增强CT和MRI在鉴别鼻腔鼻窦鳞状细胞癌与淋巴瘤中的应用  

Contrast⁃enhanced CT and MRI in differentiating squamous cell carcinoma of the nasal cavity and sinuses from lymphoma

作　　者：陈海静 杨亚英[1] 赵卫[1] 胡继红[1] 吴莉[1] 郑凌琳 吴岩[1] 李青青[1] CHEN Haijing;YANG Yaying;ZHAO Wei;HU Jihong;WU Li;ZHENG Linglin;WU Yan;LI Qingqing(Department of Radiology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,昆明650032

出　　处：《实用医学杂志》2024年第3期394-399,共6页The Journal of Practical Medicine

基　　金：云南省放射与治疗临床医学研究中心专项基金子课题资助项目(编号:202102AA100067);云南省科技厅科技计划基金资助项目(编号:202101AY070001-103)。

摘　　要：目的探讨鼻腔鼻窦鳞状细胞癌(SCC)和淋巴瘤(NHL)的增强CT和MRI影像特征,分析不同影像特征鉴别鼻腔鼻窦SCC与NHL的效能。方法回顾性分析行鼻窦增强CT和增强MRI检查并经手术病理证实的67例鼻腔鼻窦SCC及NHL患者的影像学及临床、病理资料,分析肿瘤起源部位、最大径、CT密度、MRI信号强度、增强强化程度、肿瘤内部坏死、邻近骨质破坏、对周围组织的侵犯、扫描范围内颈部淋巴结转移情况等影像特征,采用受试者操作特征(ROC)曲线及曲线下面积(AUC)分析不同影像学特征鉴别鼻腔鼻窦SCC和NHL的效能。结果鼻腔鼻窦SCC与NHL的肿瘤起源部位、最大径、肿瘤内部坏死、周围骨质破坏以及周围组织侵犯5个影像学特征组间差异有统计学意义(P<0.05),鉴别SCC与NHL的AUC分别为0.708、0.694、0.785、0.850、0.629。联合肿瘤起源部位、肿瘤内部坏死、周围骨质破坏3个影像特征鉴别SCC与NHL的AUC为0.969,灵敏度及特异度分别为83.9%及97.2%。结论肿瘤起源部位、最大径、肿瘤内部坏死、骨质破坏及周围组织侵犯的增强CT及MRI影像征象有助于鼻腔鼻窦SCC与NHL的鉴别,尤其是出现肿瘤起源于鼻腔、坏死少见、骨质破坏轻微,应优先考虑鼻腔鼻窦NHL的可能。增强CT和MRI有助于鼻腔鼻窦SCC与NHL的鉴别,联合使用有助于提高鉴别诊断效能。Objective To investigate the enhanced CT and MRI imaging features of nasal sinus squamous cell carcinoma(SCC)and lymphoma(NHL),and to analyze the efficacy of different imaging features in differentiating nasal sinus SCC from NHL.Methods The imaging,clinical and pathological data of 67 patients with sinus SCC and NHL who underwent sinus CT and MRI with contrast CT and MRI in our hospital and confirmed by surgical pathology were retrospectively analyzed,and the tumor origin,maximum diameter,CT density,MRI signal intensity,enhancement degree,tumor internal necrosis,adjacent bone destruction,invasion of surrounding tissues,and The imaging features such as cervical lymph node metastasis within the scanning range were analyzed,and the receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the efficacy of different imaging features to distinguish nasal sinus SCC and NHL.Results There were statistically significant differences between the five imaging features of nasal sinus SCC and NHL,including tumor origin,maximum diameter,internal tumor necrosis,surrounding bone destruction and peripheral tissue invasion(P<0.05),and the AUC of differentiating SCC and NHL were 0.708,0.694,0.785,0.850 and 0.629,respectively.The AUC of SCC and NHL was 0.969,and the sensitivity and specificity were 83.9%and 97.2%,respectively.Conclusion On contrast⁃enhanced CT and MRI,the imaging signs of tumor origin,maximum diameter,tumor internal necrosis,bone destruction and surrounding tissue invasion are helpful to distinguish nasal sinus SCC from NHL,especially if the tumor originates in the nasal cavity,necrosis is rare,bone destruction is mild,and the possibility of nasal sinus NHL should be given priority.Contrast⁃enhanced CT and MRI can help differentiate nasal sinus SCC from NHL,and the combination can help improve differential diagnostic performance.

关 键 词：鼻腔鼻窦 淋巴瘤 鳞状细胞癌 影像特征 鉴别诊断 

分 类 号：R445[医药卫生—影像医学与核医学]