鼻腔鼻窦SMARCB1缺失癌临床及影像学特征  

Clinical and imaging features of the SMARCB1-deficient sinonasal carcinoma

作　　者：闫钟钰[1] 张宗锐[1] 李铮[1] 郭健[1] 王久阳 鲜军舫[1] Yan Zhongyu;Zhang Zongrui;Li Zheng;Guo Jian;Wang Jiuyang;Xian Junfang(Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Pathology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730 [2]首都医科大学附属北京同仁医院病理科,北京100730

出　　处：《中华放射学杂志》2023年第5期498-503,共6页Chinese Journal of Radiology

基　　金：2019SKY影像科研基金(Z-2014-07-1912-09);北京市医院管理中心“登峰”计划专项(DFL20190203)。

摘　　要：目的探讨鼻腔鼻窦SMARCB1缺失癌临床及影像学特征。方法回顾性分析2016年1月至2021年11月首都医科大学附属北京同仁医院经手术病理证实的16例鼻腔鼻窦SMARCB1缺失癌,免疫组化染色均为SMARCB1阴性表达。总结其临床及影像学特点,包括分期、肿瘤位置、大小、CT密度及骨质改变、MRI信号、增强特点、动态增强扫描时间-信号强度曲线(TIC)类型、扩散加权成像(DWI)信号及表观扩散系数(ADC)值,并将14例患者的ADC值与病理Ki-67增殖指数进行Pearson相关性分析。结果16例SMARCB1缺失癌临床分期T_(4)期12例、T_(3)期4例;发生于筛窦4例、鼻腔1例、鼻腔和筛窦8例、筛窦和上颌窦1例、筛窦和额窦1例、筛窦和蝶窦1例;肿瘤最大径(4.5±1.2)cm。CT呈等密度13例,密度不均匀伴局部坏死3例。骨质改变包括13例局限性骨质侵蚀破坏,3例广泛性骨质侵袭破坏。与邻近肌肉相比,16例T_(1)WI均呈等信号,3例局部可见低信号;T_(2)WI呈等信号9例、高信号7例,内部可见条带状低信号6例。MRI轻度强化11例、中等强化5例,不均匀强化6例、均匀强化10例。14例行动态增强扫描,TIC类型Ⅲ型(速升流出型)10例、Ⅱ型(速升平台型)4例。14例ADC值为(1.02±0.27)×10^(-3)mm^(2)/s,Ki-67增殖指数为48%±21%,无明显相关性(r=-0.38,P=0.183)。结论SMARCB1缺失癌发生部位以鼻腔筛窦多见,侵袭性骨质反应,MRI T_(2)WI内部线条状分隔影、轻中度强化、Ⅲ型TIC有一定特征性。Objective To assess the clinical and imaging features of SMARCB1-deficient sinonasal carcinoma.Methods Form January 2016 to November 2021,the clinical data and pretreatment imaging findings of 16 cases with pathologically proven SMARCB1-deficient sinonasal carcinomas were analyzed retrospectively in Beijing Tongren Hospital,Capital Medical University.Immunohistochemistry for SMARCB1 showed loss of the protein in the tumor nuclie.Clinical and imaging features,including tumor location,TNM stage,size,density of CT,bone change,MRI signal intensity,enhancement pattern,type of time-intensity curve(TIC)of dynamic contrast enhanced MRI(DCE-MRI),apparent diffusion coefficient(ADC)value and diffusion weighted imaging(DWI)were evaluated.For 14 cases,correlation of the ADC value and Ki-67 index was subsequently evaluated with Pearson correlation analysis.Results For the 16 cases SMARCB1-deficient sinonasal carcinomas,clinical stage of T_(4)was 12 cases and T_(3)was 4 cases.The location included ethmoid sinus(n=4),nasal cavity only(n=1),both nasal cavity and ethmoid(n=8),ethmoid and maxillary sinus(n=1),ethmoid and frontal sinus(n=1),ethmoid and sphenoid sinus(n=1).The tumor size was(4.5±1.2)cm.Iso-attenuated of CT images was showed in 13 cases and heterogeneous with necrosis was showed in 3 cases.Focal bone erosion was found in 13 cases and extensive bone destruction was found in 3 cases.Compared with adjacent muscles,T_(1)WI of all 16 cases showed isointense,with focal hypointense in 3 cases.On T_(2)WI,the tumor was graded as isointense in 9 cases,hyperintense in 7 cases,with lower inner septal in 6 cases.Enhancement was graded as mild in 11 cases,moderate in 5 cases.MRI Enhancement images showed mild enhancement in 11 cases,moderate enhancement in 5 cases,heterogeneous enhancement in 6 cases,and homogeneous enhancement in 10 cases.For DCE-MRI of 14 cases,there were 10 cases ofⅢtype and 4 cases ofⅡtype of the TIC.The ADC value of 14 cases was(1.02±0.27)×10^(-3)mm^(2)/s.The Ki-67 index was 48%±21%.No correlation was

关 键 词：鼻窦肿瘤 磁共振成像 SMARCB1缺失癌 

分 类 号：R739.62[医药卫生—肿瘤]