Paranasaalsiinuste kuvamine. Jüri Hirmo Tartu 2010
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1 Paranasaalsiinuste kuvamine Jüri Hirmo Tartu 2010
2 Michelle A. Michel, MD Professor of Radiology and Otolaryngology Medical College of Wisconsin, Milwaukee RSNA IVP Estonia October 2009
3 PNS kuvamise meetodid Rö-ülesvõtted (suured muutused) KT (luuline anatoomia) MRT (haiguse levik) UH maksillaarsiinustest
4 UH maksillaarsiinustest Aitab differentseerida Tu, limaskesta paksenemist ja sekreeti. Röntgenkiirguse puudumine. Reaalajas. Odav. Operaatorsõltuvus.
5 UH maksillaarsiinusest: norm
6 UH maksillaarsiinusest: sinusiit
7 Kuvamine: Röntgen Oktsipitomentaalne ülesvõte (Waters, nina-lõuaots): näeb kõiki ninakõrvalkoopaid, eriti hästi maksillaarsiinuseid. Oktsipitofrontaalne ülesvõte (Caldwell, nina-otsmik): näha hästi frontaal- ja etmoidaalsiinused. Külgülesvõte või Submentovertikaalne ülesvõte annavad vahel lisainformatsiooni.
8 Waters ja Caldwell
9 KT Koronaarses tasapinnas Patsient kõhuli, kael väljasirutatud 1-3 mm järjestikku kihid + MPR Luu algoritm Aksiaalses tasapinnas Patsient selili 0,625 1,25 mm + MPR Luu algoritm
10 KT
11 Kuvamine: KT KT uuring koronaarses tasapinnas vaade sama mis KNK arstil paranasaale uurides. Ainuüksi KT põhjal ei diagnoosita paranasaalsiinuste haigusi, vajalik ka anamnees, kliiniline- ja endoskoopiline leid.
12 Kuvamine: KT KT uuringu pildil on info hetkeseisust: Kui patsiendil on hiljuti (4-6 nädalat) olnud sinusiit siis on muutused näha. Kui patsiendil on korduvad sinusiidid, aga pole olnud haigusnähte pikemat aega, siis võib leid olla normis Ägeda ülemiste hingamisteede infektsiooni puhul soovitatav KT edasi lükata.
13 Kuvamine: KT Ainus mis ei muutu nii kiirelt on luulised struktuurid ja veresoonte-närvide paiknemine siinuste suhtes. Hea radioloog : Teab, mis infot NKK arst tahab KT-st Vaatab, et uuring oleks optimaalselt tehtud Annab vastuses kliiniliselt olulist infot Tase saavutatav ainult regulaarse tagasiside ja haigusjuhtude ühise arutamisega.
14 Kuvamine: MRT Seeninfektsioon Sinusiidi tüsistused Kasvajad Haiguse levik väljaspoole PNS-d
15 MRT Coronal T1 4mm / 1mm 4:22 Coronal STIR 5:21 Axial T1 5:10 Axial T2 FSE FS 3:08 Axial T1 post Gad fat sat 4:02 Coronal T1 post Gad fat sat 6:10 No contrast for anosmia screening
16 Siinuste areng Ninaõõne väljasopistused Alguse piirkondadest saavad ostiumid Arengut mõjutavad: Limaskesta kasv Luude areng Teiste struktuuride regressioon Õhurõhu gradiendid
17 Siinuste areng Maksillaar Tekkivad esimesena (vastsündinul kitsad pilud), valmis 15 a Etmoid Teke sünnil, valmis a Sfenoid Sünnil minimaalsed, valmis 10 a Frontaal Sünnil puuduvad, teke 2-3 a, orbita lae tasemel 8 a
18 Funktsioon Taju, hingamine, kaitse, refleks Maitse haistmine (gustatory olfaction) Hingamine Õhu juhtimine Soojendamine Niisutamine Puhastamine
19 Nasaalne tsükkel Esineb 80-90% inimestel 30 minutit paar tundi (2-6) Verevarustus ühel poolel intensiivistub ninakarbikud paksenevad
20 Mukotsiliaarne kliirens Messerklinger 1950 ja 1960-nendatel Mukotsiliaarse kliirensi uuringud Endoskoopiline sekreedi transpordi jälgimine Lima liigub geneetiliselt määratud teed ostiumide suunas Sekreedi transport 1 cm/min
21 Sekreedi transport Kliiniliselt olulised siinused: Frontaal Eesmised etmoidid Maksillaar Kommunikatsioon keskmise ninakäiguga eelkambrite kaudu Frontaalne retsess Ethmoid infundibulum Operatsioonid suunatud eelkambritele
22 Normanatoomia Ninaõõs Lamina cribiforme Karbikud ja käigud Kõva suulagi Septum nasi
23 Normaalanatoomia
24 Foramen sphenopalatinum Ninaõõne lateraalses seinas taga-üleval Läbivad närvid ja veresooned Kaetud limaskesta poolt Otseühendus fossa pterygopalatina ja ninaõõne vahel
25 Foramen sphenopalatinum
26 Foramen sphenopalatinum
27 Frontaalsiinus Drenaazh frontaalretsessi Ductus nasofrontalis frontal infundibulum Frontaalsest ostiumist madalamal Proksimaalsel dreneerumine varieerub olenevalt processus uncinatusest Distaalsel dreneerub keskmise ninakäigu esiossa
28 Frontaalretsess
29 Frontaalretsess
30 Frontaalsiinus ja uncinatus
31 Frontaalretsess ia uncinatus
32 Processus uncinatus
33 Drenaazh Maksillaarsiinus: hiatus semilunaris keskmine ninakäik Etmoidid: ees keskmine ninakäik, taga sfenoetmoidaalretsess Sfenoid: sfenoetmoidaalne retsess Ductus nasolacrimalis: alumine ninakäik
34 Ductus nasolacrimalis
35 Keskmine ninakäik: Drenaazh Frontaalsiinusest frontaalretsessi kaudu Etmoidbulla ja etmoidrakustik anterioorsel Maksillaarsiinus infundibulumi kaudu
36 Ostiomeataalkompleks
37 Anatoomilised variatsioonid Paranasaalide ja ninakarbikute konfiguratsioon, sama individuaalne nagu sõrmejäljed Võib soodustada põletiku või obstruktsiooni teket Suurendab FESS-i tüsistuste tõenäosust
38 Agger nasi rakk ( % inimestest)
39 Ninavahesein Deviatsioon Eksostoosid (Spurs) Septumi retsessid
40 Ninavahesein
41 Tüüp I frontaalrakk
42 Tüüp II frontaalrakk
43 Tüüp III frontaalrakk
44 Tüüp IV froontaalrakk
45 Processus uncinatus variatsioonid Pneumatiseeritud (ahendab infundibulumi või keskmist ninakäiku) Deviatsioonis või atüüpilise kinnitusega (lamina papyraceaga, koljupõhimikuga või keskmise karbikuga) Atelektaatiline (lateraliseerunud orbita põhja suunas, ahendab infundiibulumi)
46 Keskmine karbik Hüpoplastiline (tüüpiline ninavaheseina deviatsiooniga) Paradoksaalne (konkaavne ninavaheseina suunas) Pneumatiseerunud (concha bullosa)
47 Infraorbital etmoidrakk (Halleri rakk)
48 Variatsioonid Dehistsentne lamina papyracea Madal fovea ethmoidalis Hüpoplastiline labürint
49 Supraorbitaalne etmoidrakk
50 Sfenoidaalsiinus
51 Sfenoidaalsiinus
52 Variatsioonid
53 Variatsioonid
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