鼻咽癌咽后内侧淋巴结的影像学诊断与保护吞咽结构靶区优化探讨  

Imaging diagnosis of the medial group of retropharyngeal lymph nodes and the exploration of the optimization of target volume for protecting the swallowing structure in nasopharyngeal carcinoma

作　　者：宗丹[1] 张兰芳[1] 陈诚[1] 顾大勇[1] 何侠[1] 黄生富[1] Zong Dan;Zhang Lanfang;Chen Cheng;Gu Dayong;He Xia;Huang Shengfu(Department of Radiation Oncology,fiangsu Cancer Hospital,fiangsu Institute of Cancer Research,Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院放疗科,南京210009

出　　处：《中华放射肿瘤学杂志》2018年第12期1035-1040,共6页Chinese Journal of Radiation Oncology

基　　金：江苏省肿瘤医院院课题(ZQ201504);江苏省肿瘤医院青蓝计划(2018)。

摘　　要：目的明确弥散加权成像(DWI)在鼻咽癌咽后内侧淋巴结的诊断价值,了解咽后内侧淋巴结的临床特点并探讨优化CT V60靶区范围的可行性。方法回顾研究2011-2017年由江苏省肿瘤医院收治的437例Ⅰ-Ⅳa期鼻咽癌患者,行MR常规成像、DWI功能成像及增强CT扫描,分析咽后内侧淋巴结临床特点及CT V60下界于C2上缘分开的剂量学优势及安全性。结果437例患者13例有咽后内侧淋巴结,横径2.0~19mm,其中横径在2.0~5.0mm占53.8%。咽后内侧淋巴结分布于C1上缘至C3上缘1/3之间,其发生与N分期、双颈部淋巴结转移有关,尤其与颈部淋巴结横径>3cm密切相关。DWI、T2压脂及增强CT的敏感度分别为100%、61.5%及23.1%。排除特殊病灶类型,将CT V60下界在C2上缘分开,吞咽结构高剂量区照射剂量和体积明显降低。入组患者5年生存率达80%,且无一在优化靶区内复发。结论咽后内侧淋巴结发生率低,其直径多≤5mm,DWI对显示咽后内侧淋巴结具有优势。将CT V60下界在C2上缘分开对吞咽结构保护具有剂量学优势且安全可行。Objective To clarify the diagnostic value of diffusion-weighed imaging ( DWI) in the medial group of retropharyngeal lymph nodes in nasopharyngeal carcinoma, understand the clinical characteristics of retropharyngeal lymph nodes and explore the feasibility of optimizing the target volume of CT V60. Methods Clinical data of 437 patients with clinical stage Ⅰ-IVa nasopharyngeal carcinoma admitted to Jiangsu Cancer Hospital from 2011 to 2017 were retrospectively analyzed. All patients underwent magnetic resonance imaging (MRI),DWI (1 000 s/mm2) and enhanced CT scans to analyze the clinical characteristics of retropharyngeal lymph nodes and investigate the dosimetric advantage and safety of CT V60 lower margin on the upper margin of C2. Results The medial lymph nodes with a transverse diameter of 2. 0-19. 0 mm were detected 13 of 437 patients,and 53. 8% of the lymph nodes were measured 2-5 mm in transverse diameter. The medial lymph nodes were distributed between the superior margin of C1and 1/3 of C3.Its occurrence was related to N stage,double cervical lymph node metastases,especially the transverse diameter of cervical lymph node> 3 cm.The sensitivity of DWI,T2and enhanced CT were 100%,61. 5% and 23. 1%.After the special cases were excluded,the lower margin of CT V60on the superior margin of C2was separated. The radiation dose and volume of the swallowing structures were significantly decreased. The 5-year survival rate was 80% without recurrence in the optimized region. Conclusions The incidence of the medial group of retropharyngeal lymph nodes is low with a diameter of less than 5 mm. DWI possesses advantages in displaying the medial group of retropharyngeal lymph nodes. Isolating the lower margin of CT V60from the superior margin of C2is safe and feasible and has dosimetric advantages for protecting swallowing structure.

关 键 词：鼻咽肿瘤 淋巴结 弥散加权成像 吞咽结构 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]