MRI联合单光子发射计算机体层成像-CT诊断鼻咽癌患者早期颅底骨侵犯的价值及其对临床决策的影响  

The value of MRI combined with single photon emission computed tomography-CT for the diagnosis of nasopharyngeal carcinoma with early skull base bone invasion and the affect on clinical decision

作　　者：李伟[1] 张汝森[1] 李雯[1] 李建生[2] 杨佩瑜[2] 刘枫[3] 

机构地区：[1]广州医科大学附属肿瘤医院核医学科,510095 [2]广州医科大学附属肿瘤医院放射科,510095 [3]南方医科大学中西医结合医院核医学科

出　　处：《中华放射学杂志》2016年第6期406-411,共6页Chinese Journal of Radiology

摘　　要：目的：探讨MRI联合单光子发射计算机体层成像-CT（SPECT-CT）诊断鼻咽癌患者早期颅底骨侵犯的价值及对临床决策的影响。方法回顾性分析经病理证实为鼻咽癌，鼻咽部CT检查未显示颅底骨侵犯且均进行过鼻咽部MRI和SPECT-CT检查，临床和随访资料完整的195例患者。分别对MRI和SPECT-CT图像上是否有颅底骨侵犯做出阳性或阴性的判定。临床医师根据MRI结果做出常规临床决策，根据MRI联合SPECT-CT结果做出联合临床决策，对比2次临床决策中变动的内容。以临床综合结果（包括症状、影像及随访等）作为判定颅底骨侵犯的标准，分析MRI、SPECT-CT及联合检查诊断颅底骨侵犯的价值。采用ROC分析MRI、SPECT-CT及联合检查的诊断效能。结果同常规临床决策比较，采用联合临床决策87例（44.6%，87/195）临床决策发生了变化，其中21例新增了颅底侵犯的诊断，46例颅底侵犯的范围增加，87例治疗方案均发生了改变。195例中，根据临床综合标准判定，114例存在颅底骨侵犯。MRI、SPECT-CT均诊断阳性的74例，均存在颅底骨侵犯；MRI、SPECT-CT均诊断阴性的58例，均不存在颅底骨侵犯。诊断为MRI阳性SPECT-CT阴性的患者，66.7%（16/24）存在颅底骨侵犯；诊断为MRI阴性SPECT-CT阳性的患者，61.5%（24/39）存在颅底骨侵犯。将MRI和（或）SPECT-CT阳性即诊断为阳性作为联合检查诊断的标准。MRI、SPECT-CT及联合检查诊断鼻咽癌患者颅底骨侵犯的敏感度分别为78.95%（90/114）、85.96%（98/114）、100.00%（114/114），特异度分别为90.12%（73/81）、81.48%（66/81）、71.60%（58/81），ROC下面积分别为0.845、0.837、0.858，错诊率分别为16.41%（32/195）、15.90%（31/195）、11.79%（23/195）。结论 MRI联合SPECT-CT检查可以提高对颅底骨侵犯诊断的准确性，有效影响鼻咽癌的临床决策。Objective To analyze the value of MRI combined with single photon emission computed tomography-CT （SPECT-CT） for the diagnosis of nasopharyngeal carcinoma with early skull base bone invasion and the effect on clinical decision. Methods This retrospective study included 195 pathologically proven nasopharyngeal carcinoma patients with complete clinical and follow-up data, which did not find the signs of skull base bone invasion by CT and be subsequently performed MRI and SPECT-CT. The MRI and SPECT-CT images were respectively analyzed and the positive or negative judgment was made on whether there was skull base bone invasion. Clinical doctors made the routine clinical decision according to MR results, and then made the combined clinical decision based on the results of MR combined with SPECT-CT. The changes between 2 clinical decisions were analyzed. To assess the value of MR, SPECT-CT and combined examination in the diagnosis of skull base bone invasion on the basis of comprehensive clinical results （including symptoms, imaging and follow up, etc） as qualitative criteria. The diagnostic power of MRI, SPECT-CT and combined examination was analyzed by ROC. Results Compared with the routine clinical decisions, combined clinical decisions （44.6%, 87/195） were changed in 87 cases, including 21 cases with new diagnosis of skull base bone invasion, 46 cases with skull base invasion range increased and 87 cases with treatment plan changes. In 195 cases, 114 cases were confirmed to have the skull base bone invasion by comprehensive clinical results. When MRI was positive and SPECT-CT positive, MRI negative and SPECT-CT negative, MRI positive and SPECT-CT negative, MRI negative and SPECT-CT positive, the presence of skull base bone invasion respectively were 100.0%（74/74）, 0 （58/58）, 66.7%（16/24）, 61.5%（24/39）. MRI and （or） SPECT-CT positive was regarded as positive, it was used as the criterion of combined examination. For skull base bone invasion, MRI, SPECT-CT and combined examination had

关 键 词：鼻咽肿瘤 磁共振成像 体层摄影术 发射型计算机 单光子 颅底 

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