一側性副鼻腔疾患における術前MRIの有用性

抄録

In addition to sinusitis, other causes of unilateral sinus disease include odontogenic maxillary sinusitis, mycosis, and tumors. In many cases, it is difficult to distinguish among these causes by sinus CT alone, which is widely used for preoperative diagnosis in patients undergoing endoscopic sinus surgery (ESS), and the usefulness of MRI to improve the accuracy of diagnosis has been reported. To improve the accuracy of preoperative diagnosis, we investigated the disease distribution, patient backgrounds, and preoperative positive diagnosis rate in patients who underwent unilateral ESS.

The subjects were 192 patients who underwent unilateral ESS between 2016 and 2023. The etiologies were classified into four groups: chronic sinusitis (CRS; n = 66), mycosis (n = 48), odontogenic maxillary sinusitis (n = 39), or tumor (n = 36); there were two cases of combined mycosis and odontogenic maxillary sinusitis and one case of tumor with odontogenic maxillary sinusitis. The mean age was the highest, and the proportion of female patients was higher, in the patient group with mycosis. The CT showed calcification, heterogeneous density, and microbubbles in the cases with mycosis. There was no significant difference in the percentage of cases with a convex and normal nasal septal curvature across all four disease groups. MRI was significantly more useful for the diagnosis of mycosis and tumors than CT.

Preoperative MRI should be performed in many patients with unilateral sinonasal disease, especially in those with mycosis and tumors, because CT alone is often not sufficient for a diagnosis.