Universidade Federal de São Paulo, Departamento de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil.
Universidade do Estado do Rio de Janeiro, Divisão de Rinologia e Base do Crânio, Rio de Janeiro, RJ, Brazil.
Braz J Otorhinolaryngol. 2024 Nov-Dec;90(6):101490. doi: 10.1016/j.bjorl.2024.101490. Epub 2024 Sep 2.
Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a disease characterized by chronic inflammation and tissue remodeling process. The remodeling process in nasal polyps has mainly been studied by histology analysis. However, it is limited to a polyp fragment and requires tissue removal. The present study aims to evaluate the ability of Magnetic Resonance Imaging (MRI) to depict and characterize the remodeling process in patients with CRSwNP.
30 patients that met clinical diagnostic criteria for CRSwNP, without previous history of rhinosinusitis surgery were submitted to MRI scan (conventional, diffusion-weighted and DCE MRI) and compared with polyp tissue histological findings, IL-6 concentrations in the tissue and eosinophil count in the blood. The examinations were evaluated, independently, by two radiologists blinded to other radiological and histological data. The pathologist, blinded to MRI results, also compared the tissue sample from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa.
This study demonstrated a characteristic pattern of nasal polyps, whose peripheral portions of nasal polypoid tissue are edematous, whereas the central portions in the middle meatus and in the middle and upper ethmoid are predominantly fibrotic. ADC values found in the most anterior portion of the polyps may be a marker for radiological phenotyping the remodeling process. This non-invasive analysis presented a high degree of agreement in the fibrosis and edema rating by two radiologists and the histological analysis was concordant with the MRI findings. The polyps were characterized as eosinophilic, and no relationship was found between the severity of the eosinophilic inflammatory process or concentration of IL-6 and the remodeling process.
MRI by using T2-weighted imaging sequence and ADCs values allows tissue characterization and is an effective tool for the differentiation of edematous and fibrotic components in CRSwNP.
伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）是一种以慢性炎症和组织重塑过程为特征的疾病。鼻息肉的重塑过程主要通过组织学分析进行研究。然而，这种方法仅限于息肉片段，并且需要组织切除。本研究旨在评估磁共振成像（MRI）在评估 CRSwNP 患者重塑过程中的能力。
30 名符合 CRSwNP 临床诊断标准且无鼻-鼻窦炎手术史的患者接受 MRI 扫描（常规、弥散加权和 DCE MRI），并与息肉组织的组织学发现、组织中的白细胞介素 6（IL-6）浓度和血液中的嗜酸性粒细胞计数进行比较。两名放射科医生独立评估检查结果，他们对其他放射学和组织学数据均不知情。病理学家对来自毗邻鼻腔底部的息肉样组织的最中央和最外周部分的组织样本进行了评估，对 MRI 结果也不知情。
本研究显示了一种特征性的鼻息肉模式，其鼻息肉样组织的外周部分是水肿的，而中鼻甲和中鼻甲及上鼻甲的中央部分主要是纤维性的。在息肉的最前部分发现的 ADC 值可能是一种对重塑过程进行放射表型分析的标志物。这种非侵入性分析在两位放射科医生对纤维化和水肿的评分以及组织学分析与 MRI 发现之间具有高度一致性。息肉被描述为嗜酸性粒细胞，并且嗜酸性粒细胞炎症过程的严重程度或 IL-6 的浓度与重塑过程之间没有关系。
使用 T2 加权成像序列和 ADC 值的 MRI 可以进行组织特征化，并且是区分 CRSwNP 中水肿和纤维性成分的有效工具。
