CAJ | 학술논문

目的探讨不同真菌所致鼻窦真菌球的CT表现特点及鉴别诊断.方法回顾性分析自2007年至2009年经真菌学和病理检查,确诊为鼻窦真菌球的74例患者的临床及CT资料,男32例、女42例,年龄15～80岁,中位年龄50岁.比较曲霉菌和非曲霉菌所致鼻窦真菌球的病变范围、钙化发生率、部位、形态、窦壁骨质改变及合并症情况.统计学方法采用x2检验.结果 74例中致病菌以曲霉菌多见,共58例,其中黄曲霉菌36例、烟曲霉菌15例、杂色曲霉菌7例;非曲霉菌共16例,包括青霉菌5例、裂褶菌6例、尖端赛多孢子菌5例.所致鼻窦真菌球在病变范围(曲霉菌单窦病变29例,非曲霉菌单窦病变2例,x2 =7.245,P=0.007)、累及筛窦的阳性率[曲霉菌为39.7％(23/58),非曲霉菌为81.3％(13/16),x2 =8.685,P=0.003]、钙化发生率(曲霉菌58例中发生钙化40例,非曲霉菌16例中5例,x2=7.485,P =0.006)和钙化部位(曲霉菌40例钙化发生部位中央型26例,周围型14例,非曲霉菌5例全部为周围型,x2=7.697,P=0.006)上差异有统计学意义;而在病变侧别(x2=1.002,P=0.317),上颌窦(x2 =0.020,P=0.888)、蝶窦(x2=0.704,P=0.401)、额窦(x2=0.126,P=0.723)受累,窦壁骨质改变(x2=2.024,P=0.155),钙化形态(x2=2.045,P=0.153)以及合并鼻息肉(x2=0.018,P=0.893)或黏膜囊肿(x2=0.779,P=0.378)上差异无统计学意义.结论鼻窦真菌球的共同特征是多单侧鼻窦受累,窦腔内密度不均匀增高并可见斑片状钙化.曲霉菌性真菌球的CT特征是不易累及筛窦,钙化多见且多位于病变中心部;非曲霉菌性真菌球的CT特征为易累及筛窦,钙化少见,多位于病变周边部.
목적 탐토불동진균소치비두진균구적CT표현특점급감별진단.방법 회고성분석자2007년지2009년경진균학화병리검사,학진위비두진균구적74례환자적림상급CT자료,남32례、녀42례,년령15～80세,중위년령50세.비교곡매균화비곡매균소치비두진균구적병변범위、개화발생솔、부위、형태、두벽골질개변급합병증정황.통계학방법채용x2검험.결과 74례중치병균이곡매균다견,공58례,기중황곡매균36례、연곡매균15례、잡색곡매균7례;비곡매균공16례,포괄청매균5례、렬습균6례、첨단새다포자균5례.소치비두진균구재병변범위(곡매균단두병변29례,비곡매균단두병변2례,x2 =7.245,P=0.007)、루급사두적양성솔[곡매균위39.7％(23/58),비곡매균위81.3％(13/16),x2 =8.685,P=0.003]、개화발생솔(곡매균58례중발생개화40례,비곡매균16례중5례,x2=7.485,P =0.006)화개화부위(곡매균40례개화발생부위중앙형26례,주위형14례,비곡매균5례전부위주위형,x2=7.697,P=0.006)상차이유통계학의의;이재병변측별(x2=1.002,P=0.317),상합두(x2 =0.020,P=0.888)、접두(x2=0.704,P=0.401)、액두(x2=0.126,P=0.723)수루,두벽골질개변(x2=2.024,P=0.155),개화형태(x2=2.045,P=0.153)이급합병비식육(x2=0.018,P=0.893)혹점막낭종(x2=0.779,P=0.378)상차이무통계학의의.결론 비두진균구적공동특정시다단측비두수루,두강내밀도불균균증고병가견반편상개화.곡매균성진균구적CT특정시불역루급사두,개화다견차다위우병변중심부;비곡매균성진균구적CT특정위역루급사두,개화소견,다위우병변주변부.
Objective To evaluate CT characteristics of fungal ball in paranasal sinus caused by different fungi and to enhance differential diagnosis.Methods CT results and clinical data of 74 patients with fungal ball arising from the paranasal sinuses proved by histopathology from 2007 to 2009 were analyzed retrospectively.The CT characteristics of fungal ball in paranasal sinus caused by different fungi were compared using x2 test with P ＜ 0.05 considered statistically significant.Results Among 74 mycotic pathogenic agents,aspergillus was found in 58 cases (including 36 cases with aspergilhs flavus,15 cases with aspergillus fumigatus and 7 with aspergillus versicolor),the others including 5 cases with penicillium,6 cases with schizophyllum commune,and 5 cases with scedosporium apiospermum.There were significant differences in the number of sinus involved ( single sinus involvement was seen in 29 cases caused by aspergillus group and 2 cases caused by non-aspergillus-group,respectively,with x2 =7.245,P =0.007 ),the incidence of fungus ball in ethmoid sinus [ 39.7％ ( 23/58 ) of cases caused by aspergillus group and 81.3 ％ ( 13/16 ) of cases caused by non-aspergillus-group,respectively,with x2 =8.685,P =0.003 ] and calcification (40 of 58 cases caused by aspergillus group and 5 of 16 cases caused by non-aspergillus-group,respectively,with x2 =7.485,P =0.006 ),the location of calcification ( 26 of 40 cases with central calcification and 14 of 40 cases with peripheral calcification in cases caused by aspergillus group,while all of 5 cases caused by non-aspergillus-group with peripheral calcification,x2 =7.697,P =0.006).However,there was no significant difference in the incidence of bilateral lesions ( x2 =1.002,P =0.317 ),maxillary sinus involvement ( x2 =0.020,P =0.888 ),sphenoidal sinus involvement ( x2 =0.704,P =0.401 ),frontal sinus involvement ( x2 =0.126,P =0.723 ),bony sclerosis ( x2 =2.024,P =0.155 ),lamellar calcification (x2 =2.045,P =0.153 ),complication of nasal polyps( x2 =0.018,P =0.893) and submucosal cyst( x2 =0.779,P =0.378 ).Conclusions The common CT characteristics of fungal ball in paranasal sinus are unilateral sinus involvement with inhomogeneous high-density soft tissue and lamellar calcification.The CT findings of fungal ball caused by non-aspergillus-group are ethmoid sinus involvement and calcification located on the periphery instead of the center of fungal ball.