鼻咽癌颅底骨侵犯CT漏诊MR和SPECT/CT诊断价值比较  

Comparison of SPECT/CT and MR in diagnosis of skull base bone early invasion in nasopharyngeal carcinoma with negative CT finding

作　　者：李伟[1] 张汝森[1] 张林启 汤日杰[2] 李建生[2] 

机构地区：[1]广州医科大学附属肿瘤医院核医学科,广东广州510095 [2]广州医科大学附属肿瘤医院放射科,广东广州510095

出　　处：《中华肿瘤防治杂志》2016年第7期446-451,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的CT容易漏诊鼻咽癌的早期颅底骨侵犯灶。而MR和99Tc m-MDPSPECT／CT判断早期颅底骨侵犯的价值尚不明确。本研究比较MR和SPECT／CT在判断CT漏诊的早期颅底骨侵犯方面的诊断价值，并比较它们在各具体颅底骨的价值。方法广州医科大学附属肿瘤医院2010—01—01—201406—30CT未提示颅底骨侵犯的鼻咽癌患者80例，在治疗前行99Tc m-MDP SPECT／CT和MR检查。以6个月的随访影像（CT、MR）资料和临床资料作为颅底骨侵犯的定性标准。计算SPECT／CT和MR在判断整体颅底骨侵犯和具体各骨侵犯方面的敏感性、特异性和准确性。通过受试者工作特征（receiver operating characteristic，ROC）曲线的Az值比较它们的诊断价值。结果关于敏感性，在整体及蝶骨翼突方面，MR（86．3％、79．4％）比SPECT／CT（92．2％、85．3％）略减小（x2=0．917，P=0．338；x2=0．405，P=0．525）；在颞骨岩尖方面，MR（87．5％）与SPECT／CT（87．5％）等同（x2=0．000，P=1．000）；在枕骨斜坡方面，MR（95．2％）比SPECT／CT（92．9％）略增大，x2=0．213，P=0．645。关于特异性，在整体及蝶骨翼突、颞骨岩尖和枕骨斜坡方面，MR（89．7％、91．3％、92．6％、100．0％）比SPECT／CT（75．9％、89．7％、89．7％和94．7％）略增大（x2=1．933，P=0．164；x2=0．184，P=0．668；x2=0．731，P=0．393；x2=2．054，P=0．152）。关于准确性，在整体、颞骨岩尖和枕骨斜坡方面，MR（87．5％、91．3％和97．5％）比SPECT／CT（86．3％、89．4％和93．8％）略增大（x2=0．055，P=0．815；x2=0．321，P=0．571；x2=1．345，P=0．246）；在蝶骨翼突方面，MR（88．8％）与SPECT／CT（88．8％）等同（x2=0．000，P=1．000）。关于Az值，在整体及枕骨斜坡方面，MR（0．880和0．976）比SPECT／CT（0．840和0．938）略增大（Z=1．081，P=0．280；Z=1．747，P=0．081）；在颞骨岩尖方面OBJECTIVE Easily missing the early skull base bone invasion of nasopharyngeal carcinoma （NPC） is the shortcoming of CT. The value of MR and 99 Te m-MDP SPECT/CT to assess the early skull base bone invasion is not clear. This study was to explore the value of 99 Tc-m MDP SPECT/CT in conjunction with MR to examine early skull base bone invasion in nasopharyngeal carcinoma （NPC） with negative CT finding and analyzed their value on each invaded skull base bone. METHODS Eighty patients of NPC with negative CT finding of skull base bone invasion from 2010. 1. 1 to 2014.6.30 in Cancer Hospital of Guangzhou Medical University were given 99 Te m-MDP SPECT/CT and MR examination 1 week after CT scanning before treatment. Follow-up images （CT and MR） and detailed clinical materials in 6 months were obtained as the gold standard of skull base bone invasion. The sensitivity, specificity and accuracy of SPECT/CT and MR for diagnosis skull base bone invasion on the whole and on each skull base bone were calculated. The diagnostic value were evaluated and compared through Az values of ROC curves. RESULTS The sensitivity of MR （86.3% ,79.4%） was slightly less than that of SPECT/CT（92.2% , 85.3% ） on the whole and sphenoid pterygoid process （x2 = 0. 917, P=0. 338; X2 =0. 405, P=0. 525）. The sensitivity of MR（87.5% ） was equal to SPECT/CT（87.5 %） on petrous apex （x2 = 0. 000, P= 1. 000）. The sensitivity of MR（95.2 %） was slightly higher than that of SPECT/CT（92.9 %） on basilar clivus （x2 =0. 213, P=0. 645）. The specificity of MR（89.7%, 91.3%, 92.6%, 100.0%） was slightly higher than that of SPECT/CT（75.9%, 89.7%, 89.7%, 94.7%） on the whole and each bone （x2 = 1. 933, P=0. 164; x2 = 0.184, P=0.668; x2=0.731, P=0.393; X2=2.054, P=0.152）. The accuracy ofMR（87. 5%, 91.3%, 97.5%） was slightly higher than that of SPECT/CT（86.3%, 89.4%, 93.8%） on the whole, petrous apex and basilar clivus （x2 = 0.055, P=0.815; x2=0.321, P=0.571; x2=1.345, P=0.246）. The accuracy of MR�

关 键 词：磁共振 单光子发射型计算机断层成像 鼻咽肿瘤 颅底骨侵犯 

分 类 号：R739.63[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2