李少朋;程传东;邓克学;

• 1:安徽省立医院南区影像科
• 2:安徽省立医院南区神经外科

摘要(Abstract)：

目的研究MRI和CT在鼻咽癌颅底骨质侵犯临床诊断中的应用价值。材料与方法回顾性分析2018年2月至2020年7月于本院接诊的70例鼻咽癌患者完整临床资料,所有患者均经病理证实,将患者临床症状、影像资料以及随访等综合结果作为颅底骨质受侵的判定标准,统计分析CT和MRI对诊断鼻咽癌颅底骨质侵犯的价值。结果鼻咽癌颅底骨质侵犯在CT上主要表现为骨皮质增厚模糊或增生硬化、单或多部位虫蚀样骨质破坏;MRI上主要表现为骨髓高信号消失呈中等信号。70例患者中,CT诊断颅底骨质受侵者24例,检出率为34.3%,其中多部位受侵者17例。MRI诊断颅底骨质受侵者51例,检出率为72.9%,其中多部位受侵者31例,两种检查方法检出率比较差异有统计学意义(P<0.05)。CT和MRI检查均显示颅底骨质侵犯岩锥尖发生率较高。结论 MRI在鼻咽癌颅底骨质侵犯诊断中能显著提高检出率,为临床医师治疗方案的选择提供了影像依据。

关键词(KeyWords)： 鼻咽癌;诊断价值;磁共振成像;检出率;颅底侵犯;电子计算机断层扫描

Abstract:

Keywords:

基金项目(Foundation): 安徽省科技厅联合项目(编号：WK9110000032)~~

作者(Author): 李少朋;程传东;邓克学;

Email:

DOI:

参考文献(References)：

• [1]Messer JA,Mohamed ASR,Hutcheson KA,et al.Longitudinal characterization of MRI kinetics in irradiated dysphagia-related structures for nasopharyngeal carcinoma patients receiving IMRT.Int J Radiat Oncol Biol Phys,2016,94(4):919.DOI:10.1016/j.ijrobp.2015.12.161.
• [2]Zheng D,Yue Q,Ren W,et al.Early responses assessment of neoadjuvant chemotherapy in nasopharyngeal carcinoma by serial dynamic contrast-enhanced MR imaging.Magn Reson Imaging,2017,35(1):125-131.DOI:10.1016/j.mri.2016.08.011.
• [3]Huang B,Kwong DL,Lai V,et al.Dynamic contrast-enhanced magnetic resonance imaging of regional nodal netastasis in nasopharyngeal carcinoma:Correlation with nodal staging.Contrast Media Mol Imaging,2017(5):4519653.DOI:10.1155/2017/4519653.
• [4]Qin Y,Yu X,Hou J,et al.Prognostic value of the pretreatment primary lesion quantitative dynamic contrast-enhanced magnetic resonance imaging for nasoph-aryngeal carcinoma.Acad Radiol,2019,26(11):1473-1482.DOI:10.1016/j.acra.2019.01.021.
• [5]Ni L,Liu Y.Contrast-enhanced dynamic and diffusion-weighted magnetic resonance imaging at 3.0 T to assess early-stage nasopharyngeal carcinoma.Oncol Lett,2018,15(4):5294-5300.DOI:10.3892/ol.2018.7948.
• [6]Ji MF,Huang QH,Yu Xia,et al.Evaluation of plasma epstein-barr virus DNA load to distinguish nasopharyngeal carcinoma patients from healthy high-risk populations in Southern China.Cancer,2014,120(9):1353-1360.DOI:10.1002/cncr.28564.
• [7]Li W,Zhang RS,Li W,et al.The value of MRI combined with single photon emission computed tomography (CT) in the diagnosis of early skull base invasion in patients with nasopharyngeal carcinoma and its influence on clinical decision-making.Chin J Radiol,2016,50(6):406-411.DOI:10.3760/cma.j.issn.1005-1201.2016.06.002.李伟,张汝森,李雯,等.MRI联合单光子发射计算机体层成像-CT诊断鼻咽癌患者早期颅底骨侵犯的价值及其对临床决策的影响.中华放射学杂志,2016,50(6):406-411.DOI:10.3760/cma.j.issn.1005-1201.2016.06.002.
• [8]Cai YL,Li J,Lu AY,et al.Diagnostic significance of combined detection of Epstein-Barr virus antibodies,VCA/IgA,EA/IgA,Rta/IgG and EBNA1/IgA for nasopharyngeal carcinoma.Asian Pac J Cancer Prev,2014,15(5):2001-2006.DOI:10.7314/apjcp.2014.15.5.2001.
• [9]Wu LQ,Cui CY,Li HJ,et al.Prognostic analysis of paranasal sinus invasion in nasopharyngeal carcinoma based on magnetic resonance imaging and imrt.J Clin Radiol,2019,38(5):806-810.DOI:10.13437/j.cnki.jcr.2019.05.013.吴莉青,崔春艳,黎浩江,等.基于磁共振成像及调强放疗的鼻咽癌副鼻窦侵犯的预后分析.临床放射学杂志,2019,38(5):806-810.DOI:10.13437/j.cnki.jcr.2019.05.013.
• [10]Zhang XG,Liang SX,Pan SM,et al.Relationship between lymph node capsule invasion and prognosis of nasopharyngeal carcinoma (NPC)3DRT based on MRI.Chin J Radiation Oncol,2017,26(6):621-626.DOI:10.3760/cma.j.iggn.1004-4221.2017.06.003.张相国,梁思贤,潘素明,等.基于MRI的淋巴结包膜侵犯与鼻咽癌3DRT的预后关系.中华放射肿瘤学杂志,2017,26(6):621-626.DOI:10.3760/cma.j.iggn.1004-4221.2017.06.003.
• [11]Fang YH,Chen YB,Lin SJ,et al.Prognosis of nasopharyngeal carcinoma with sinus invasion based on MRI and IMRT.Chin J Radiat Oncol,2016,25(1):9-13.DOI:10.3760/cma.j.issn.1004-4221.2016.01.003.方燕红,陈韵彬,林少俊,等.基于MRI和IMRT的鼻咽癌鼻窦侵犯的预后研究.中华放射肿瘤学杂志,2016,25(1):9-13.DOI:10.3760/cma.j.issn.1004-4221.2016.01.003.
• [12]Yu QM,Cai J,Ge Q,et al.Clinical analysis of radiation temporal lobe injury after imrt of cavernous sinus in nasopharyngeal carcinoma.J Clin Oncol,2016,21(12):1099-1102.俞岑明,蔡晶,葛琴,等.鼻咽癌海绵窦侵犯调强放疗后放射性颞叶损伤的临床分析.临床肿瘤学杂志,2016,21(12):1099-1102.
• [13]Li YZ,Xie CM,Wu YP,et al.Nasopharyngeal carcinoma patients with retropharyngeal lymph node metastases:A minimum axial diameter of6 mm is a more accurate prognostic predictor than 5 mm.AJR Am JRoentgenol,2015,204(1):20-23.DOI:org/10.1002/cncr.23555.
• [14]Akimoto E,Kadoya T,Kajitani K,et al.Role of~(18)F-PET/CT in predicting prognosis of patients with breast cancer after neoadjuvant chemotherapy.Clin B reast Cancer,2018,18(1):45.DOI:10.1016/j.clbc.2017.09.006.
• [15]Morita T,Tatsumi M,Ishibashi M,et al.Assessment of mediastinal tumors using SUVmax and volumetric parameters on FDG-PET/CT.Asia Oceania J Nuclear Med Biology,2017,5(1):22-29.DOI:10.22038/aojnmb.2016.7996.
• [16]Park JK,Kim JJ,Moon SW.A study about different findings of PETCTbetween neoadjuvant and nonneoadjuvant therapy:SUVmax is not a reliable predictor of lymphatic involvement after neoadjuvant therapy for esophageal cancer.J Thorac Dis,2016,8(5):784-794.DOI:10.21037/jtd.2016.03.20.
• [17]Dancheva Z,Bochev P,Chaushev B,et al.Dual-time point 18F DGPET/CT imaging may be useful in assessing local recurrent disease in high grade bone and soft tissue sarcoma.Nuclear Med Review Central Eastern Eur,2016,19(1):22.DOI:10.5603/NMR.2016.0005.
• [18]Albano D,Patti C,Lagalla R,et al.Wholebody MRI,FDG-PET/CT,and bone marrow biopsy,for the assessment of bone marrow involvement in patients with newly diagnosed lymphoma.J Magne Reson Imaging,2016,45(4):18.DOI:10.1002/jmri.25439.
• [19]Herlemann A,Wenter V,Kretschmer A,et al.(68)Ga-PSMA positron emission tomography/computed tomography provides accurate staging of lymph node regions prior to lymph node dissection in patients with prostate cancer.Eur Urology,2016,70(4):553-557.DOI:10.1016/j.eururo.2015.12.051.
• [20]Jia F.Diagnostic value of CT and MRI in local invasion of patients with nasopharyngeal carcinoma.Med Equip,2017,30(9):128-129.贾芳.CT与MRI检查对鼻咽癌患者局部侵犯情况的诊断价值.医疗装备,2017,30(9):128-129.
• [21]Jia WH,Collins A,Zeng YX,et al.Complex segregation analysis of nasopharyngeal carcinoma in Guangdong,China:evidence for a multifactorial mode of inheritance(complex segregation analysis of NPCin China).Eur J Human Ge netics,2016,13(2):248-252.DOI:10.1038/sj.ejhg.5201305.