中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
47期
3779-3782
,共4页
田丽%莫运仙%李贻卓%刘立志%樊卫
田麗%莫運仙%李貽卓%劉立誌%樊衛
전려%막운선%리이탁%류립지%번위
鼻咽癌%鼻窦%侵犯%磁共振
鼻嚥癌%鼻竇%侵犯%磁共振
비인암%비두%침범%자공진
Nasopharyngeal carcinoma%Paranasal sinus%Invasion%Magnetic resonance imaging
目的 分析182例鼻咽癌鼻窦侵犯的磁共振征象,提高对鼻咽癌鼻窦侵犯的MRI诊断认识.方法 回顾性分析中山大学肿瘤防治中心2003年1月至2004年12月182例鼻咽癌鼻窦侵犯患者的磁共振资料.结果 182例患者发生鼻窦侵犯,其中蝶窦侵犯的发生率最高.鼻咽癌鼻窦侵犯的主要磁共振征象包括:鼻窦窦壁破坏182例(100％)、鼻窦黏膜不均匀增厚174例(95.6％)、鼻窦腔内肿块与鼻咽原发肿瘤相连103例(56.6％),上述病灶T1WI平扫呈等或稍低信号,T2WI平扫呈等或稍高信号,增强扫描较明显不均匀强化,与鼻咽原发肿瘤的平扫信号和强化方式一致.141例(77.5％)合并鼻窦腔大量积液.T2加权序列鼻窦炎症增厚的黏膜和积液呈明显高信号,增强扫描炎症增厚的黏膜呈薄线样/环形强化;而窦腔肿瘤组织T2 WI呈等或稍高信号,增强扫描明显不均匀强化.横断位T1平扫、T2平扫、T1增强扫描序列对于上颌窦、筛窦侵犯的检出率分别为88.4％、77.9％、96.5％和65.8％、73.7％、94.7％,T1增强扫描对于上颌窦、筛窦侵犯的检出率明显高于横断位T1、T2平扫(P＜0.05);矢状位T1增强扫描可检出100％的蝶窦侵犯.结论 MR多方位平扫及增强扫描能够提高鼻咽癌侵犯鼻窦的诊断率.鼻咽癌侵犯鼻窦的磁共振征象为:(1)鼻窦的窦壁破坏;(2)鼻窦的窦壁黏膜不均匀增厚;(3)鼻窦腔内肿块与鼻咽原发肿瘤相连,或伴有窦腔内大量积液.T2加权序列和增强扫描序列有助于鉴别鼻窦炎症和肿瘤侵犯.横断位T1增强扫描为显示上颌窦和筛窦侵犯的最佳序列,矢状位T1增强扫描为显示蝶窦侵犯的最佳序列.
目的 分析182例鼻嚥癌鼻竇侵犯的磁共振徵象,提高對鼻嚥癌鼻竇侵犯的MRI診斷認識.方法 迴顧性分析中山大學腫瘤防治中心2003年1月至2004年12月182例鼻嚥癌鼻竇侵犯患者的磁共振資料.結果 182例患者髮生鼻竇侵犯,其中蝶竇侵犯的髮生率最高.鼻嚥癌鼻竇侵犯的主要磁共振徵象包括:鼻竇竇壁破壞182例(100％)、鼻竇黏膜不均勻增厚174例(95.6％)、鼻竇腔內腫塊與鼻嚥原髮腫瘤相連103例(56.6％),上述病竈T1WI平掃呈等或稍低信號,T2WI平掃呈等或稍高信號,增彊掃描較明顯不均勻彊化,與鼻嚥原髮腫瘤的平掃信號和彊化方式一緻.141例(77.5％)閤併鼻竇腔大量積液.T2加權序列鼻竇炎癥增厚的黏膜和積液呈明顯高信號,增彊掃描炎癥增厚的黏膜呈薄線樣/環形彊化;而竇腔腫瘤組織T2 WI呈等或稍高信號,增彊掃描明顯不均勻彊化.橫斷位T1平掃、T2平掃、T1增彊掃描序列對于上頜竇、篩竇侵犯的檢齣率分彆為88.4％、77.9％、96.5％和65.8％、73.7％、94.7％,T1增彊掃描對于上頜竇、篩竇侵犯的檢齣率明顯高于橫斷位T1、T2平掃(P＜0.05);矢狀位T1增彊掃描可檢齣100％的蝶竇侵犯.結論 MR多方位平掃及增彊掃描能夠提高鼻嚥癌侵犯鼻竇的診斷率.鼻嚥癌侵犯鼻竇的磁共振徵象為:(1)鼻竇的竇壁破壞;(2)鼻竇的竇壁黏膜不均勻增厚;(3)鼻竇腔內腫塊與鼻嚥原髮腫瘤相連,或伴有竇腔內大量積液.T2加權序列和增彊掃描序列有助于鑒彆鼻竇炎癥和腫瘤侵犯.橫斷位T1增彊掃描為顯示上頜竇和篩竇侵犯的最佳序列,矢狀位T1增彊掃描為顯示蝶竇侵犯的最佳序列.
목적 분석182례비인암비두침범적자공진정상,제고대비인암비두침범적MRI진단인식.방법 회고성분석중산대학종류방치중심2003년1월지2004년12월182례비인암비두침범환자적자공진자료.결과 182례환자발생비두침범,기중접두침범적발생솔최고.비인암비두침범적주요자공진정상포괄:비두두벽파배182례(100％)、비두점막불균균증후174례(95.6％)、비두강내종괴여비인원발종류상련103례(56.6％),상술병조T1WI평소정등혹초저신호,T2WI평소정등혹초고신호,증강소묘교명현불균균강화,여비인원발종류적평소신호화강화방식일치.141례(77.5％)합병비두강대량적액.T2가권서렬비두염증증후적점막화적액정명현고신호,증강소묘염증증후적점막정박선양/배형강화;이두강종류조직T2 WI정등혹초고신호,증강소묘명현불균균강화.횡단위T1평소、T2평소、T1증강소묘서렬대우상합두、사두침범적검출솔분별위88.4％、77.9％、96.5％화65.8％、73.7％、94.7％,T1증강소묘대우상합두、사두침범적검출솔명현고우횡단위T1、T2평소(P＜0.05);시상위T1증강소묘가검출100％적접두침범.결론 MR다방위평소급증강소묘능구제고비인암침범비두적진단솔.비인암침범비두적자공진정상위:(1)비두적두벽파배;(2)비두적두벽점막불균균증후;(3)비두강내종괴여비인원발종류상련,혹반유두강내대량적액.T2가권서렬화증강소묘서렬유조우감별비두염증화종류침범.횡단위T1증강소묘위현시상합두화사두침범적최가서렬,시상위T1증강소묘위현시접두침범적최가서렬.
Objective The aim of the study was to analyze the nuclear magnetic resonance image (MRI) findings for invasion of paranasal sinuses in patients with nasopharyngeal carcinoma (NPC) and to improve the understanding of its MRI diagnosis.Methods The MRI data of 182 patients with nasopharyngeal carcinoma and paranasal sinus invasion were retrospectively analyzed.Results One hundred and eigty-two patients developed paranasal sinus invasion,of which,the incidence of sphenoid sinus invasion was highest.The MRI findings of paranasal sinus invasion of patients with NPC were as follows:100％,95.6％ and 56.6％ patients revealed damage of sinus wall,uneven thickening of mucosa,masses of the sinus cavity connected with the primary tumor of nasopharynx,and all the lesions presented iso-or slightly hypo-intense signal on T1WI and iso-or slightly hyper-intense signal on T2 WI and significantly heterogeneous enhancement after contrast administration,which were consistent with the primary tumor of the nasopharynx regarding to the signal intensity and reinforcement schedule.77.5％ patients presented massive sinus cavity effusion.T2-weighted images are excellent in differentiating high signal intensity thickened mucosa or retained secretions from relatively lower signal intensity tumor.In contrast-enhanced MRI,tumor with solid enhancement can be differentiated from thickened mucosa related to inflammation with a thin superficial enhancement.96.5％ and 94.7％ patients with maxillary sinus invasion and ethmoid sinus invasion were detected with the contrast enhanced axial T1-weighted MR imaging respectively,which were higher than those with the non-enhanced axial T1 and T2 imaging (88.4％ and 77.9％ for maxillary sinus invasion;65.8％ and 73.7％ for ethmoid sinus invasion),the differences were statistically significant (P ＜0.05 for all comparison).All patients with sphenoid sinus invasion were detected with the contrast enhanced sagittal T1-weighted MR imaging.Conclusion Multiplanner MR scan and enhanced scan can improve the diagnosis of nvasion of paranasal sinuses in patients with NPC.The MRI findings of patients with NPC with paranasal sinus invasion include sinus wall damage; unevenly thickening mucous membrane of sinuses; tumors in sinus cavity connective with the primary tumor of nasopharynx,or with massive sinus cavity effusion.The T2-weighted sequence and contrast enhanced sequence are conducive to differential diagnosis of inflammatory changes from neoplastic tissues.The enhanced axial T1-weighted section and the enhanced sagittal T1weighted section are most helpful to detection of maxillary sinus,ethmoid sinus invasion and spheuoid sinus invasion,respectively.
