MRI对鼻咽癌放疗后改变的影像价值研究
摘要
目的:探讨磁共振成像对鼻咽癌放射治疗后改变的影像诊断价值,尤其是放疗后复发的诊断及鉴别诊断。方法:收集新疆肿瘤医院2006年1月-2009年10月经病理证实的鼻咽癌病例67例,其中39例行弥散加权像(DWI)扫描。所有病例均行放射治疗、有完整MR复查资料,分析其放疗后不同情况下的MRI表现,及MRI对复发或残留的检出,并进一步利用弥散加权像测定的ADC值来研究放疗后复发与纤维化及残留的鉴别。结果:①MRI基本能反应放疗后咽壁不同变化情况;②MR最初对复发或残留的检出,敏感性85.00%,特异性91.49%,准确性89.55%;③放疗后鼻咽纤维化者ADC值较复发者及残留者明显高(P<0.05),而复发者咽后淋巴结ADC值较纤维化者及残留者明显低(P<0.05)。结论:MRI能清晰地显示鼻咽癌放疗后变化情况,并且对复发的检出准确性较高,放疗后纤维化、残留及复发者ADC值的不同或许为鉴别诊断提供一定参考价值,MRI对放射治疗鼻咽癌的效果评价至关重要。
Objective: To analyze Magnetic Resonance Imaging (MRI) features and value of naso- pharyngeal carcinoma (NPC) after radiotherapy, and to investigate the values of MRI in differential diagnosis between local recur in post radiotherapy and local radio- fibrosis. Methods: MR scans of 67 patients with proven histological nasopharyngeal carcinoma who were treated mainly with radiation therapy in our hospital from Jan 2006 to Oct 2009 with intact imaging files were analyzed, 39 of 67 patients were scanned with DWI. The tumors’response to the radiation therapy on the follow-up scans was analyzed. And MRI in the differential diagnosis of local recurrence and post radiation fibrosis and residue in NPC was evaluated. Results:①MRI could reflect the shifts of nasopharynx after radio- therapy;②The sensitivity, specificity and accuracy of MRI evaluation in the diagnosis of residue or local recurrence of NPC after radiotherapy, were 85.00%, 91.49%, 89.55%;③The mean apparent diffusion coefficient(ADC) values of NPC in fibrosis after radio- therapy were higher than in local recurrences or residues, but the mean ADC values of retropharyngeal lymph nodes were lower in recurrences of NPC. Conclusion: MRI possesses the obvious advantages in nasopharyngeal carcinoma post-radiotherapy follow up. The accuracy of MRI image evaluation in the diagnosis of recurrence or residue of NPC after radiotherapy is relatively higher. The ADC value may be helpful for the differential diagnosis of post- radiotherapy local recur patients and local fibrosis patients in NPC.
Objective: To analyze Magnetic Resonance Imaging (MRI) features and value of naso- pharyngeal carcinoma (NPC) after radiotherapy, and to investigate the values of MRI in differential diagnosis between local recur in post radiotherapy and local radio- fibrosis. Methods: MR scans of 67 patients with proven histological nasopharyngeal carcinoma who were treated mainly with radiation therapy in our hospital from Jan 2006 to Oct 2009 with intact imaging files were analyzed, 39 of 67 patients were scanned with DWI. The tumors’response to the radiation therapy on the follow-up scans was analyzed. And MRI in the differential diagnosis of local recurrence and post radiation fibrosis and residue in NPC was evaluated. Results:①MRI could reflect the shifts of nasopharynx after radio- therapy;②The sensitivity, specificity and accuracy of MRI evaluation in the diagnosis of residue or local recurrence of NPC after radiotherapy, were 85.00%, 91.49%, 89.55%;③The mean apparent diffusion coefficient(ADC) values of NPC in fibrosis after radio- therapy were higher than in local recurrences or residues, but the mean ADC values of retropharyngeal lymph nodes were lower in recurrences of NPC. Conclusion: MRI possesses the obvious advantages in nasopharyngeal carcinoma post-radiotherapy follow up. The accuracy of MRI image evaluation in the diagnosis of recurrence or residue of NPC after radiotherapy is relatively higher. The ADC value may be helpful for the differential diagnosis of post- radiotherapy local recur patients and local fibrosis patients in NPC.
引文
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[3] Abrigo JM, King AD, Leung SF, et al. MRI of radiation-induced tumors of the head and neck in post-radiation nasopharyngeal carcinoma [J]. Eur Radiol, 2009 ,19(5):1197-1205.
[4]李继轩,杜日昌.鼻咽癌的CT和MRI影像分析对比[J].临床医学,2005,25(5):67-68.
[5] Kwong DL, Sham JS, Leung LH, et al. Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma [J]. Int J Radiat Oncol Biol Phys, 2006, 64(2): 374-381.
[6]黄国森,胡学锋,高明勇,等.鼻咽癌颅底侵犯的临床及影像学分析[J].国际肿瘤学杂志,2006,33(4): 304-306.
[7]谢传淼,梁碧玲,林浩皋,等. MRI对鼻咽癌T、N分期的影响[J].中华肿瘤杂志,2002,24(2):181-184.
[8] King AD,Teo P,Lam WW,et al. Paranasopharyngeal space involvement in nasopharyngeal cancer:detection by CT and MRI [J]. Clin Oncol(R Coll Radiol),2000,12(6):397-402.
[9] Glastonbury CM. Nasopharyngeal carcinoma:the role of magnetic resonance imaging in diagnosis,staging,treatment,and follow-up [J]. Top Magn Reson Imaging,2007,18 (4):225-235.
[10]戴军进,樊卫,王国慧,等. 18F- FDG PET/CT显像对鼻咽癌放疗后复发早期诊断的临床价值[J].现代医学仪器与应用,2008,20(1):12-14.
[11] Evans ES, Hahn CA, Kocak Z, et al. The role of functional imaging in the diagnosis and management of late normal tissue injury [J]. Semin Radiat Oncol, 2007, 17(2): 72-80.
[12]周洁瑕,王红霞.鼻咽癌及鼻咽癌放疗后复发的CT表现[J].江苏医药,2005,31,11:880.
[13]吴沛宏,李贻卓,黄金华,等.鼻咽癌放疗后局部复发和纤维变的动态CT增强特征[J].中华肿瘤杂志,1999,21,2:131-133.
[14]辛棣,黄伟荧.早期鼻咽癌放疗前后的CT评价[J].长江大学学报(自然科学版),2009,6(2):150-151.
[15]王立侠,周纯武,连世东,等.鼻咽癌的MRI表现-附180例病例分析[J].中国医学影像技术,2006,22(6):854-857.
[16]张成祥,柏会明,仇红艳,等.化疗配合放疗治疗中晚期鼻咽癌的近期疗效分析[J].临床和实验医学杂志,2008, 7(1): 48-49.
[17]崔巍,张芹.鼻咽癌放疗后CT征象的变化[J].临床医药实践杂志,2008,17(9B):859-861.
[18] Kim YI. Han MH. Cha SH,et al. Nasopharyngeal carcinoma: post treatment changes of imaging findings [J]. American Journal of Otolaryngology. 2003,24(4):224-230.
[19] Fee, Willard E,Moir, et al. Nasopharyngectomy for Recurrent Nasopharyngeal Cancer: A 2- to 17-Year Follow-up [J]. Archives of Otolaryngology -- Head & Neck Surgery, 2002, 128(3):280-284.
[20] King AD, Ahuja AT, Yeung DK,et al. Delayed complications of radiotherapy treatment for nasopharyngeal carcinoma: imaging findings [J]. Clinical Radiology, 2007, 62(3):195-203.
[21] Danesi, Giovanni, Zanoletti, et al. Salvage Surgery for Recurrent Nasopharyngeal Carcinoma [J]. Skull Base: An Interdisciplinary Approach, 2007, 17(3):173-180.
[22] Chong VFH, Fan YF. Detection of recurrent nasopharyngeal carcinoma. CT vs MR imaging [J]. Radiology, 1997, 202:453-470.
[23] M.Comoretto, L.Balestreri, E.Borsatti, et al. Detection and restaging of residual and/or recurrent nasopharyngeal carcinoma after chemotherapy and radiation therapy: comparison of MR imaging and FDG PET/CT [J]. Radiology, 2008, 49(1):203-211.
[24]刘丽东,苏丹柯,金观桥,等.鼻咽癌多层螺旋CT灌注参数阈值及其诊断价值研究[J].实用放射学杂志,2008,24(3):299-302.
[25]吴佳兴,洪振芳,蔡玉真,等.并有庞大颈部淋巴结转移的鼻咽癌病人以MRI及临床触诊作N分期的比较[J].放射治疗与肿瘤学, 2008,15 (3) :189-199.
[26]王远飞,王根和,杨春晖,等.鼻咽癌放疗后复发转移39例临床分析[J].实用医院临床杂志,2006,3(4):39-41.
[27]钟毓,黎静.复发鼻咽癌的诊断研究进展[J].临床影像技术,2009,24(6):122-125.
[28]何涌,刘美莲,邱维加.鼻咽癌放射治疗后MR I检查的价值[J].广西医学,2008,30(7):991-992.
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