| Objective: By analyzing the incidence,types,characteristics and significance of convoluted cerebriform pattern in MRI scans of SIP,and using the Convoluted cerebriform pattern retrospective method to predict the origin of tumor,and following up the recurrence rate of patients after SIP,to explore the guidance of MRI convoluted cerebriform pattern on diagnosis and treatment of sinonasal inverted papilloma.Methods: Collecting 40 patients with inonasal inverted papilloma who were hospitalized in Otolaryngology of the First Affiliated Hospital of Dalian Medical University Hospital from January 2015 to January 2018,which postoperative pathological results were confirmed to be inonasal inverted papilloma,review and analyze the data of these 40 cases.The equipment used in the patients’ preoperative MRI scans were Philips Achieva 3.0 MRI scanners of the First Affiliated Hospital of Dalian Medical University Hospital.Using the UNISIGHT Team View software to analyze the preoperative MRI scan images of all cases,study the brain signs in the MRI images,carefully observe the patient’s lesion site,range,signal characteristics,and determine the origin;consult the surgical records to determine the actual tumor attachment site.Calculate the incidence of brain sign,the coincidence rate of the origin site and the tumor attachment,the correlation between the anatomical structure of the brain sign and the coincidence rate,and the correlation between the type of brain sign and the coincidence rate.The follow-up recurrence rate of patients after SIP was followed up,and the guiding value of MRI brain return on the diagnosis and treatment of sinonasal inverted papilloma was explored.The data of the result group were analyzed by SPSS17.0 software.Results: In 37 patients(92.5%)of 40 patients,streak shadows of high and low signal intervals in the tumor were seen,that is,curly brain gyrus(CCP),which was diffusely distributed.Among them,28 cases(75.7%)had a curved CCP,and 9 cases(24.3%)had a parallel line.There were no obvious characteristic streaks(7.5%)in 3cases.Among them,malignant change(3.5%)was confirmed by pathology after operation,and there were irregular long necrosis T1 and long T2 signals in the center of the mass.(2)Primary site: According to the intraoperative findings,the actual tumor attachment site was most commonly located in 19 cases(47.9%)of the lateral wall of the sinonasal cavity,followed by 11 cases(27.5%)of the maxillary sinus,and 7 cases(17.5%)of the ethmoid sinus again.),1 case in frontal sinus,sphenoid sinus,and paper template(2.5%).MRI images were used to predict the origin of tumors by retrograde backtrace of brain: A total of 36 cases with presumed origin of the lesions were reported,including 12 cases of maxillary sinus(33%),4 cases of ethmoid sinus in the anterior group(11.1%),and 3 cases of uncinate process(8.3%),2 cases of frontal sinus(5%),11 cases of turbinate(30.6%),including 9 cases of middle turbinate,2 cases of upper turbinate,and 1 case of ethmoid sinus and sphenoid sinus(2.8%)in the back group.There were 3 cases(8.3%)of recurrence,the origin was 1 case of maxillary sinus,1case of anterior ethmoid sinus,and 1 case could not be confirmed.Brain retrograde retrospective method predicts the actual coincidence rate of tumor origin and tumor is about 72.5%.(3)Lesion involvement range: The lesions were located on the left side in23 cases(57.5%),the right side in 14 cases(35%),and bilateral cases in 3 cases(invasion to the contralateral side)(7.5%).It was limited to 4 cases in the sinonasal cavity,15 cases involved the maxillary sinus of the sinonasal cavity,13 cases of the maxillary sinus and the ethmoid sinus(2 cases violated the contralateral frontal and ethmoid sinus through the frontal sinus),5 cases of the ethmoid sinus and frontal sinus,7 cases of frontal sinus,2 cases of maxillary sinus,2 cases of sinonasal maxillary sinus,ethmoid sinus,and frontal sinus,1 case of sinonasal maxillary sinus,ethmoid sinus,sphenoid sinus,and intraorbital,1 case of ethmoid sinus,and the coincidence rate of MRI staging and surgical staging reached 97.5%.(4)According to the postoperative pathological findings,2 cases(7.1%)of SIP combined with atypical dysplasia and 1case(3.6%)of malignant changes(focal squamous cell carcinoma)were found.One patient with malignant squamous cell carcinoma had no obvious streaks,and there were irregular long necrosis T1 and long T2 signals in the center of the mass.(5)Postoperative follow-up results: sinonasal endoscopic anterior lacrimal crypt approach surgery group: 1/9,recurrence rate of 10.1%;sinonasal endoscopy group: 3/21,recurrence rate of 14.3%;sinonasal endoscope In the combined Caldwell-Luc group:1/10,the recurrence rate was 10%.The overall recurrence rate is about 12.5%.Conclusions:1.The MRI brain return sign shows a high rate in inverted papilloma of the sinonasal cavity and sinuses,of which CCP is the most common.The brain sign is a reliable indicator for diagnosis of inverted papilloma.2.The MRI results of sinonasal sinus and inverted sinus papilloma were compared with the pathological staging of the operation,and the consistency was high,which can better judge the staging of the operation and provide a basis for preoperative diagnosis.3.The CCP has high accuracy in determining the origin of the sinonasal cavity and sinus inverted papilloma lesions before operation,and provides strong support for grasping the origin information of the lesions before surgery,determining the surgical plan,completely removing the lesions during surgery,and preventing recurrence after surgery. 4.The follow-up results of this group of cases show that the overall recurrence rate is 12.5%,compared with the existing Mate analysis data,the overall recurrence rate has dropped to 15-19%.The recurrence rate in this group of research results is within a reasonable range and slightly lower.At 15%,the previous research results confirm the value of MRI in SIP.The number of cases in this study is small,and there may be error bias.The effect of MRI as a preoperative examination on tumor recurrence rates requires larger data and more rigorous investigations. |
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