鼻咽癌侵犯颅底骨SPECT/CT与CT检测诊断价值对比分析  

Comparison of SPECT/CT,CT and MRI in diagnosis of skull base bone invasion in nasopharyngeal carcinoma

作　　者：朱海生[1] 严浩林[1] 阙丽琳[1] 覃金莲[1] 甘媚[1] 

机构地区：[1]玉林市第一人民医院肿瘤科,广西玉林537000

出　　处：《中华肿瘤防治杂志》2017年第2期108-112,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的核磁共振成像(magnetic reaonance imaging,MRI)能够早期检测鼻咽癌的颅底骨侵犯灶,是治疗前标准检查。而SPECT/CT和CT检测颅底骨侵犯的价值尚不明确。本研究对比分析SPECT/CT和CT对鼻咽癌(nasopharyngeal carcinoma,NPC)颅底骨侵犯(skull base bone involvemen,SBBI)检测能力及临床价值。方法对2014-01-01-2015-12-31玉林市第一人民医院165例NPC初治患者于放疗前同期进行SPECT/CT颅底断层骨显像,鼻咽颅底CT、MRI检查。以MRI结果为标准,采用双盲法对两者检测结果进行比较。根据肿瘤的不同侵犯途径,进一步把颅底骨分斜坡、岩尖,蝶骨体、蝶窦底和翼突、翼板等区域进行统计分析。结果 SPECT/CT和CT检测颅底骨破坏灵敏度分别为96.7%(89/92)和60.9%(56/92),特异度分别为72.6%(53/73)和95.9%(70/73),准确度分别为86.1%(142/165)和76.4%(126/165),Kappa值分别为0.711和0.542。SPECT/CT和CT的AUC值(ROC曲线下面积)分别为0.847和0.784,分别与曲线下面积0.5行Z检验比较,差异有统计学意义,Z=12.43,P<0.001;Z=10.09,P<0.001。在斜坡和岩尖区域,SPECT/CT和CT检测SBBI灵敏度分别为96.7%(88/91)和57.1%(52/91),特异性分别为89.2%(66/74)和100.0%(74/74),准确度值分别为93.3%(154/165)和76.4%(126/165),SPECT/CT和CT检测AUC值分别为0.929和0.786,两者差异有统计学意义,Z=4.425,P<0.001。结论 SPECT/CT和CT能有效地检测鼻咽癌SBBI,在斜坡、岩尖区域,SPECT/CT检测效能优于CT。OBJECTIVE MRI data can assess the early skull base bone invasion（SBBI） and it has become common practice for pre-treatment evaluation of patients with NPC. The value of 99 Tem MDP SPECT/CT and CT to assess tbe early skull base bone invasion is not clear. This study was to evaluate the diagnostic efficacy of single photon emission computed tomography/computed tomography （SPECT/CT） imaging, computed tomography （CT） compared magnetic resonance imaging （MRI） for the detection of skull base invasion in NPC. METHODS One hundred and sixty-five naso pharyngeal carcinoma untreated patients from 2014.1.1 to 2015.12.31 in Yulin First People＇s Hospital were given whole body and skull-base tomography SPECT/CT, nasopharynx and skull base CT and MRI before radiotherapy. MRI data was used as a standard control. The results were double-blind compared and evaluated. In addition, SBBI was checked in different regions which were the clivus and petrous apex of the skull base, the base of spilenoid bone and sphenoid sinus region, the Pterygoid process and lamina lateralis,lamina medialis region. RESULTS The sensitivity, specificity, accura- cy and Kappa values for SBBI detection by SPECT/CT and CT were 96.7%（89/92）, 72.6%（53/73）, 86.1%（142/165）, 0. 711 and 60.9%（56/92）, 95. 9% （70/73）, 76. 4% （126/165）, 0. 542 respectively. The area under the ROC curve （AUC） were 0. 847 and 0. 784 compared the standard 0. 5 with significant level（Z= 12.43, P〈0. 001;Z= 10.09, P〈 0. 001）. In the SBBI evaluation by SPECT/CT and CT for different regions, the sensitivity, specificity and accuracyvalues for the clivus and petrous apex region of the skull base were 96.7%（88/91）, 89.2%（66/74）, 93.3%（154/165） and 57.1%（52/91）,100.0%（74/74）,76.4%（126/165）,respectively. their AUC were 0.929 and 0.786 with significant level （Z=4. 425,P〈0. 001）. CONCLUSION SPECT/CT and CT could be used for the detection of nasopharyngeal SB- BI, and in the clivus and petrous apex region of the skul

关 键 词：鼻咽肿瘤 肿瘤侵犯 颅骨 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 99 Tcm-亚甲基二膦酸盐 

分 类 号：R739.63[医药卫生—肿瘤]