiseaseintheventral2/3oftheorbit.Whenpathologyapproachestheorbitalapex,anMRIstudyisnecessarytoassessspreadtothecavernoussinusandintracranialcompartment.CTisperformedwithoutcontrastmedium.Ifadditionalimagingisnecessary,orbitalMRIisthenextstep.CT也同樣對(duì)于判斷位于眼眶內(nèi)側(cè)3分之2的鼻腔鼻竇病變對(duì)眶內(nèi)是否有侵犯非常有幫助。如果病變侵犯眶尖，那么需要進(jìn)行MRI檢查，以判斷病變向海綿竇以及顱內(nèi)腔的播散。4精選pptTherealvalueofunenhancedCTisthefollowing:ifyouseeanopacifiedsinuswithhyperdensecontents,itisusuallyasignofbenigndisease.Tumorisnothyper-dense.

Thehyperdensityisduetooneoracombinationofthefollowing:inspissatedsecretionsfungusblood非增強(qiáng)CT的真正診斷價(jià)值在于：如果渾濁的竇腔內(nèi)出現(xiàn)更高密度影，那么這個(gè)病變通常是良性的。腫瘤的密度不會(huì)很高。CT上的這種更高密度影主要由以下組成：濃縮的黏液；真菌；血液。5精選pptOntheleftyouseeacasethatwasinitiallyinterpretedasatumor.Thehyperdensityisagoodprognosticsign,indicatingabenignprocess.Thisisanexampleofallergicfungalsinusitis.Usuallyitismoreanteriorlylocated.這是一張非增強(qiáng)的CT。我們最初認(rèn)為是一個(gè)腫瘤。在右側(cè)后組篩竇、雙側(cè)蝶篩隱窩、蝶竇和斜坡的病變內(nèi)我們發(fā)現(xiàn)了更高密度影。這種更高密度影提示這可能是一個(gè)良性病變。最后證實(shí)這是一個(gè)過(guò)敏性真菌性鼻竇炎，通常位置靠前，這個(gè)病變靠后一些。6精選pptAllergicfungalsinusitis-unenhancedCTOntheleftanother,morecharacteristic,exampleofallergicfungalsinusitis.Thereisbilateralopacificationofthenasalcavities,usuallyasignofaninflammatoryprocessorpolyps.Notetheconcentriclamellatedappearanceofalternatinghyper-andhypodensityinthemaxillarysinusses.Thehyperdensityisduetoinspissatedsecretionsandfungalelements.Thehypodensityreflectscysts,mucosaldisease,andgranulationtissue.Intheethmoidalregionsomeofthehyper-densityreflectsperiostitisandneo-osteogenesisalongtheseptae.這是一個(gè)非常典型的過(guò)敏性真菌性鼻竇炎的病例。雙側(cè)鼻腔渾濁，通常提示炎癥或息肉。需要注意觀察的是在上頜竇內(nèi)可以看到上下密度同心層狀排列的征象。那么這里的高密度主要是由濃縮的黏液和真菌組成。低密度反映的是囊腫，粘膜疾病和肉芽組織。篩竇內(nèi)的一些高密度還可以反映骨膜炎和沿著鼻中隔的新生骨形成。7精選pptSignalcharacteristicsofsecretionsMRIisextremelyhelpfulincomplicatedsinonasaldisease.MRIcandiscernsecretionsandmucosafrommasses.Whenyouunderstandthesignalcharacteristics,youarereadilyabletodistinguishsofttissuesmassesfrominspissatedsecretions.Thesignalintensityofsecretionscanvaryandmainlydependsontheratioofwatertoproteinandtheviscosity.DifferentproteincontentsresultindifferentsignalintensitiesonT1andT2W-images.Fungususuallyhasahighproteincontentofmorethan28%andcanmimicanaeratedsinusbecauseitislowonT1-andT2WI.YouneedCTtomakethedistinction!黏液的特征：MRI對(duì)于復(fù)雜的鼻腔鼻竇病變是非常有幫助的。MRI可以區(qū)分腫瘤與粘液、粘膜。如果掌握了黏液的信號(hào)特征，那么是可以將軟組織腫塊與濃縮黏液進(jìn)行區(qū)分的。黏液的信號(hào)可以多樣，主要取決于水和蛋白質(zhì)的比例以及粘滯度。不同的蛋白成分可以導(dǎo)致黏液在T1和T2上信號(hào)的不同。真菌的蛋白含量通常超過(guò)28%，因此在T1和T2上信號(hào)非常低，是鼻竇腔看上去像含氣的空腔。此時(shí)，需要做的是建議CT。8精選pptThesignalintensityofsinussecretionsdependsontheproteincontent不同蛋白含量導(dǎo)致信號(hào)不同9精選pptMRIisalsousefulfordetermininginvasionoftheskullbase.InvolvementoftheskullbaseisseenasreplacementofthehighsignalofthefattymarrowonT1WIbyhypointensesignalofthetumor.Alsolookforforaminalextension,whetherbyperineuralspreadordirectinvasionofthetumor.MRIisalsothestudyofchoicefordetectingintracranialextensionofsinonasaldisease.MRI同樣對(duì)于判斷鼻腔鼻竇病變對(duì)顱底的侵犯非常有幫助。信號(hào)改變主要表現(xiàn)為：T1上顱底諸骨髓腔內(nèi)脂肪的高信號(hào)被腫瘤的低信號(hào)取代。也可以觀察腫瘤沿著顱底孔道的播散，不管是沿著神經(jīng)還是直接侵犯。MRI同樣也是判斷鼻腔鼻竇病變顱內(nèi)侵犯的首選。10精選pptRoleofCTandMRISignalcharacteristicsofsecretions黏液的信號(hào)特征Pseudo-pneumatizedsinus假性氣化的竇腔Enhancement增強(qiáng)ComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)TumorandtumorlikelesionsEncephaloceleMucoceleInvertedpapillomaMalignanttumorsofthesinonasaltractMeningiomaKeratocystSilentsinusFibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy11精選pptPseudo-pneumatizedsinus

假性氣腔OntheleftaT2W-imageinanimmuno-compromisedpatientwithfever.InitiallyaMRIwasperformedtoruleoutsinusitis.

Noticethelowsignalintensityoftheleftsphenoidsinus,whichalsohadalowsignalintensityontheT1W-image(notshown).

ContinuewiththeCT.免疫缺陷患者，發(fā)燒。最初的T2像是為了排除鼻竇炎。需要注意的是蝶竇內(nèi)的低信號(hào)，患者的T1上此處也為低信號(hào)〔沒(méi)展示〕。12精選pptPseudo-pneumatizedsinusonMR.Bewareoffungus!TheCTclearlyshowstheopacifiedsinus,whichisslightlyhyperdense.ThesignalcharacteristicsonMRIandtheattentuationonCTarearesultofthehighproteincontentoffungus.Thisisagoodexampleofthepitfallofthe'pseudo-pneumatizedsinus'.So,wheninvasivefungalinfectionissuspected,startwithaCT,thenmoveontoMRItoruleoutspreadtotheeye,cavernoussinusandintracranialcompartment!這位患者的CT清晰的顯示了渾濁的竇腔，內(nèi)見(jiàn)少量的更高密度。那么，在MRI上T1和T2都低以及CT上的高密度提示這是一個(gè)含有高蛋白的真菌性鼻竇炎。這就是一個(gè)很好的“假性氣腔〞的例子。因此，當(dāng)我們疑心患者有真菌感染的時(shí)候，首先需要進(jìn)行的檢查是CT，然后可以進(jìn)行MRI檢查以觀察病變是否侵及眼部、海綿竇和顱內(nèi)腔。13精選pptRoleofCTandMRISignalcharacteristicsofsecretions黏液的信號(hào)特征Pseudo-pneumatizedsinus假性氣化的竇腔Enhancement增強(qiáng)的作用ComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)TumorandtumorlikelesionsEncephaloceleMucoceleInvertedpapillomaMalignanttumorsofthesinonasaltractMeningiomaKeratocystSilentsinusFibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy14精選pptEnhancementIngeneralbrightsignalonT2isasignofbenigndisease,sincefluidandmucosaldiseaseusuallyhaveahighwatercontent.Secretionsdonothavesolidenhancement.Ifyouhaveanenhancingmass,youmustruleouttumor.增強(qiáng)的作用：通常情況下在T2上比較亮的病變都是良性的，因?yàn)橐后w或粘膜的病變通常含水非常多。黏液不會(huì)出現(xiàn)實(shí)性強(qiáng)化。如果腫塊出現(xiàn)強(qiáng)化，那么必須排除腫瘤性病變。15精選pptOntheleftanexampleofinfectioussinonasaldisease.Onthepre-contrastscanyouseerelativelyhighsignalcontentofthemaxillarysinussesduetoproteineousmaterial.Aftertheadministrationofi.v.contrastthereisonlyenhancementofthecircumferentialmucosaandnosolidenhancement.T1上可見(jiàn)雙側(cè)上頜竇內(nèi)的信號(hào)相對(duì)鼻腔內(nèi)的要高一些，主要是由于其含有蛋白成分。增強(qiáng)之后可見(jiàn)只有環(huán)形的粘膜強(qiáng)化，沒(méi)有實(shí)性強(qiáng)化。因此這是一個(gè)鼻腔鼻竇的感染性病變。16精選pptOntheCT-imagesthefindingsare:Softtissuemassinthemaxillarysinus(redarrow).Destructionofthesinuswall(yellowarrow).Remodellinganddestructionofthepterygoidbone(bluearrow).Largesofttissuemassinthemasticatorspace(asterisk).CT上可見(jiàn)左側(cè)上頜竇內(nèi)見(jiàn)軟組織腫塊〔紅箭頭〕。腫塊對(duì)上頜竇壁有破壞〔黃色箭頭〕。翼骨有膨脹及破壞〔藍(lán)色箭頭〕。在咀嚼肌區(qū)可見(jiàn)大的軟組織腫塊〔星號(hào)〕。對(duì)于比較復(fù)雜的病例需要同時(shí)進(jìn)行CT和MRI檢查。這名患者肺移植術(shù)后出現(xiàn)發(fā)熱，多發(fā)、快速開(kāi)展的顱神經(jīng)麻痹。Theimageontherightismorecranial.Thereisopacificationofthesphenoidsinuswithdestructionandosteopeniaofthesphenoidbone.CTnicelydemonstratesthebonedestructionandsomeofthesofttissueinvolvement.ContinuewiththeMR-images.更上一張CT可見(jiàn)蝶竇竇腔渾濁，竇壁骨質(zhì)吸收。CT清晰的顯示了病變對(duì)骨質(zhì)的破壞和累及的一些軟組織。接下來(lái)看磁共振。17精選pptThefindingsare:Fluidintherightsphenoidsinus(redarrow).Hypointensetissueintheleftsphenoidsinus(yellowarrows).Trackingalongtheduralmarginofthemiddlecranialfossa(bluearrows).Extensionintotheleftzygomatic-masticatorspace(largeyellowarrow).Followingcontrast,thereisnosolidenhancementofthetissueinthesphenoidspace.Continuewiththecoronalimages.與CT相應(yīng)的MRI層面?？梢?jiàn)右側(cè)蝶竇內(nèi)的液體〔紅箭頭〕。左側(cè)蝶竇內(nèi)低信號(hào)的組織〔黃箭頭〕。沿著中顱窩的腦膜蔓延〔藍(lán)色箭頭〕。延伸到左側(cè)顴-咀嚼肌區(qū)?！泊蟮狞S色箭頭〕。增強(qiáng)之后，蝶竇內(nèi)的組織沒(méi)有出現(xiàn)實(shí)性強(qiáng)化。接下來(lái)看冠狀位。18精選pptLymphomaofsphenoidsinusandskullbaseCoronalimagesofthesamepatient:T1pre-andpost-contrast.NormalaspectoftherightMeckel‘scave,tissueintheleftMeckel’scaveextendingintothecavernoussinus(bluearrow).Theredarrowpointstotheduralmarginofthecavernoussinus:thereisenhancementonbothsidesofthedura.Thediseasewrapsaroundthetemporallobe(greenarrow)andextentsdownwardintheforamenovale(yellowarrow)andintothemasticatorspace.Theasterixindicatesnormalnon-enhancingtissueinthemasticatorspace.該患者的冠狀位T1和增強(qiáng)。右側(cè)美克耳腔正常，左側(cè)美克耳腔內(nèi)的組織延伸到海綿竇〔藍(lán)色箭頭〕。紅色箭頭標(biāo)出的是海綿竇的硬膜邊緣，硬膜雙側(cè)都有強(qiáng)化。病變包繞顳葉〔綠色箭頭〕，并進(jìn)入到咀嚼肌區(qū)域。星號(hào)指出咀嚼肌區(qū)正常的沒(méi)有增強(qiáng)的組織。19精選pptThispatienthadalymphoma.Nineoutoftentimesanimmunocompromisedpatientwillhaveafungalinfection,inoneoutoftenitwillbealymphoma.CTandMRhaveacomplimentaryroleinthiscase,butfinallyabiopsyiscalledfortodifferentiatebetweenthesetwodiagnoses,becauseofdifferenttreatment.這個(gè)患者最后確診為淋巴瘤。雖然蝶竇內(nèi)病變沒(méi)有實(shí)性強(qiáng)化。免疫缺陷患者出現(xiàn)上述影像學(xué)表現(xiàn)時(shí)，10個(gè)人有9個(gè)人是真菌感染，剩下的一個(gè)人可能就是個(gè)淋巴瘤。雖然CT和磁共振可以很好的顯示了這兩個(gè)病變，但最終還是需要活檢證實(shí)這兩種不同的病變，因?yàn)椴扇〉闹委煵煌?0精選pptRoleofCTandMR(4)

Ontheleftimagesofa64-yrs-old,immuno-competentpatient,whohadafollow-upscanforleft-sidedvestibularneuroma.Ontheimageonthelefthypointensetissueisseeninthepterygo-palatinefossaandvideancanal(yellowarrow).Ontheimageontheright,whichismorecranial,thereishypointensetissueinthepterygo-maxillaryfissureandpterygo-palatinefossa.Continuewiththecontrast-enhancedT1W-image.64歲，免疫缺陷患者，這張片子是為了隨訪聽(tīng)神經(jīng)瘤而拍攝的。T2像上右側(cè)翼腭窩和翼管處可見(jiàn)低信號(hào)病變。右側(cè)的是更上一張，在翼上頜裂和翼腭窩處可見(jiàn)低信號(hào)組織。接下來(lái)看T1增強(qiáng)。21精選pptThereissolidenhancementoftheabnormality.Thedifferentialdiagnosisagainconsistsof2catagories:neoplasmandchronicinvasivefungalinfection.Inanimmuno-competentpatient,aneoplasmismuchmorelikely.ContinuewiththeCT-images.T1增強(qiáng)病變出現(xiàn)實(shí)性強(qiáng)化。那么鑒別診斷主要有2方面，腫瘤和慢性侵襲性真菌感染。如果患者沒(méi)有免疫缺陷，那么更傾向于腫瘤。接下來(lái)看CT。22精選pptThisisthecorrespondingCT,performednottomakethediagnosis,buttoassesstheconditionoftheadjacentbonystructures,especiallythesphenoidsinus.

Also,itservestoguidetheendoscopistforintraoperativebiospy.

Thereisextensivedestructionoftheskullbase.相應(yīng)的CT層面。進(jìn)行CT檢查不是為了做出診斷，而是為了評(píng)估病變周?chē)墓墙Y(jié)構(gòu)，特別是蝶竇的。顱底的骨質(zhì)有廣泛的破壞?；颊哌M(jìn)行了經(jīng)鼻內(nèi)規(guī)鏡下活檢。23精選pptThecoronalimageillustratesanormalforamenrotundumontheleft(yellowarrow),whichontherighthasbeenobliteratedbysofttissue.Thereisextensivebonedestruction,andapossibleareaforbiopsyisindicatedbythebluearrow.Atbiopsythediagnosisofaspindlecellcarcinomawasmade.冠狀位CT顯示左側(cè)圓孔是正常的〔黃色〕。右側(cè)圓孔被軟組織充填。這個(gè)局部有廣泛的骨質(zhì)破壞，因此可以作為取活檢的位置〔藍(lán)色〕。最后病理證實(shí)是梭形細(xì)胞癌。24精選pptRoleofCTandMRISignalcharacteristicsofsecretions黏液的信號(hào)特征Pseudo-pneumatizedsinus假性氣化的竇腔Enhancement增強(qiáng)ComplicationsofSinusitis鼻竇炎的合并癥Brainabscess腦膿腫Mucocele黏液囊腫OrbitalCellulitisandAbscess眼眶蜂窩織炎和膿腫ComplicationofFESS(Functionalendoscopicsinussurgery)功能性鼻內(nèi)窺鏡術(shù)后合并癥TumorandtumorlikelesionsEncephaloceleMucoceleInvertedpapillomaMalignanttumorsofthesinonasaltractMeningiomaKeratocystSilentsinusFibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy25精選pptComplicationsofSinusitisWhenassessingthecomplicationsofsinusitis,CTisexcellentforimagingofsubperiostialabscessesororbitalextensionintotheventral2/3oftheorbit.MRIisnecessaryforassessingintracranialcomplications,suchasbrainorepiduralabscesses,subduralempyemaorsinusthrombosis.

CT對(duì)于評(píng)估鼻竇炎合并癥的作用：對(duì)于判斷骨膜下膿腫和向眶內(nèi)側(cè)3分之2的擴(kuò)散非常有幫助。MRI對(duì)于評(píng)估鼻竇炎合并癥的作用：主要評(píng)估顱內(nèi)的合并癥，例如腦和硬膜外膿腫，硬膜下積膿或者竇內(nèi)血栓。26精選pptBrainabscessOntheleftimagesofapatientwasinitiallydiagnosedwithaglioblastomamultiforme.Thereareabnormalitiesinbothfrontallobes.

Noticehowevertheabnormaltissueinthefrontalsinus(yellowarrow),subperiostealabscess(redarrow)andthefluid-fluidlevel(greenarrow)inthelargeintracraniallesionwhichhasringenhancement.

這名患者最初的診斷是多形性膠質(zhì)母細(xì)胞瘤。雙側(cè)額葉異常。值得注意觀察的是顱內(nèi)較大的病變，如額竇內(nèi)的異常組織〔黃色箭頭〕，骨膜下膿腫〔紅色箭頭〕，和液平〔綠色箭頭〕，都是環(huán)形強(qiáng)化的。27精選pptBrainabscessAllabnormalitiesarecontinuousmeaningthereisfrontalbonydestruction.

Therestricteddiffusionalsosupportsthediagnosisofbrainabscess.

Thisisasubperiostealabscessandosteomyelitisofthefrontalbone,usuallywithasofttenderswellingoftheforehead.

ThisisalsocalledPott'spuffytumorafterSirPott,anEnglishsurgeonwhofirstdescribedthisentity.這些異常提示額骨有骨質(zhì)破壞。彌散像上的表現(xiàn)也符合腦膿腫。額骨的骨膜下膿腫和骨髓炎，通常表現(xiàn)為前額質(zhì)軟、壓痛的腫脹，也可以稱為波特頭皮腫瘤，最初是由一個(gè)叫波特的英國(guó)醫(yī)生描述的。28精選pptBrainabscess(2)

Ontheleftimagesofanotherpatient,whohadrecentlybeentreatedforsinusitisandnowpresentedwithaseizure.TheCTshowsanabnormalityinthelefttemporallobewithshaggythickrimenhancement,andalargeamountofvasogenicedema.Thisisalsoabrainabscess,mostprobablyduetorefluxofbacteriaintocranialveinsandthevenousplexusaroundthecavernoussinus.另外一個(gè)患者。曾經(jīng)接受過(guò)鼻竇炎的治療，現(xiàn)在出現(xiàn)了癲癇。CT顯示出左側(cè)顳葉的異常并有粗厚的環(huán)形強(qiáng)化，和大量的血管源性水腫。這個(gè)病變同樣也是一個(gè)腦膿腫，最有可能的原因是細(xì)菌逆流進(jìn)入海綿竇周?chē)娘B內(nèi)靜脈和靜脈叢。29精選pptRoleofCTandMRISignalcharacteristicsofsecretions黏液的信號(hào)特征Pseudo-pneumatizedsinus假性氣化的竇腔Enhancement增強(qiáng)ComplicationsofSinusitis鼻竇炎的合并癥Brainabscess腦膿腫Mucocele黏液囊腫OrbitalCellulitisandAbscess眼眶蜂窩織炎和膿腫ComplicationofFESS(Functionalendoscopicsinussurgery)功能性鼻內(nèi)窺鏡術(shù)后合并癥TumorandtumorlikelesionsEncephaloceleMucoceleInvertedpapillomaMalignanttumorsofthesinonasaltractMeningiomaKeratocystSilentsinusFibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy30精選pptMucoceleOntheleftimagesofapatientwithacutesinusitisandethmoidaircelldisease.

Hepresentedwithblurredvision.

Firststudytheimages,thencontinuereading.Noticethefluidintheleftanteriorclinoidprocess.Theopticnerverunsmedialtoit.Continuewiththecoronalimages.

這個(gè)患者患有急性鼻竇炎和篩竇氣房病變。主訴是視力模糊。首先在T2上左側(cè)前床突處可見(jiàn)液體，視神經(jīng)在其內(nèi)側(cè)走行。接下來(lái)看冠狀位。31精選pptMucoceleThecoronalT2WIshowsexpansionoftheclinoidprocess.

TheT1WIshowslossofnormalfatcomparedwiththerightside,andextensionintotheorbitalapex(redarrow).

Thisisamucoceleoftheanteriorclinoidwithsecondaryinvolvementoftheopticnerve.冠狀位T2上可見(jiàn)床突的膨脹。T1上可見(jiàn)相較于對(duì)側(cè)，左側(cè)床突的髓內(nèi)脂肪信號(hào)消失，并且病變延伸到眶尖〔紅色箭頭〕。這是一個(gè)前床突的粘液囊腫伴繼發(fā)累及視神經(jīng)。32精選pptRoleofCTandMRISignalcharacteristicsofsecretions黏液的信號(hào)特征Pseudo-pneumatizedsinus假性氣化的竇腔Enhancement增強(qiáng)ComplicationsofSinusitis鼻竇炎的合并癥Brainabscess腦膿腫Mucocele黏液囊腫OrbitalCellulitisandAbscess眼眶蜂窩織炎和膿腫ComplicationofFESS(Functionalendoscopicsinussurgery)功能性鼻內(nèi)窺鏡術(shù)后合并癥TumorandtumorlikelesionsEncephaloceleMucoceleInvertedpapillomaMalignanttumorsofthesinonasaltractMeningiomaKeratocystSilentsinusFibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy33精選pptOrbitalCellulitisandAbscessLeftisanaxialT1WI,rightisacoronalT2WI.Thereisanabnormalityontheleftside,buttoalesserdegreealsoontheright.Trytodeterminewhichstructuresareinvolved.Theyellowarrowspointtothenaso-lacrimalducts.Thenaso-lacrimalsacconnectswiththeduct,whichthendrainsintotheinferiormeatus.Ontheleftthereisperi-orbitalpre-septalsofttissueswelling.Onthecoronalimagethereisbilateralhighsignalatthejunctionofthenasolacrimalductandsac,indicativeofafluidcollection.

左邊是軸位T1，右邊是冠狀位T2。雙側(cè)鼻淚管處可見(jiàn)異常，左側(cè)為著。黃色箭頭所示的就是鼻淚管。需要考慮的是受累及的組織。鼻淚囊連接鼻淚管，引流至下鼻道。左側(cè)T1上可見(jiàn)眶周眶隔前軟組織腫脹。冠狀位T2可見(jiàn)雙側(cè)鼻淚管和淚囊交界處的異常高信號(hào)，提示有液體積聚。34精選pptOrbitalCellulitisandAbscessPost-contrastT1WI,axialandcoronal.

Lateraltothenaso-lacrimalductsonbothsides,therearethefluidcollectionswhichnowshowperipheralenhancement.增強(qiáng)T1的軸位和冠狀位。雙側(cè)鼻淚管的外側(cè)積聚的液體表現(xiàn)為周?chē)鷱?qiáng)化。35精選pptOrbitalCellulitisandAbscessTheadditionalimages(T2WI)showmucosaldiseaseoftherightmaxillarysinusandafluidlevelintheleftmaxillarysinus,inadditiontoextensiveethmoidalandsphenoidalsinusdisease.Thispatienthadacutesinusitiswhichwascomplicatedbyorbitalcellulitisanddacrocystitiswithabscesses.Developmentalorinflammatorynarrowingofthenaso