鼻咽癌局部复发的MRI诊断及误诊漏诊分析  

MRI Diagnosis of Local Recurrent Nasopharyngeal Carcinoma and Analysis of the Misdiagnosis and Missed Diagnosis

作　　者：王志龙[1] 王星蕊 钟柱 肖学红[1] Wang Zhilong;Wang Xingrui;Zhong Zhu;Xiao Xuehong(Department of Medical Imaging Center,Zhongshan Peoples Hospital,Zhongshan,Guangdong 528403)

机构地区：[1]中山市人民医院医学影像中心,广东中山528403

出　　处：《现代医用影像学》2023年第4期595-601,606,共8页Modern Medical Imageology

摘　　要：目的:回顾性分析经病理或MRI与临床随访确诊鼻咽癌局部复发(local recurrent nasopharyngeal carcinoma,LRNPC)的MRI影像特征以及不同资历影像医师的首诊报告,探讨首诊报告的误诊漏诊原因,以期提高诊断。方法:回顾性分析135例经病理或MRI与临床随访确诊LRNPC的MRI影像特征,所有病例常规进行MRI平扫和增强扫描,其中99例行DWI扫描。根据MRI影像特征与低年资、高年资、头颈部亚专科影像医师的首诊报告,采用卡方检验或Fisher确切概率法,统计不同MRI影像特征、不同资历影像医师的诊断表现有无统计学差异,以P值<0.01为差异有统计学意义。结果:LRNPC为鼻咽腔内复发(72)、鼻咽腔外复发(63),表现为单纯黏膜型(26)、浸润肿块型(109),后者分为实性肿块(92),囊实性肿块(9),囊性肿块(8)。首诊报告正确诊断(84)、误诊(8)、漏诊(24),19例由于在MRI检查前经鼻咽镜病理活检确诊不计在内,误诊漏诊率27.6%(32/116)。MRI影像特征包括复发肿瘤大小、腔内或腔外复发、是否伴有治疗后改变(posttreatment changes,PTC),以及不同资历影像医师的诊断表现有显著统计学差异,P值均小于0.01。结论:LRNPC的MRI影像特征多变,误诊漏诊的主要原因为复发肿瘤小、腔外复发、伴有PTC,以及影像医师未充分认识其MRI影像特征。充分认识LRNPC的MRI影像特征,经验丰富的影像医师,可做出正确诊断。Objective:To evaluate MRI imaging characteristics and the initial diagnosis with various seniority radiologists of local recurrent nasopharyngeal carcinoma(LRNPC),to analyze causes of misdiagnosis and missed diagnosis,in order to improve the diagnosis.Methods:To retrospectively analyze the imaging findings of LRNPC confirmed by pathology or by the outcome of clinical and MRI fllow-up.conventional MRIexaminations including plan scan and Gd-DTPA enhancement in all the cases,and 99 cases were scanned with DWI.Based on the MRI imaging characteristics of LRNPC and the initial diagnosis with junior,senior and head and neck subspecialty radiologists,statistical analysis was performed with the chi-square test or Fisher exact probability test to evaluate the diagnostic performance with various MRI characteristics and various seniority radiologists,and regard as statistical difference with the P value less than 0.01.Results:LRNPC showed as intracavitary recurrence in 72 cases and extracavitary recurrence in 63 cases,also showed as exclusive involvement of the nasopharyngeal mucosa in 26 cases and infiltrative mass in 109 cases,the latter showed as solid mass in 92 cases,mixed cystic and solid mass in 9 cases,cystic mass in 8 cases.The initial diagnosis was correct in 84 cases,and misdiagnosis in 8 cases,missed diagnosis in 24 cases,19 cases were excluded which were comfirmed by pathological biopsy with nasopharyngoscopy before the MRI examination,and the rate of overall misdiagnosis and missed diagnosis was 27.6%(32/116).There were statistical difference among the diagnostic performance of MRI characteristics included the size of local recurrence,intracavitary or extracavitary relapse,local recurrence accompanied with posttreatment changes or not,and various seniority radiologists,and all the P value less than O.O1.Conclusion:The MRI characteristics of LRNPC is various,the major causes of misdiagnosis and missed diagnosis as followed:LRNPC was tiny,extracavitary,accompanied with posttreatment changes,and the radiologist in

关 键 词：鼻咽癌 局部复发 磁共振成像 误诊 漏诊 

分 类 号：R73[医药卫生—肿瘤]