Dextran-DTPA-Gd兔舌癌哨位淋巴结间质磁共振淋巴造影的诊断价值  

Potential application of dextran-DTPA-Gd for studying sentinel lymph node of tongue carcinoma with interstitial MR lymphography

作　　者：李方龙[1] 冯元勇[1] 刘世恩[2] 万升标[3] 宋凯[1] 江涛[3] 尚伟[1] 

机构地区：[1]青岛大学附属医院口腔颌面外科,山东青岛266000 [2]青岛大学附属医院放射科,山东青岛266000 [3]中国海洋大学医药学院,山东青岛266000

出　　处：《中国口腔颌面外科杂志》2015年第4期314-318,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的 :探讨Dextran-DTPA-Gd间质磁共振淋巴造影(IMRLG)定位兔VX2舌癌哨位淋巴结(SLN)及判断颈淋巴结转移的价值。方法:健康纯种新西兰大白兔16只,采用VX2瘤组织块植入左侧舌缘,建立兔舌癌移植瘤模型。21 d后,于荷瘤兔双侧舌缘肿瘤黏膜下注射Dextran-DTPA-Gd造影剂各0.2 m L,后分别于15、30、45、60 min,4 h,24h行IMRLG检查,计算增强前、后不同时间淋巴结的信号强化率(E%);定位SLN,观测淋巴管走行、淋巴结信号强度及形态等特征。24 h后,全麻下于相同部位注射亚甲蓝行淋巴染色,解剖颈淋巴结,行组织病理学检查。使用SPSS19.0软件包对数据进行统计学分析。结果 :成功建立兔舌癌移植瘤模型14只(14/16),淋巴转移12只(12/14),双侧淋巴结在磁共振增强扫描后相同时间信号强化率差别具有统计学意义(P<0.05)。解剖30枚淋巴结,其中IMRLG诊断癌转移淋巴结15枚,病理诊断转移13枚,诊断阳性率为86.7%(13/15),2种诊断方法无统计学差异(P>0.05)。IMRLG定位SLN与亚甲蓝染色位置一致。结论 :Dextran-DTPA-Gd间质磁共振淋巴造影可有效定位兔VX2舌癌SLN,为判断区域淋巴结是否转移提供依据。PURPOSE： To evaluate the feasibility of interstitial magnetic resonance lymphography（IMRLG） by using dextran-DTPA-Gd for studying sentinel lymph node（SLN） and detecting cervical lymph node metastasis in rabbit VX2 tongue cancer. METHODS： VX2 tumor tissues were transplanted into the left ventral submucosa of the tongue of 16 healthy New Zealand rabbits. After 21 days of transplantation, 0.2 m L dextran-DTPA-Gd were injected into the bilateral submucosa of the tongue,then the MR images were obtained by using 3D enhancement magnetic resonance lymphography at 15,30,45,60 mins and 4,24 hs after injection. The signal intensities after enhancing were measured to calculate the enhancing rates（E %） of lymph nodes at the same time. Further evidences were provided for positioning SLN, observing the lymphatic drainage lines and the density and morphology of the neck and the cervical lymph nodes. Methylene blue was injected into the same areas of tongue after 24 hours of IMRLG, and then dissection and histopathological examination of methylene blue-labeled SLNs were performed. SPSS19.0 software package was used for statistical analysis. RESULTS：Fourteen rabbits were successfully transplanted with VX2 tumor tissues（14/16） and 12 rabbits were detected with lymphatic metastasis. The differences of enhancing rates between the metastatic lymph nodes and the normal nodes was significant in each rabbit at the same time（P〈0.05）. Fifteen lymph nodes were diagnosed as metastatic lymph nodes by IMRLG in 30 lymph nodes of 12 rabbits, while 13/15 metastatic lymph nodes were affirmed by pathological diagnosis without significant difference（P〈0.05）. The SLN can be positioned readily by IMRLG and methylenc blue, and the results obtained had a good consistency. CONCLUSIONS： Dextran-DTPA-Gd could effectively position the cervical lymph node and was feasible in localization of the SLNs of tongue carcinoma metastasis. It also provides evidences in diagnosing the status of regional lymph node metastasis.

关 键 词：舌癌 哨位淋巴结 磁共振成像 淋巴造影 钆 

分 类 号：R739.86[医药卫生—肿瘤]