磁共振扩散加权成像在鼻咽癌放疗后随访复查中的临床应用价值

发布时间：2018-04-19 19:37

本文选题：磁共振成像 + 扩散加权成像　；参考：《安徽医科大学》2012年硕士论文

【摘要】：目的：探讨磁共振扩散加权成像(DWI)在鼻咽癌(NPC)放疗后随访复查中的临床应用价值。方法：经临床和病理证实的83例鼻咽癌放疗后复查的患者，放疗后6个月以内的分为肿瘤残留和无残留组，6个月以上的分复发组和无复发组，行鼻咽部常规MRI及DWI检查，详细分析他们的MRI资料，并对鼻咽局部残存肿块和（或）鼻咽壁增厚、骨质破坏缺损处及两侧翼外肌进行表观扩散系数（ADC）测量。结果： 1.鼻咽癌放疗后无残留组33例，其中鼻咽腔正常10例，鼻咽腔变形25例，鼻咽壁增厚28例，鼻咽部/或咽旁残留肿块17例，咽旁间隙变窄/消失17例，颅底残留破坏缺损6例，蝶骨翼板破坏2例，其中鼻咽壁增厚及鼻咽部/或咽旁残留肿块ADC值(1.843±0.133)×10~(-3)mm~2/s。 2.残留组4例，鼻咽壁增厚2例，鼻咽部/或咽旁残留肿块2例，咽旁间隙变窄/消失2例，蝶骨体骨质破坏1例，，斜坡骨质破坏1例，其ADC均值(1.097±0.183)×10~(-3)mm~2/s。 3.无复发组41例，鼻咽腔正常12例，鼻咽腔变形29例，鼻咽壁增厚31例，鼻咽部/或咽旁残留肿块25例，咽旁间隙变窄/消失21例，颅底破坏缺损2例，其中鼻咽壁增厚及鼻咽部和（或）咽旁残留肿块ADC值（1.884±0.134）×10~(-3)mm~2/s。 4.复发组5例，鼻咽壁增厚5例，鼻咽部/或咽旁残留肿块5例，颅底骨质破坏3例，蝶骨体骨质破坏1例，咽旁间隙变窄/消失5例，其ADC均值（0.787±0.067）×10~(-3)mm~2/s。经统计学处理，残留组和复发组ADC值明显低于翼外肌ADC值，无残留组和无复发组ADC值明显高于翼外肌ADC值，其差异均有统计学意义（P＜0.05）。结论：MRI能够很好的显示鼻咽癌放疗后的改变，尤其在DWI方面，能提供细胞水平的定性和定量信息，通过对兴趣区ADC值的测量，可敏感而准确地鉴别鼻咽癌放疗后残留、纤维化斑块和肿瘤复发。
[Abstract]:Objective: to evaluate the clinical value of diffusion weighted Mr imaging (DWI) in the follow-up of patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods: 83 patients with nasopharyngeal carcinoma confirmed by clinical and pathological examination after radiotherapy were divided into two groups within 6 months after radiotherapy. The patients who were more than 6 months old were divided into recurrence group and non-recurrence group. Routine nasopharynx MRI and DWI were performed. Their MRI data were analyzed in detail, and the apparent diffusion coefficient was measured at the site of local mass and / or thickening of nasopharynx wall, bone destruction defect and bilateral lateral pterygoid muscles. Results: 1. There were 33 cases of nasopharyngeal carcinoma without residual after radiotherapy, including 10 cases of normal nasopharyngeal cavity, 25 cases of nasopharyngeal cavity deformation, 28 cases of nasopharyngeal wall thickening, 17 cases of residual nasopharynx / or parapharyngeal mass, 17 cases of narrowing / disappearance of parapharyngeal space, 6 cases of skull base residual destruction and defect. Sphenoid wing plate was destroyed in 2 cases. The ADC value of nasopharynx wall thickening and residual nasopharynx / parapharyngeal mass was 1.843 卤0.133) 脳 10 ~ (-3) mm ~ (-1) / s. 2. In the residual group, there were 2 cases of nasopharyngeal wall thickening, 2 cases of nasopharynx / parapharyngeal residual mass, 2 cases of narrowing / disappearance of parapharyngeal space, 1 case of sphenoid bone destruction and 1 case of Clivus bone destruction. The ADC mean value was 1.097 卤0.183) 脳 10 ~ (-3) mm ~ (-3) / s. 3. There were 41 cases in no recurrence group, 12 cases normal nasopharyngeal cavity, 29 cases nasopharyngeal cavity deformation, 31 cases nasopharynx wall thickening, 25 cases nasopharyngeal / parapharyngeal residual mass, 21 cases parapharyngeal space narrowing / disappearance, 2 cases skull base damage and defect. The ADC value of nasopharyngeal wall thickening and residual masses in nasopharynx and / or parapharyngeal region was 1.884 卤0.134 脳 10 ~ (-3) mm ~ (-1) / s. 4. In the recurrent group, there were 5 cases of nasopharyngeal wall thickening, 5 cases of nasopharyngeal / parapharyngeal residual mass, 3 cases of skull base bone destruction, 1 case of sphenoid bone destruction, and 5 cases of parapharyngeal space narrowing / disappearance. The ADC mean value was 0.787 卤0.067) 脳 10 ~ (-3) mm ~ (-3) / s. The ADC value of the residual group and the recurrent group was significantly lower than the ADC value of the lateral pterygoid muscle, and the ADC value of the non-residual group and the non-recurrent group was significantly higher than that of the ADC value of the lateral pterygoid muscle, and the difference was statistically significant (P < 0.05). Conclusion the changes of nasopharyngeal carcinoma after radiotherapy can be well demonstrated by Mr imaging, especially in DWI, which can provide qualitative and quantitative information of cell level. By measuring the ADC value of the region of interest, it can be sensitive and accurate to distinguish the residual after radiotherapy for nasopharyngeal carcinoma. Fibrosis plaques and tumor recurrence.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

【引证文献】