CT and MRI signs and diagnostic value of skull base bone invasion in nasopharyngeal carcinoma
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摘要:
目的 探讨鼻咽癌颅底骨质侵犯的CT与MRI征象及其诊断价值。 方法 选取2018年4月~2022年7月我院收治的130例鼻咽癌患者作为研究对象。均采用CT及MRI进行检查。统计病理结果,以定性诊断为金标准,记录CT、MRI对颅底骨质侵犯的诊断结果,采用ROC曲线分析CT及MRI检查对鼻咽癌颅底骨质侵犯的诊断价值。 结果 130例患者经病理活检显示均为鳞状细胞癌,其中有88例分化性非角化型鳞癌,13例分化性角化型鳞癌,29例未分化性鳞癌。定性诊断共检出颅底骨质侵犯98例,检出率为75.38%,CT检查共检出颅底骨质侵犯80例,检出率为61.54%,MRI检查共检出颅底骨质侵犯97例,检出率为74.62%,MRI检查检出率高于CT检查(P < 0.05)。MRI检查对鼻咽癌颅底骨质侵犯的诊断敏感度、特异度、准确度分别为95.92%、90.62%、94.62%,均高于CT检查的76.53%、84.37%、78.46%(P < 0.05)。 结论 相比于CT检查,MRI检查对鼻咽癌颅底骨质侵犯的检出率更高,具有较高诊断价值。 Abstract:Objective To explore the CT and MRI signs and value of diagnostic in skull base bone invasion in nasopharyngeal carcinoma. Methods A total of 130 patients with nasopharyngeal carcinoma treated in our hospital from April 2018 to July 2022 were selected as the research subjects. All patients were performed with CT and MRI. The pathological results were counted, qualitative diagnosis was taken as the gold standard, the diagnostic results of CT and MRI for skull base bone invasion were recorded. ROC curve was used to analyze the diagnostic value of CT and MRI for skull base bone invasion of nasopharyngeal carcinoma. Results All 130 patients had squamous cell carcinoma by biopsy, including 88 cases of differentiated non keratinized squamous cell carcinoma, 13 cases of differentiated keratinized squamous cell carcinoma, and 29 cases of undifferentiated squamous cell carcinoma. A total of 98 cases of skull base bone invasion were detected by qualitative diagnosis, with a detection rate of 75.38%. 80 cases of skull base bone invasion were detected by CT, with a detection rate of 61.54%. 97 cases of skull base bone invasion were detected by MRI, with a detection rate of 74.62%. The detection rate of MRI examination was higher than that of CT examination (P < 0.05). The diagnostic sensitivity, specificity and accuracy of MRI examination for skull base bone invasion of nasopharyngeal carcinoma were 95.92%, 90.62%, 94.62%, respectively, which were higher than 76.53%, 84.37%, 78.46% of CT examination (P < 0.05). Conclusion Compared with the CT examination, MRI examination has a higher detection rate of skull base bone invasion in nasopharyngeal carcinoma, which has higher diagnostic value. -
图 2 患者1影像学表现
Figure 2. Image findings of patient 1. A: On T1WI, irregular mixed slightly long T1 slightly signal and unclear boundary could be seen in the posterior wall of nasopharynx, bilateral nasal cavity, right maxillary sinus, bilateral ethmoid sinus and sphenoid sinus; B: T1 enhanced showed uneven enhancement of the lesion; C-D: CT examination found that the right maxillary sinus peripheral wall, sphenoid sinus, ethmoid sinus and medial orbital wall were damaged and invaded.
图 3 患者2影像学表现
Figure 3. Image findings of patient 2. A-B: On CT, soft tissue density shadow could be seen in the left nasopharyngeal cavity, left maxillary sinus and sphenoid sinus, the boundary between the lesion and adjacent bone was unclear, and adjacent bone continuity was interrupted; C-D: On T2WI, irregular mixed slightly long T2 signals could be seen in the left nasopharynx cavity, left maxillary sinus and sphenoid sinus, the boundary was unclear, and the enhancement scan showed obvious uneven enhancement.
表 1 CT对颅底骨质侵犯的诊断结果
Table 1. Diagnostic results of CT for skull base bone invasion (n)
CT examination Qualitative diagnosis Total Positive Negative Positive 75 5 80 Negative 23 27 50 Total 98 32 130 表 2 MRI对颅底骨质侵犯的诊断结果
Table 2. Diagnostic results of MRI for skull base bone invasion (n)
MRI examination Qualitative diagnosis Total Positive Negative Positive 94 3 97 Negative 4 29 33 Total 98 32 130 表 3 CT、MRI检查对鼻咽癌颅底骨质侵犯的诊断价值分析
Table 3. Analysis of diagnostic value of CT and MRI examination for skull base bone invasion in nasopharyngeal carcinoma
Examination AUC 95% CI Sensitivity(%) Specificity(%) Accuracy(%) CT 0.805 0.726-0.869 76.53 84.37 78.46 MRI 0.933* 0.875-0.969 95.92* 90.62* 94.62* *P < 0.05 vs CT examination. -
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