目的：探讨原发于额窦恶性肿瘤的CT及MRI表现，以提高对本病的认识。方法：回顾性分析14例经活检或手术病理证实的额窦原发恶性肿瘤患者的临床和影像学资料，病理类型包括鳞癌5例，浆细胞瘤3例，恶性黑色素瘤2例，横纹肌肉瘤、骨肉瘤、小细胞癌、间叶来源恶性肿瘤各1例。6例行CT平扫，2例行平扫+增强CT扫描，4例行增强CT扫描，13例行MR扫描，5例加DWI序列。结果：11例肿块位于左侧额窦，2例位于右侧额窦，1例位于双侧额窦，侵犯眶壁14例，侵入眶内7例，侵犯筛窦10例、对侧额窦3例、前颅底10例、额部皮下7例。CT平扫时肿块均呈中等密度，增强扫描4例呈不均匀强化，2例均匀强化，破坏额窦下壁（眶内上壁）14例、后壁12例、前壁7例。MR T2WI上，10例呈等或稍高信号，其中4例伴有小片高信号、2例伴局部低信号、2例呈等高混杂信号、1例呈略低信号，增强后10例肿块呈不均匀强化，3例呈均匀强化，4例扩散受限，1例轻度扩散受限。结论：原发于额窦的恶性肿瘤常见的为鳞癌、浆细胞瘤和黑色素瘤，额窦下壁和后壁常呈侵蚀性吸收破坏，肿块易侵犯同侧眼眶、前组筛窦和前颅底，DWI扩散受限是其影像学上的重要征象，浆细胞瘤和恶性黑色素瘤信号有一定特征。
Abstract
Objective: To explore the CT and MRI findings of the primary malignant tumors of the frontal sinus, in order to improve the clinic diagnosis of these diseases. Methods: The imaging data of 14 patients with pathologically proved malignant tumors were analyzed retrospectively, including 5 squamous carcinomas(one of which cancerated from inverted papilloma), 3 plasmocytomas, 2 melanomas, 1 rhabdomyosarcoma, 1 small cell carcinoma, 1 osteosarcoma and 1 mesenchymal sarcoma. Eight patients underwent plain CT, 6 patients underwent enhanced CT scan, and 13 patients underwent MRI examinations. Results: Eleven lesions originated from the left frontal sinus, 2 lesions from the right, while one from bilateral sinuses. The lesions invaded orbit walls in 14 cases, ethmoid sinuses in 10 cases, forehead in 7 cases, anterior cranial fossa in 10 cases and contralateral frontal sinus in 3 cases. One lesion was a regular nodule, while the other 13 lesions were irregular or diffused. On plain CT of 8 cases, tumors showed isointensity. After contrast enhancement, four masses were heterogeneously enhanced and two were homogenously enhanced. The tumors eroded the anterior walls of frontal sinus in 7 cases, the posterior walls in 12 cases and inferior walls in 14 cases. On T2WI of MRI, 10 masses showed isointense or slightly hyperintense signal, 2 masses showed mixed isointense and hyperintense signal, 1 mass showed slightly hypointense signal. After contrast enhancement, 10 lesions showed heterogeneous enhancement on T1WI images, three plasmocytomas showed homogenous enhancement. Four masses showed limited diffusion on DWI, and one showed slightly limited diffusion. Conclusion: The most common malignant tumors that originate from frontal sinuses are squamous carcinoma, plasmocytoma and melanoma. The posterior and inferior walls of the frontal sinuses are eroded in most cases. Most lesions invade to the outside of the sinuses, including orbits, ethmoid sinuses and anterior cranal fossae. The masses show limited diffusion on DWI. Plasmocytoma and melanoma have some characteristic MR signals. Combining CT and MRI images is helpful to confirm the characters and ranges of the lesions.
关键词
鼻窦肿瘤；体层摄影术 /
X线计算机；磁共振成像
Key words
Paranasal sinus neoplasms /
Tomography, X-ray computed /
Magnetic resonance imaging
中图分类号：
Ｒ739.62
Ｒ814.42
Ｒ445.2
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