多模态磁共振技术在颈部淋巴结定性诊断中的临床应用研究
摘要
<正>在淋巴系统中,引流丰富的颈部淋巴结约占全身淋巴结1/3~([1])。临床扪诊淋巴结肿大较为常见,是炎症、结核、淋巴瘤和转移癌等良恶性疾病的表现之一。临床上,对良恶性病变性质的判定是制定治疗计划和判断预后的基础,而准确地评价淋巴结是其关键所在。根据欧洲放射肿瘤协会(ESTRO)和肿瘤放射治疗协助组(RTOG)等多个协作小组提出2013版头颈部肿瘤颈部淋巴结分区指南(简称2013版颈部淋巴结分区指南)~([2]),不同分区颈部淋巴结对转移性肿瘤的判断以及治疗方案有重要的参考价值。国内外文献报道对淋巴结的大小对淋巴结病变的性质判断存在一定争议,直径8～15mm为分界均有提倡,而有的淋巴结很小,但其内信号发生改变,
引文
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[19]Kvistad KA,Rydland J,Smethurst HB,et al.Axilary lymph node metastases in breast cancer:preoperative detection with dynamic contrast-enhanced MRI[J].Eur Radiol,2000,10(9):1464-1471.
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[22]Liu Y,Cao L,Hillengass J,et al.Quantitative assessment of micro-circulation and diffusion in the bone marrow of osteoporotic rats using VCT,DCE-MRI,DW-MRI,and histology[J].Acta Radiol,2013,54(2):205-213.
[23]Breault SR,Heye T,Bashir MR,et al.Quantitative dynamic contrast-enhanced MRI of pelvic and lumbar bone marrow:effect of age and marrow fat content on pharmacokinetic parameter values[J],AJR,2013,200(3):297-303.
[2]Gregoire V,Ang K,Budach W,et al.Delineation of the neck node levels for head and neck tumors:a 2013 update.DAHANCA,E-ORTC,HKNPCSG,NCIC CTG,NCRI,RTOG,TROG consensus guidelines[J].Radiother Oncol,2014,110(1):172-181.
[3]李琳,罗德红,葛江梅,等.头颈部不同原发肿瘤颈部淋巴结转移的CT表现[J].临床放射学杂志,2005,24(2):116-120.
[4]Mancuso AA,Harnsberger HR,Muraki AS,et al.Computed tomography of cervical and ratropharyngeal lymphnodes:normal anatomy,variants of normal,and application in staging head and neck cancer.Part I:pathology[J].Radiology,1983,148(3):715-723.
[5]Steinkamp HJ,Cornehl M,Hosten N,et al.Cervical lymphadenopathy:ratio of long to short axis diameter as a predictor of malignancy[J].Br J Radiol,1995,68(807):266-270.
[6]Van den Brekel MW,Stel HV,Castelijns JA,et al.Cervical lymph node metastasis:assessment of radiologic criteria[J].Radiology,1990,177(2):379-384.
[7]Abdel-Razek AA,Soliman NY,Elkhamary S,et al.Role of diffusion weighted MR imaging in cervical lymphadenopathy[J].Eur Radiol,2006,16(7):1468-1477.
[8]Le Bihan D.Diffusion/perfusion MR imaging of the brain:from structure to function[J].Radiology,1990,177(2):328-329.
[9]Lu JC,Wei BQ,Chen WZ,et al.Staging of nasopharyngeal carcinoma investigated by magnetic resonance imaging[J].Radiother Oncol,2006,79(1):21-26.
[10]Lu XB,Wang L,Wang JX,et al.Application of serum protein fingerprint model in diagnosis of thyroid cancer[J].Chin J Exper Surg,2008,23(6):703-705.
[11]Ryu OH,Atkinson JC,Hoehn GT,et al.Identification of parotid salivary biomarkersin Sjogren′s syndrome by surface-enhanced laser desorption/ionization time-of-flight mass specrometry and two-dimen-sional difference gelelectrophoresis[J].Rheumatology(Oxford),2008,45(9):1077-1086.
[12]高光锋.颈部良恶性淋巴结的弥散加权成像研究[J].实用放射学杂志,2011,27(7):996-1001.
[13]Wu ZZ,Wang JG,Zhang XL.Diagnostic model of saliva protein finger print analysis of patents with gastric cancer[J].World JGastroenterol,2009,15(7):865-870.
[14]Loeffelbein DG,Kesting,MR,Mielke E,et al.Image fusion of bone SPECT and CTA specific diagnostic method in oral and maxillofacial surgery[J].Mund Kiefer Gesichtschir,2007,11(1):33-41.
[15]Cooper JS,Cohen R,Stevens RE.A comparison of staging systems for nasopharyngeal carcinoma[J].Cancer,2008,83:213-219.
[16]Lee AW,Foo W,Law SC,et al.Staging of nasopharyngeal carcinoma:from Ho to the new UICC system[J].Int J Cancer,2009,84:179-187.
[17]郝彩仙,刘筠,钟进,等.MRI在良恶性淋巴结病变诊断及疗效评估中的应用[J].实用放射性杂志,2014,30(10):1706-1709.
[18]Ma J,Mai HQ,Hong MH,et al.Is the 1997 UICC/AJCC staging system for nasopharyngeal carcinoma prognostically useful for Chinese patient populations[J].Int J Radiat Oncol Biol Phys,2007,50(5):1181-1189.
[19]Kvistad KA,Rydland J,Smethurst HB,et al.Axilary lymph node metastases in breast cancer:preoperative detection with dynamic contrast-enhanced MRI[J].Eur Radiol,2000,10(9):1464-1471.
[20]O′Connor JP,Jackson A,Parker GJ,et al.DCE-MRI biomarkers in the clinical evaluation of antiangiogenic and vascular disrupting agents[J].Br J Cancer,2007,96(2):189-195.
[21]Sourbron SP,Buckley DL.Classic models for dynamiccontrastenhanced MRI[J].NMR Biomed,2013,26(8):1004-1027.
[22]Liu Y,Cao L,Hillengass J,et al.Quantitative assessment of micro-circulation and diffusion in the bone marrow of osteoporotic rats using VCT,DCE-MRI,DW-MRI,and histology[J].Acta Radiol,2013,54(2):205-213.
[23]Breault SR,Heye T,Bashir MR,et al.Quantitative dynamic contrast-enhanced MRI of pelvic and lumbar bone marrow:effect of age and marrow fat content on pharmacokinetic parameter values[J],AJR,2013,200(3):297-303.