| Part I The Study about the Morphometry of Adenoid Hypertrophy on MR Imaging in ChildrenObjective: To investigate the manifestation of adenoid hypertrophy on MR imaging in children and to introduce a measuring technique and to discuss both the standards of diagnosis and indication of operative treatment. Material and methods: We measured and compared the adenoid-nasopharynx ratio (A/N ratio) and pharyngeal airway space (PAS) with methodology of Fujioka developed based on lateral plain film of nasopharynx on sagittal midline T1 weighted images before operation in 100 adenoid hypertrophy affected children and 100 sex and age matched control children aged 1-13 years. Results: In the study group : A/N ratio ranged 0.512～0.604(n=27), 0.621～0.678 (n=44), 0.695～0.859(n=39) ; PAS ranged 2～2.8 mm(A/N =0.55,under 3-year-old), 4.1～5.2 mm(A/N ≥0.65,age range 4 to 8-year-old ), PASI of the other cases were less than 8mm. In the control group: A/N ratio ranged ≤0.55(n=69), 0.556～0.613(n=24), ≥0.66(n=7) ; PASI range over 8～10 mm (over 3 years old), over 4 mm (under 3-year-old ). There are four kinds of appearance of adenoid on sagittal midline MR imaging: sickle-like, scabbard-like, bullet-like and hill-like. The former two kinds were seen mainly in the control group while the latter two were seen mainly in study group. Conclusion: The morphometry of adenoid on MR Imaging is a very good method and better than nasopharyngeal lateral plain film. A/N ratio and PASI are the important criterion of diagnosis. The A/N≥0.70 and PASI≤5mm in children aged 3-13 years old or A/N≥0.61 and PASI≤2mm in infant younger than 3 years is the indication of adenoid hypertrophy to be treated with operation.Part II Quantitive morphologic analysis and clinical applied study of CT diagnosis of adenoid vegetation in childObjective: To explore the manifestation, methods of measurement and clinical value of CT adenoid vegetation of children. Material and methods:Nasopharyngeal CT plain scans and dynamic CINE CT scan were obtained in 50 children aged 9 months to 14 years with operation proved adenoid hypertrophy as study group and 50 age and gender matched children without adenoid hypertrophy as control. Measurement of maximum thickness of adenoid/anterior-posterior diameter of nasopharyngeal air space ratio (A/N ratio), effective anterior-posterior diameter of nasopharyngeal air space (D value), effective sectional areas of nasopharyngeal air space (Sn) and difference of Sn on dynamic CINE CT (ΔS) were carried out at the level of sphenoccipital junction on midline sagittal plane. Results: On the transverse CT, hypertrophic adenoid manifested as sort tissue mass that was symmetric, unilateral or embedded into choana. Measurements of study group were: A/N ratio ranged 0.61-0.86, D ranged 1-2.8 mm, Sn ranged 0-97.86mm~2 and ΔS ranged 0-32.54mm~2. The correspondent measurements of control group were 0.34-0.61, 7.5-12.2 mm, 217.87-623.98mm~2 and 175.87-274.02mm~2 respectively. Conclusion: CT is much better than the lateral X-ray plain film measurement of nasopharynx in diagnosis of adenoid vegetati on for CT can provide much more information and can clearly depict the nasopharynx and CT CINE is especially useful to reflect the changes of nasopharynx with respiration. A/N ratio and D value can be used as indicators: pathologic adenoid hypertrophy should be considered when there is an A/N ratio greater than 0.71 and a D value less than 3mm.Part III Correlation between pediatric adenoid hypertrophy and nasosinusitis and secretory otitis media: a clinical imageological studyObjective: To investigate the correlation between the CT appearance of adenoid hypertrophy in children and nasosinusitis and secretory otitis media. Material and methods: Nasopharyngeal CT images of 105 children with operation proved adenoid hypertrophy and nasosinusitis or/and secretory otitis media were retrospectively reviewed. Results: CT appearances of paranasal sinus and auris externa and auris media in group of moderate/severe adenoid hypertrophy include: maxillary sinusitis(26/45 cases), ethmoiditis(17/43 cases).frontal sinusitis(3/11 cases), sphenoiditis(7/14 cases), turbinal hypertrophy(30/44 cases), external otitis(3/5 cases), tympanitis(23/40 cases) and intramastoiditis(23/40 cases). 71% of cases have both nasosinusitis and secretory otitis media simutanously. Conclusion: The severity of adenoid hypertrophy has a positive correlation with incidence of being complicated with nasosinusitis and secretory otitis media. The incidence of nasosinusitis and secretory otitis media in children with severe adenoid hypertrophy is much higher than those with moderate lesions. The incidence of multi-nasosinusitis and bilateral secretory otitis media is higher than mono-nasosinusitis and unilateral secretory otitis media in children with severe adenoid hypertrophy.Part IV Immune state of children with adenoid hypertrophyObjective: To investigate the immune state of children with adenoid hypertrophy and the change of the immune state after curettage hypertrophic adenoid so as to explore the most suitable timing of operation. Material and Methods: Serum IgA, IgG, IgM, C3 and C4 level were assayed before and 7-10 days after curettage hypertrophic adenoid in 48 children aged 1 year and 2months to 14 years and in 24 control children. Results: Serum IgA, IgG, IgM, C3 and C4 level of affected children younger than 6 years were higher than that of control (P<0.05) while there were no difference of significance between children aged 6-14 years in both groups. Serum IgA, IgG, C3 and C4 level assayed 3 weeks after curettage were lower than that before the operation in 10 children. Conclusion: There is a decline in the serum IgA and IgG after adenoid curettage, especially in children younger than 6 years.
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