利用MR扩散加权成像在鼻咽癌随访中帮助提高内窥镜活检价值的研究

发布时间：2018-11-01 17:58

【摘要】：目的:通过MR扩散加权成像在鼻咽癌随访中帮助内窥镜提高活检阳性率。方法:135例鼻咽癌治疗后随访可疑复发但首次内窥镜活检却没有发现癌组织的病例,再次行内窥镜活检前均行MR常规序列及扩散加权序列检查,通过观察MR图像对鼻咽活检部位进行定位,分为MR-A定位(MR常规序列)、MR-B定位(MR常规序列结合扩散加权序列)。然后再次内窥镜活检,先单独依据内窥镜影像(内镜定位)进行1次活检,然后再分别根据MR-A定位、MR-B定位各进行1次活检。通过与定性结果比较,分析3种定位方式的诊断价值,以及定位一致性对于2种MR定位的影响。结果:135例样本最终定性复发56例、未复发79例。内镜定位、MR-A定位、MR-B定位分别发现阳性26例、33例、40例,阴性109例、102例、95例,敏感度为46.4%、58.9%、71.4%,特异度均为100%,Az值分别为0.732、0.795、0.857。由于特异度均为100%,因此只分析复发病例。2种MR定位方式之间亦存在相关性(χ~2=4.250,r_P=0.039,K_(appa)=0.265)。56例复发病例中,2种MR方式定位32例活检部位一致,24例活检部位不一致。活检方向一致性对MR-A定位的结果存在显著性影响(χ~2=5.171,r_P=0.023,r_p=0.304),对MR-B定位的结果不存在显著性影响(χ~2=0.007,r_P=0.932,r_p=0.011)。当活检方向不一致时,MR-A定位的阳性率41.7%(10/24)小于MR-B定位的阳性率70.8%(17/24),存在显著性差异(χ~2=4.148,P=0.042)。结论 :在鼻咽癌随访中,MR辅助定位可以帮助鼻咽癌内窥镜提高活检结果的准确率、降低漏诊率,而以MR扩散加权成像辅助定位的价值更大。
[Abstract]:Objective: to improve the positive rate of endoscopic biopsy by MR diffusion-weighted imaging in nasopharyngeal carcinoma (NPC) follow-up. Methods: 135 cases of nasopharyngeal carcinoma were followed up with suspected recurrence but no cancer tissue was found in the first endoscopic biopsy. MR routine sequence and diffusion-weighted sequence were performed before endoscopic biopsy again. The nasopharyngeal biopsy site was located by observing MR images, which were divided into MR-A localization (MR routine sequence) and MR-B localization (MR routine sequence combined with diffusion-weighted sequence). Then endoscope biopsy was performed once more according to endoscope image (endoscope localization) and then respectively according to MR-A localization and MR-B localization. By comparing with the qualitative results, the diagnostic value of the three localization methods and the influence of location consistency on the two MR localization were analyzed. Results: there were 56 cases of qualitative recurrence and 79 cases of no recurrence in 135 cases. Endoscopic localization, MR-A localization and MR-B localization showed positive results in 26 cases, 33 cases, 40 cases, 109 cases negative, 102 cases, 95 cases, sensitivity 46.4%, 58.9% and 71.4%, respectively. The specificity was 100%. The Az values were 0.732U 0.795U 0.857, respectively. Because the specificity was 100%, only recurrent cases were analyzed. There was also a correlation between the two MR localization methods (蠂 ~ 2 ~ 2 ~ 2 ~ 4. 250 ~ 0. 039 K _ (appa) = 0.265). The biopsy sites were identical in 32 cases and inconsistent in 24 cases by two MR methods. The consistency of biopsy direction had a significant effect on the results of MR-A localization (蠂 ~ 25.171), but had no significant effect on the results of MR-B localization (蠂 ~ 2. 007 ~ 0. 007 / P ~ 0. 932 ~ 0. 011). When the direction of biopsy was different, the positive rate of MR-A localization was 41.7% (10 / 24) less than that of MR-B localization 70.8% (17 / 24), there was significant difference (蠂 ~ 2 ~ (4.148) P ~ (0.042). Conclusion: in the follow-up of nasopharyngeal carcinoma, MR assisted localization can improve the accuracy of biopsy results and reduce the rate of missed diagnosis, and the value of MR diffusion weighted imaging is more valuable.
【作者单位】：广州医科大学附属肿瘤医院广州市"恶性肿瘤治疗转化医学"重点实验室;
【分类号】：R739.63;R445.2

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