临床颅神经检查与MR对鼻咽癌三叉神经侵犯诊断对比分析

发布时间：2018-07-16 20:12

【摘要】：目的:探讨MR与临床颅神经检查在评价鼻咽癌患者三叉神经受侵犯方面的差异。方法:回顾性分析中山大学肿瘤防治中心2005-01-01-2005-06-30 308例初诊鼻咽癌患者的临床资料和磁共振图像资料。临床诊断三叉神经受侵根据临床症状和体格检查;三叉神经侵犯MR诊断标准包括:1)肿瘤直接侵犯三叉神经;2)肿瘤沿三叉神经周围扩散。结果:临床颅神经检查确诊15例(4.8%)患者有三叉神经分支受侵,受累的三叉神经分支共32支,包括眼神经支(V1,7支)、上颌神经支(V2,15支)和下颌神经支(V3,10支)。32支神经受侵的分支中,均有磁共振阳性征象,其中30支(93.8%)有三叉神经的颅内段或眶内段受侵,2支(6.2%)仅颅底段受侵,29支(91.0%)出现海绵窦段受侵。MR检查发现105例患者出现三叉神经受侵犯征象,其中90例(85.7%)临床颅神经检查未检出。临床颅神经检查诊断三叉神经颅内或眶内受侵率阳性更高(22.2%vs 5.9%),χ2=5.719,P=0.017。结论:大部分临床颅神经检查诊断三叉神经受侵的患者,磁共振检查均能发现三叉神经分支的颅内段或眶内段受侵征象,特别是海绵窦段的受侵。磁共振较临床颅神经检查能更早的发现三叉神经受侵。
[Abstract]:Objective: to explore the difference between Mr and clinical cranial nerve examination in evaluating the trigeminal nerve invasion in nasopharyngeal carcinoma (NPC) patients. Methods: the clinical data and MRI images of 308 newly diagnosed nasopharyngeal carcinoma patients from January to June 2005 in Cancer Center of Sun Yat-sen University were analyzed retrospectively. Clinical diagnosis of trigeminal nerve invasion according to clinical symptoms and physical examination the diagnostic criteria of trigeminal nerve invasion include: 1) the tumor directly invades the trigeminal nerve and 2) the tumor diffuses around the trigeminal nerve. Results: in 15 patients (4.8%), the trigeminal nerve branches were involved in 15 cases (4.8%). The involved branches of trigeminal nerve included the optic nerve branch (V1 nerve branch, 7 branches), the maxillary nerve branch (V2N branch, 15 branches) and the mandibular nerve branch (V3Ns, 10 branches) .32 branches of the involved trigeminal nerve branch. 30 (93.8%) of them had trigeminal nerve invasion in intracranial segment or intraorbital segment (6.2%), only 29 of them (91.0%) had cavernous sinus invasion. Mr examination showed that 105 patients had trigeminal nerve invasion. Among them, 90 cases (85.7%) were not detected by clinical cranial nerve examination. The positive rate of intracranial or intraorbital invasion of trigeminal nerve was higher in clinical cranial nerve examination (22.2%vs 5.9%). Conclusion: most of the patients with trigeminal nerve involvement were diagnosed by clinical cranial nerve examination. MRI can find the invasion of the intracranial or intraorbital segment of the trigeminal nerve branch, especially the cavernous sinus segment. MRI can detect trigeminal nerve invasion earlier than clinical cranial nerve examination.
【作者单位】：华南肿瘤学国家重点实验室·中山大学肿瘤防治中心医学影像介入中心;新疆医科大学附属肿瘤医院CT室;华南肿瘤学国家重点实验室·中山大学肿瘤防治中心放疗科;华南肿瘤学国家重点实验室·中山大学肿瘤防治中心神经外科;
【基金】：2012年广东省科技计划(2012A030400038)
【分类号】：R739.63

【参考文献】