鼻部病变影像学检查路径及分析思路杨本涛

鼻部病变影像学检查路径及分析思路,首都医科大学附属北京同仁医院杨本涛,内 容,影像学检查方法病变影像学检查路径分析思路新技术应用,影像学检查方法,X线平片体层摄影超声CTMRIPET-CT,影像学检查方法,CT骨质分辨率高最常用的方法价值定位和定性诊断内窥镜手术路径图,HRCT-routine procedure,scanning (reformatting )techniquehigh Kvbone algorithm reconstructionmargin enhancement section thickness 2 mmsmall FOVWW/WL 2000/200HU axial, coronal and sagittal planes,鼻窦CT质控,鼻窦横断位,鼻窦冠状位,鼻窦矢状位,normal CT images,影像学检查方法,MRI软组织分辨率高较常用检查方法价值病变大小侵犯范围浸润骨髓神经累及定性诊断,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,T1WI: 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 mm,MR cisternography,DCE-MRI,DWI,影像学检查方法,PET-CT疗效评价,影像学检查路径,CT为首选方法MRI为补充方法PET-CT为后选方法,简单化、最优化及合理化,常见鼻部病变,外伤炎症息肉肿瘤,（一）外伤,CT为首选检查方法准确认识解剖结构诊断报告描述全面注意并发症的发生,鼻颌缝,颅骨标本大体解剖及双侧鼻骨孔,颅骨标本CT扫描后VR重组像,横断面图像及冠状面图像诊断为鼻骨骨折,VR图像证实为鼻骨孔,鼻骨骨折,上颌骨额突骨折,fracture？,（二）炎症,细菌性炎症真菌性炎症肉芽肿性病变,细菌性炎症,CT常规检查方法分期骨质改变,acute sinusitis,acute sinusitis,chronic sinusitis,odontogenic sinusitis,mucocele,mucocele,mucocele,bilateral mucoceles,真菌性炎症,CT首先检查方法MRI补充检查方法该类炎症发病率高注意该类炎症分型掌握各型影像学特点,fungus ball,fungus ball,AFS,AFS,CIFS,AFFS,肉芽肿炎症,CT、MRI联合使用该类炎症为少见病着重掌握诊断要点首先确定炎性病变可选用排除诊断法,WG,WG,rhinoscleroma,tuberculosis,EAF,（三）息肉,属于常见、多发病影像学能判别类型常见息肉：CT首选上颌窦-后鼻孔息肉：CT首先出血坏死性息肉：MRI最佳注意与真菌炎、肿瘤鉴别,nasal polyp,antrochoanal polyp,出血、渐进性强化征,hemorrhagic necrotic polyp,olfactory neuroblastoma,（四）肿瘤,分类软组织起源骨组织起源合理选择检查方法定位诊断定性诊断肿瘤分期,骨源性肿瘤的检查路径,主要靠CT诊断MRI可作为补充,osteoma,osteoma,Gardner syndrome,OF,OF with ABC,osteosarcoma,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,LCH,2007521,2007820,软组织起源肿瘤检查路径,CT和MRI联合使用 CT平扫MRI平扫+增强PET-CT应适时选择,分析思路,定位良、恶性判别骨质组织学性质推断密度信号临床重视恶性肿瘤分期加强疗后影像学随访,fat accumulation,F/43鼻出血10余日紫红色肿块随心率搏动,meningoencephalocele,IP,IP,IP transformation,capillary 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,ON pretreatment,postreatment,F/38ACC8 years of postsurgery,2010-4-8,F/26SCC2 months ofpostsurgery,2