鼻咽癌放疗后CT与MRI影像分析

发布时间：2018-09-13 11:14

【摘要】：目的：提高对鼻咽癌(NPC)放疗后改变及复发的CT和MRI表现的认识。方法：详细分析经临床和病理证实的NPC放疗后复查的118例CT资料和49例MRI资料。结果：1、CT检查组118例中,放疗后复发53例,其中鼻咽壁增厚/肿块28例,茎内增厚致密40例,颅底侵犯24例；无复发65例中,鼻咽壁增厚35例,鼻咽壁肿块5例,茎内增厚致密18例,颅底残留骨质破坏6例。经统计学处理,对于茎内增厚致密,复发与无复发之间有显著性差异(P0.05)；而在鼻咽壁增厚/肿块方面,两者之间则无显著性差异(P0.05)。复发病例中,23例增强扫描均显示明显强化；而无复发病例中,25例增强扫描表现为无强化、轻微强化或环形强化。 2、MRI检查组49例中,放疗后无复发28例,其中鼻咽腔正常2例,鼻咽腔变形15例,鼻咽壁增厚19例,茎内增厚7例,咽旁间隙变窄3例,颅底残留破坏缺损5例。复发21例,鼻咽壁和茎内增厚各12例,颅底骨质破坏18例,颞下窝肿块4例,口咽肿块2例,眼眶、上颌骨/上颌窦骨质破坏2例,颞颌关节骨质破坏1例,乳突骨质破坏、双侧腮腺肿块及环绕颈部浸润肿块1例,咽旁间隙变窄/消失9例。经统计学处理,在茎内增厚、咽旁间隙变窄/消失方面,两者间均有显著性差异(P0.05)。无复发病例中,7例茎内增厚在T1WI和T2WI上均表现为茎内软组织等信号或低信号肿块影,5例无强化,2例轻度强化；复发病例中,12例茎内增厚在T1WI和T2WI上表现为形态不规则的等信号或略高号肿块影,11例行增强扫描,明显强化9例,轻度强化2例。结论：1、CT和MRI可较好地显示NPC放疗后变化。 2、茎内改变是判断复发与否的重要征象。 3、CT和MRI对放疗后纤维化斑块与肿瘤复发鉴别有重要作用。
[Abstract]:Objective: to improve the understanding of CT and MRI findings of nasopharyngeal carcinoma (NPC) after (NPC) radiotherapy. Methods: the data of 118 cases of CT and 49 cases of MRI confirmed by clinical and pathological NPC were analyzed in detail. Results among 118 cases of CT inspection group, 53 cases recurred after radiotherapy, including 28 cases of nasopharyngeal wall thickening / mass, 40 cases of thickening and compactness of stem, 24 cases of skull base invasion, 35 cases of nasopharyngeal wall thickening and 5 cases of nasopharynx wall mass, among 65 cases without recurrence, 35 cases with nasopharyngeal wall thickening and 5 cases with nasopharyngeal wall mass. There were 18 cases of thickening and compaction in stem and 6 cases of skull base residual bone destruction. Statistical analysis showed that there was a significant difference between the thickening and densification of stem, recurrence and no recurrence (P0.05), but there was no significant difference in thickening / mass of nasopharyngeal wall between them (P0.05). In 23 cases of recurrence, enhanced scan showed obvious enhancement, while in 25 cases of no recurrence, the enhanced scan showed no enhancement, slight enhancement or ring enhancement. 2 in 49 cases of MRI inspection group, 28 cases had no recurrence after radiotherapy. The nasopharynx cavity was normal in 2 cases, nasopharyngeal cavity deformation in 15 cases, nasopharyngeal wall thickening in 19 cases, stem thickening in 7 cases, parapharyngeal space narrowing in 3 cases, skull base residual destruction in 5 cases. Recurrence occurred in 21 cases, thickening of nasopharynx wall and stem in 12 cases, skull base destruction in 18 cases, subtemporal fossa mass in 4 cases, oropharyngeal mass in 2 cases, orbital and maxillary / maxillary sinus bone destruction in 2 cases, temporomandibular joint bone destruction in 1 case, mastoid bone destruction in 1 case. Bilateral parotid masses and infiltrating masses around the neck in 1 case, parapharyngeal space narrowing / disappearance in 9 cases. Statistical analysis showed that there was significant difference between the two groups in thickening of stem and narrowing / disappearance of parapharyngeal space (P0.05). In 7 cases of no recurrence, the thickening of stem in both T1WI and T2WI showed iso-signal in stem soft tissue or low signal mass in 5 cases, and no enhancement in 2 cases. In 12 cases of recurrence, the thickening of the stem showed irregular iso-signal on T1WI and T2WI in 11 cases, obvious enhancement in 9 cases and slight enhancement in 2 cases. Conclusion CT and MRI can show the changes of NPC after radiotherapy. 2Stem change is an important sign to judge recurrence or not. 3CT and MRI play an important role in differentiating fibrosis plaques from tumor recurrence after radiotherapy.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

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