舌鳞癌颈淋巴结转移的MRI诊断  

Magnetic Resonance Imaging Diagnosis of Cervical Lymph Node Metastasis from Lingual Squamous Cell Carcinoma

作　　者：丁忠祥[1] 梁碧玲[1] 沈君[1] 谢榜昆[1] 黄穗乔[1] 张彬[2] 

机构地区：[1]中山大学附属第二医院放射科,广东广州510120 [2]中山大学附属第二医院口腔科,广东广州510120

出　　处：《癌症》2005年第2期199-203,共5页Chinese Journal of Cancer

摘　　要：背景与目的明确有无颈部淋巴结转移对舌癌的治疗与预后评价意义重大,单纯触诊诊断淋巴结转移的准确率难以令人满意,MRI越来越多地用于颈部淋巴结转移的评价。本研究旨在分析舌鳞癌颈淋巴结转移的MRI特点及规律,探讨MRI在诊断舌鳞癌颈部淋巴结转移中的作用。方法对92例舌鳞癌患者共448个颈部淋巴结区进行MRI鄄病理对照分析。结果448个淋巴结区中,166区(37.1%)病理为淋巴结转移,其中Ⅱ区最常受累,Ⅰ、Ⅱ区MRI诊断的假阳性率及假阴性率均较高。舌体鳞癌颈部淋巴结各区转移率与舌根鳞癌比较无统计学差异。76个淋巴结区有明确的淋巴结中央坏死,病理证实均为转移淋巴结。包膜外侵犯34区,MRI上淋巴结边缘不规则,周围脂肪带模糊、不完整,其中2例包绕颈内动脉。以淋巴结最小直径≥8mm,或中央坏死作为MRI诊断转移淋巴结的标准,敏感性79.5%,特异性90.4%,准确性86.4%。结论舌鳞癌颈部淋巴结转移以Ⅱ区最高,淋巴结的大小、有无中央坏死及边缘是否规则可作为MRI诊断的主要依据。MRI对于Ⅲ、Ⅳ及Ⅴ区诊断的淋巴结转移诊断准确性高,但对Ⅰ、Ⅱ区淋巴结转移诊断价值有限。BACKGROUND & OBJECTIVE: The identification of cervical lymph node metastasis is very important for the treatment and prognosis prediction of lingual squamous cell carcinoma. Simple palpation is unsatisfac-tory for the accurate diagnosis of cervical lymph node metastasis. Magnetic resonance imaging (MRI) has been increasingly used to evaluate cervical lymph node status. This study was to explore MRI features of cervical lymph nodes metastasis from lingual squamous cell carcinoma, and to investigate the role of MRI in diagnosing this kind of metastasis. METHODS: The MR images of 448 nodal levels in 92 patients with lingual squamous cell carcinoma were analyzed, and compared with their pathologic diagnoses. RESULTS: Of the 488 nodal levels, 166 (37.1%) were proved pathologically as metastases, level Ⅱ was the most commonly involved. False-positive and false-negative rates of MRI diagnoses were higher in levels Ⅰ, and Ⅱ than in levels Ⅲ, Ⅳ, and Ⅴ. There is no statistical difference in the incidence of cervical lymph nodes metastases of different nodal levels between squamous cell carcinoma of corpus linguae and that of radix linguae. Obvious central nodal necrosis was seen in 76 nodal levels at MR images,which were proved pathologically as metastatic nodes. Extracapsular nodal invasions in 34 nodal levels had irregular contour, and infiltration of adjacent fat tissues around lymph nodes, among which carotid artery walls were encased in 2 cases. With the diagnostic criteria of metastasis as the minimal nodal diameter of ≥ 8 mm or central nodal necrosis, the diagnostic sensitivity, specificity, and accuracy of MRI were 79.5%, 90.4%, and 86.4%, respectively. CONCLUSIONS: The incidence of cervical lymph nodes metastasis from lingual squamous cell carcinoma is highest in level Ⅱ. MRI diagnostic criteria of cervical lymph nodes metastasis are nodal size, central nodal necrosis, and irregular contour of lymph nodes. MRI may diagnose lymph node metastasis in levels Ⅲ-Ⅴ with high accuracy, While its diagno

关 键 词：舌肿瘤 鳞状细胞癌 颈部淋巴结 淋巴转移 磁共振成像 诊断 

分 类 号：R739.86[医药卫生—肿瘤]