DWI在鼻咽癌颅底侵犯治疗后随访的初步探讨  

A preliminary study of diffusion-weighted imaging for the follow-up of nasopharyngeal carcinoma with skull base invasion after treatment

作　　者：王志龙[1] 张晶晶[2] 肖学红[1] 汪泽燕[1] 黄晓星[1] FANG Zhilong;ZHANG Jingjing;XIAO Xuehong;FANG Zeyan;HUANG Xiaoxing(Department of Radiology,Zhongshan City People＇ s Hospital,Zhongshan 528403,P.R.China;Career Center,Zhongshan City People＇ s Hospital,Zhongshan 528403,P.R.China)

机构地区：[1]广东省中山市人民医院MR室,广东中山528403 [2]广东省中山市人民医院肿瘤中心,广东中山528403

出　　处：《医学影像学杂志》2018年第8期1258-1263,共6页Journal of Medical Imaging

基　　金：广东省中山市卫生局医学科研立项课题(编号:2014J064)

摘　　要：目的探讨DWI在鼻咽癌(nasopharyngeal carcinoma,NPC)颅底侵犯治疗后随访的诊断价值。方法确诊NPC颅底侵犯28例,本组因4例有2个不同类型颅底侵犯、2例治疗后有2个不同转归颅底侵犯灶,共34个病灶入列研究,由两位经验丰富的影像医师进行分析,若意见不同,通过讨论达成一致。颅底侵犯依据治疗前MRI表现进行分型,以脑桥作为内源性参照物,采用相对值定量方法分析治疗前、后DWI与常规MRI,采用SSPS 13. 0统计学软件对NPC治疗后首次诊断肿瘤复发、完全缓解(complete response,CR)的随访数据进行分析,以鼻咽病理活检、继续随访≥6月MRI结果作为金标准,用ROC曲线评价DWI对NPC颅底侵犯疗效的诊断效能,以P <0. 05为差异有统计学意义。结果溶骨型颅底侵犯13个,随访确诊CR 11个、肿瘤复发2个,前者转归为不同成熟程度纤维化;浸润型颅底侵犯21个,随访均确诊CR,转归为黄骨髓。ROC分析显示r ADC、△ADC、r ADC联合r C与r ADC联合r C、r T1WI的曲线下面积、P值分别为0. 344、0. 464,0. 109、0. 067,1. 000、0. 019与1. 000、0. 019。结论 NPC颅底侵犯治疗后CR的转归因骨质破坏类型不同而异,溶骨型转归为纤维化,浸润型转归为黄骨髓化。单凭DWI评价NPC颅底侵犯的疗效并不可靠,DWI结合常规MRI,才能准确地评价NPC颅底侵犯的疗效。Objective To evaluate the diagnostic value of DWI for the follow-up of nasopharyngeal carcinoma with skull base invasion after treatment. Methods 28 patients of nasopharyngeal carcinoma with skull base invasion were recruited and 34 nidi of the skull base invasion were included in this study,since there were 4 patients with two nidi of different patterns of skull base invasion and 2 patients with different treatment outcomes. First,the patterns of the skull base invasion were assessed by two experienced radiologists,and decisions were made by the consensus when there was a divergence of opinion. And then,the pontine was taken as an internal reference parameter,signal intensity ratio of the skull base to pontine was applied as relative value to quantitatively analyze the serial DWI and conventional MRI before and after treatment. Taking the outcome with nasopharyngeal biopsy and the flow-up of MRI at least 6 months as the main study objectives,the diagnostic performance of the DWI,which were first time confirmed recurrent or evaluated as CR,was evaluated using the receiver operating characteristic（ROC） analysis. The statistical analysis was performed with SPSS 13. 0,and P〈0. 05 was considered statistically significant. Results The patterns of skull base invasion included osteolysis and marrow infiltration. There were 13 nidi of osteolysis with CR（n = 11） and recurrence（n = 2） confirmed by the follow-up. The transformation outcome of osteolysis was fibrosis with different periods. There were 21 nidi of marrow infiltration with CR（n = 21） confirmed by the follow-up,and the transformation outcome of marrow infiltration was yellow marrow. ROC analysis showed that the area under the curve（AUC） and P value of r ADC,△ADC,r ADC combined with r C,r ADC combined with r C and r T1 WI were 0. 344 and 0. 464,0. 109 and 0. 067,1. 000 and 0. 019,1. 000 and 0. 019,respectively. Conclusion Due to the different patterns of skull base invasion for nasopharyngeal carcinoma,the outcomes of CR nidi confirmed by

关 键 词：鼻咽癌 颅底 扩散加权成像 磁共振成像 

分 类 号：R739.6[医药卫生—肿瘤] R445.2[医药卫生—临床医学]