{"id":5123,"date":"2015-12-18T11:28:50","date_gmt":"2015-12-18T11:28:50","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=5123"},"modified":"2016-01-15T12:58:00","modified_gmt":"2016-01-15T12:58:00","slug":"evaluarea-imagistica-asinusurilor-paranazale","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/evaluarea-imagistica-asinusurilor-paranazale\/","title":{"rendered":"Evaluarea imagistic\u0103 a sinusurilor paranazale"},"content":{"rendered":"

Dificult\u0103\u021bile de vizualizare \u0219i investigare a sinusurilor paranazale au fost dep\u0103\u0219ite de evolu\u021bia explor\u0103rilor imagistice de la radiografia simpl\u0103 la tomografia computerizat\u0103, rezonan\u021ba magnetic\u0103 \u0219i mai recent PET-CT, care au schimbat modul de abordare \u0219i \u00een\u021belegere a anatomiei \u0219i patologiei sinusale.
\nAcest articol \u00ee\u0219i propune o scurt\u0103 descriere a tehnicilor de investiga\u021bie imagistic\u0103 cu avantajele \u0219i dezavantajele fiec\u0103reia, precum \u0219i o privire de ansamblu a celor mai frecvente afec\u0163iuni sinusale.1
\n\u00cen patologia inflamatorie,tomografia computerizat\u0103 cu achizi\u021bii axiale de 1mm \u015fi reconstruc\u0163ii \u00een plan coronal (pentru o bun\u0103 vizualizare a c\u0103ilor de drenaj sinusale), at\u00e2t \u00een fereastr\u0103 osoas\u0103 c\u00e2t \u0219i \u00een fereastr\u0103 pentru \u021besuturi moieste tehnica imagistic\u0103 de prim\u0103 inten\u021bie, ce:
\n– Identific\u0103 reperele \u0219i variantele anatomice (esen\u021biale \u00een planingul operator)
\n– Eviden\u021biaz\u0103 modific\u0103rile de structur\u0103 osoas\u0103 (osteolitice sau osteocondensante)
\n– Evalueaz\u0103 complica\u0163iile procesului patologic sinonazal (extensia \u00een 2\/3 anterioare ale orbitei \u015fi abcesul periostal)
\nSemnul CT cel mai valoros este identificarea unui con\u021binut hiperdens intrasinusal (s\u00e2nge, secre\u021bii purulente, con\u021binut fungic). Acesta este \u00eentotdeauna semn de benignitate, tumora nefiind hiperdens\u0103.<\/p>\n

Imagistica prin Rezonan\u021b\u0103 Magnetic\u0103<\/strong>
\n-diferen\u021biaz\u0103 procesele inflamatorii (\u00eengro\u0219\u0103rile de mucoas\u0103 \u0219i secre\u021biile) de forma\u021biunile tumorale pe baza diferen\u021belor de semnal. Astfel inflama\u021bia mucoasei va fi \u00een hipersemnal T2 \u0219i hiposemnal T1 datorit\u0103 con\u021binutului crescut \u00een ap\u0103, \u00een timp ce forma\u021biunile tumorale, datorit\u0103 celularit\u0103\u021bii crescute, vor avea hiposemnal T1 hipo\/izosemnal T2. \u00cen func\u021bie de con\u021binutul proteic, procesele patologice intrasinusale pot avea semnal diferit \u00een secven\u021bele T1 \u0219i T2 (vezi tabel)<\/p>\n

Con\u021binut proteic T1 T2
\n<10% hiposemnal hipersemnal
\n20-25% hipersemnal hipersemnal
\n>25% hipersemnal hiposemnal
\n>28% hiposemnal hiposemnal<\/p>\n

– eviden\u021biaz\u0103 invazia bazei de craniu \u2013 \u00eenlocuirea hipersemnalului osos T1 cu hiposemnalul T1 tumoral
\n– extensia intraforaminal\u0103 prin invazie direct\u0103 sau extensie perineural\u0103
\n– este examinarea de elec\u021bie \u00een evaluarea extensiei intracraniene a patologiei inflamatorii sinonazale (abcesul cerebral, abcesul epidural, empiemul subdural,tromboza de sinus cavernos).
\nProtocolul examin\u0103rii IRM include secven\u021bele T1 \u0219i T2 cu grosime de 3 mm, \u00een plan coronal \u0219i axial (la nevoie \u0219i \u00een plan sagital sau oblic), T1 postcontrast cu supresie a gr\u0103simii \u0219i complementar secven\u021ba de difuzie.
\nDe\u0219i examinarea IRM este de elec\u021bie \u00een patologia descris\u0103 anterior, \u00een cazul existen\u021bei contraindica\u021biilor (pacemaker,implanturi metalice, fragmente metalice, clipuri vasculare sau claustrofobie) se efectueaz\u0103 CT cu substan\u021b\u0103 de contrast.
\nExist\u0103 situa\u021bii \u00een care nici CT \u0219i nici IRM nu poate diferen\u021bia \u021besutul tumoral de cel inflamator (\u021besut de granula\u021bie). O examinare PET-CT (atunci c\u00e2nd este accesibil\u0103) poate aduce informa\u021bii suplimentare prin eviden\u021bierea acumul\u0103rii crescute a FDG \u00een celulele tumorale comparativ cu celulele normale. Din nefericire \u0219i celulele inflamatorii au comportament similar cu cele tumorale, astfel \u00eenc\u00e2t se poate diagnostica tumora atunci c\u00e2nd zona de fixare patologic\u0103 aradiotrasorului se suprapune peste masa identificat\u0103 CT. Sunt \u00een desf\u0103\u0219urare studii pentru a identifica substan\u0163e noi cu acumulare exclusiv\u0103 \u00een celulele tumorale.<\/p>\n

Concluzii:<\/strong>
\nEvolu\u021bia explor\u0103rilor imagistice ofer\u0103 clinicianului identificarea reperelor \u0219i variantelor anatomice (pentru stabilirea protocolului operator), localizarea procesului patologic \u0219i \u00een majoritatea cazurilor natura acestuia, iar \u00een situa\u021bia \u00een care este totu\u0219i necesar\u0103 biopsia pentru diagnostic diferen\u021bial, identific\u0103 cel mai bun traseu de punc\u021bie.
\nBibliografie:
\n1. Girish M. Fatterepekar, Bradley N. Delman, Peter M. Som. \u2013 Imaging the paranasal sinuses: Where we are and where we are going; vol. 291, Issue 11, 24 oct 2008, Wiley Online Library.
\n2. http:\/\/www.radiologyassistant.nl\/en\/p491710c96a36d\/paranasal-sinuses-mri.html<\/p>\n

\n

Dr. Emanuela BONCIU<\/p>\n

MEDINST Diagnostic
\nRom\u00e2no-German<\/p>\n

\"MADinst\"<\/a><\/p>\n

Medinst Diagnostic Rom\u00e2no-German func\u021bioneaz\u0103 din anul 1997 \u00een cadrul Institutului Na\u021bional de Neurologie \u0219i Boli Neurovasculare Bucure\u0219ti.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Dificult\u0103\u021bile de vizualizare \u0219i investigare a sinusurilor paranazale au fost dep\u0103\u0219ite de evolu\u021bia explor\u0103rilor imagistice de la radiografia simpl\u0103 la tomografia computerizat\u0103, rezonan\u021ba magnetic\u0103 \u0219i mai recent PET-CT, care au […]<\/p>\n","protected":false},"author":6,"featured_media":5150,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[33,440],"tags":[442],"class_list":["post-5123","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-orl","tag-medinst"],"yoast_head":"\nEvaluarea imagistic\u0103 a sinusurilor paranazale - Jurmed - Medici<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/evaluarea-imagistica-asinusurilor-paranazale\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Evaluarea imagistic\u0103 a sinusurilor paranazale - 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