| Imaging examinations on nasal cavity, paranasal sinuses and skull base, such as: X-ray, computerized tomography (CT), magnet resonance imagination (MRI), digital substraction angiography (DSA), had improved the diagnostic levels on diseases in nasal cavity, paranasal sinuses, skull base and nasocular. However, CT, MRI, and DSA is costly, and DSA is a invasive examination, such examinations cannot offer satisfied description on the fine examination of nasal mucous membrane and blood supplying condition of lesions in nasal cavity, paranasal sinuses and skull base. The application of nasal endoscope and the emergence of catheter transducer give us a chance to directly observe the nasal mucosa that we were interested in. The high frequency catheter transducer has fine vertical resolution that not only can accurately measure the thickness of mucous membrane, but also can display the echo structure of mucous membrance and submucous layer. It can help us to study the structure characteristics of nasal parenchyma without invasion. According to the above-mentioned background, we carried on some studies as follows: (1)Empirical study on intra-nasal scanning of canine nasal cavity with endoscopic ultrasonography; (2)Measured nasal cavity of healthy youth with endoscopic ultrasonography; (3) Intra-nasal scanning of occupational lesions in nasal cavity, paranasal sinuses and skull base with endoscopic ultrasonography.Objective1. To explore the feasibility of nasal parenchyma through intra-nasal scanning with endoscopic ultrasonography.2. To measure the nasal parenchyma of healthy youth through intra-nasal scanning with endoscopic ultrasonography, providing the foundation of developing the ultrasonography of nasal cavity in clinic and of establishing the normal index of the ultrasonography of nasal cavity.3. To present the sonographic appearance and the blood supply of different diseases through intra-nasal scanning of occupational lesions in nasal cavity, paranasal sinuses and skull base with endoscopic ultrasonography. Compared with the general imaging examinations such as CT MRI to evaluate the application value of the endoscopic ultrasonography of masses in nasal cavity, paranasal sinuses and skull base.Methods1. Under the guidance of nasal endoscope, ultrasonography of nasal cavity was performed by using 10 MHz section probes with diameter of 3.3mm. Thirty nasal cavities of fifteen healthy adulthood canines were scanned. Analyse the sonograms of the nasal septums and inferior turbinates. Decrease the influence of the ultraphonic artifact and correct the data error by the sink experiment to obtain the correction factor.2. Under the guidance of nasal endoscope, ultrasonography of nasal cavity was performed by using 10 MHz section probes with diameter of 3.3mm. Thirty nasal cavities of fifteen healthy young men and thirty nasal cavities of fifteen healthy young women were scanned. Analyse the sonograms of their nasal septums and inferior turbinates. Use the correction factor to eliminate the data error to obtain the actual thickness value of nasal parenchyma of the healthy youth. Compare with the thickness of nasal parenchyma between young men and young women.3. Under the guidance of nasal endoscope, ultrasonographic scan of 18 masses within nasal cavity, paranasal sinuses and skull base was performed using 10 MHz section probes with diameter of 3.3 mm under local anesthesia to obtain the sonographic appearance and the blood supply of different diseases. Eleven ofthem were benign tumors and seven of them were malignant ones, which were confirmed by pathological examination of resected specimens. Compared with general imaging examinations such as CT and MRI to evaluate its application value.Results1. Healthy adulthood crossbred canines: In gray scale ultrasound, most mucous membranes and submucous layers within nasal cavity were hypoechoic, with some sporadic distributing hyperechoic echoes and blood vessel echoes. The septal cartilage was echoless, and the cartilaginous membrane of the septal cartilage displayed a consecutive hyperechogenicity line. The average thickness of the nasal septums and the mucous membranes and submucous layers of the inferior turbinates were 1.89 ± 0.30mm and 2.94 ± 0.37mm respectively. The soft tissues in the two positions showed rich blood flowing signals by color Doppler flow imaging (CDFI). Pulsed Doppler view of the nasal septums showed a venous waveform with the velocity ranging from 3.1 to 13.8cm/s and the arterial waveform with the peak systolic velocity ranging from 10 to 54.8cm/s. Resistance index ranged from 0.31 to 0.57. Pulsed Doppler view of the inferior turbinates showed a venous waveform with the velocity ranging from 4.0 to 17.3cm/s and the arterial waveform with the peak systolic velocity ranging from 7.5 to 79.6cm/s. Resistance index ranged from 0.25 to 0.62.2. Healthy youth: In gray scale ultrasound, most mucous membranes and submucous layers within nasal cavity were hypoechoic, with some sporadic distributing hyperechoic echoes and blood vessel echoes. The septal cartilage was echoless, and cartilaginous membrane of the septal cartilage displayed a consecutive hyperechogenicity line. The average thickness of the septal cartilage, the mucous membranes and submucous layers of the nasal septums and the inferior turbinates of healthy young men were 0.97±0.13mm, 0.78 ± 0.14mm and 2.39 ± 0.53mm respectively. And those of healthy young women were 0.80 ± 0.10mm, 0.77 ± 0.19mm and 2.31 ± 0.49mm respectively. The soft tissues in the two positionsshowed rich blood flowing signals by CDFI. For healthy young men pulsed Doppler view of the nasal septum showed a venous waveform with the velocity ranging from 3.5 to 40.3cm/s and the arterial waveform with the peak systolic velocity ranging from 6.9 to 55.8cm/s, resistance index ranged from 0.38 to 0.63. Pulsed Doppler view of the inferior turbinates showed a venous waveform with the velocity ranging from 3.1 to 23.8cm/s and the arterial waveform with the peak systolic velocity ranging from 6.5 to 44.0cm/s, resistance index ranged from 0.29 to 0.67. For healthy young women pulsed Doppler view of the nasal septum showed a venous waveform with the velocity ranging from 2.3 to 27.0cm/s and the arterial waveform with the peak systolic velocity ranging from 8.9 to 42.8cm/s, resistance index ranged from 0.38 to 0.76. Pulsed Doppler view of the inferior turbinates showed a venous waveform with the velocity ranging from 4.0 to 24.4cm/s and the arterial waveform with the peak systolic velocity ranging from 11.3 to 30.4cm/s, resistance index ranged from 0.36 to 0.64.According to statistical analysis of the thickness data from the healthy youth 's soft tissue of nasal septums, cartilage of nasal septums and soft tissue of the inferior turbinates, all the datas were of normal distribution. Compare all the thickness values of nasal cavity of men with that of women by using T test. The result showed that the differences from the thickness values of nasal cavity of men and that of women have no statistical significance.3. Under the guidance of nasal endoscope, masses could be observed accurately with catheter transducer. On gray scale ultrasound, most masses were heterogeneous hypoechoic, tumors with rich blood vessels were lower hypoechoic, and some showed irregular anechoic area due to dilated vascular net. The rich flow signals and high velocity could be detected by CDFI in malignant tumors. Pre-embolism, fibroangioma was big in volume and was heterogeneous hypoechoic on gray scale ultrasound, the richer of blood vessel the lower hypoechoic. Rich blood supply was observed in fibroangioma. The fibroangioma was detected to be homogeneous hypoechoic and was diminution with endoscopic ultrasonography 24 hours post-embolism, and its blood supply was decreased. Chordoma was withoutdistinct edge and capsule.Conclusion1. Nasal endoscopic ultrasonography for nasal soft tissues is of exact location, clear image, high resolution and well feasibility. It can show blood flowing signals, differentiating arterial and venous blood signals and getting the velocity of the vessels. It provides a new imaging modality for diseases within nasal cavity, paranasal sinuses and skull base.2. Nasal endoscopic ultrasonography can scan nasal parenchyma qualitatively and quantitatively, providing more information of nasal mucous and some diseases.3. Nasal endoscopeic ultrasonography for soft tissue masses in nasal cavity, paranasal sinuses and skull base can measure the size of masses exactly and display the relationship to perienchyma. Besides, it can show blood flowing signals that are from and around masses sensitively, differentiating arterial and venous blood signals and getting the velocity of the vessels. The information about leisions is much different with CT and MRI, which can help surgeons to decide whether to perform digital substraction angiography (DSA) and selective arterial embolization in patients with tumors. It has great significance to preoperative evaluation and operation selection.
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