CAJ | 학술논문

目的探讨鼻咽癌局部复发患者经鼻内镜手术后颅底骨质MR信号的变化.方法回顾性分析经鼻内镜入路鼻咽切除术的20例复发鼻咽癌患者资料,术前均行放射治疗,放射治疗后复发时间8 ～83个月,平均复发时间(22±17)个月.患者在MR扫描后2周内行鼻咽癌救援术,术后2周、3个月、6个月行MR扫描,以后约每半年MR随访1次,随访时间6～45个月,中位随访时间18个月.术前及术后颅底骨质MR信号的变化及变化趋势采用两独立样本的x2检验进行统计学分析.结果 20例患者共92个部位颅底骨质在术后2周至3个月内出现MRI信号的改变,表现为平扫T1WI上呈低信号,增强扫描中-明显强化.在随访期间内36个部位颅底骨质信号改变逐渐减小或恢复正常,34个部位趋于稳定,22个部位更加明显.毗邻术区(72个部位)较远隔术区(20个部位)的颅底骨质更易出现信号的变化(x2 =33.128,P＜0.01).复发肿瘤同侧(68个部位)较对侧(24个部位)的颅底骨质更易出现信号的变化(x2 =21.182,P＜0.01).结论鼻咽癌救援术后会引起颅底骨质MR信号的改变,而这种信号改变有特定的发生部位,大部分颅底骨质信号的改变会逐渐修复或趋于稳定状态.
목적 탐토비인암국부복발환자경비내경수술후로저골질MR신호적변화.방법 회고성분석경비내경입로비인절제술적20례복발비인암환자자료,술전균행방사치료,방사치료후복발시간8 ～83개월,평균복발시간(22±17)개월.환자재MR소묘후2주내행비인암구원술,술후2주、3개월、6개월행MR소묘,이후약매반년MR수방1차,수방시간6～45개월,중위수방시간18개월.술전급술후로저골질MR신호적변화급변화추세채용량독립양본적x2검험진행통계학분석.결과 20례환자공92개부위로저골질재술후2주지3개월내출현MRI신호적개변,표현위평소T1WI상정저신호,증강소묘중-명현강화.재수방기간내36개부위로저골질신호개변축점감소혹회복정상,34개부위추우은정,22개부위경가명현.비린술구(72개부위)교원격술구(20개부위)적로저골질경역출현신호적변화(x2 =33.128,P＜0.01).복발종류동측(68개부위)교대측(24개부위)적로저골질경역출현신호적변화(x2 =21.182,P＜0.01).결론 비인암구원술후회인기로저골질MR신호적개변,이저충신호개변유특정적발생부위,대부분로저골질신호적개변회축점수복혹추우은정상태.
Objective To evaluate the signal changes of the skull base after salvage surgury via endoscopic transnasal approach for local recurrent nasopharyngeal carcinoma.Methods Twenty patients with nasopharyngeal carcinoma after radiation failure underwent nasophargeryngectomy via an endoscopic transnasal approach were selected from April 2006 to December 2011,including 16 males and 4 females with 31 to 67 years old.Each patient had previously received irradiation and experienced recurrence after 8 to 83 months of completed irradiation.All patients underwent MRI no more than 2 weeks before the salvage surgery and were subjected to repeat MRI scans 2 weeks,3 months,6 months later and semi-annually thereafter,with the follow-up time of 6 to 45 months(median 18 months).A two-sided Chi-square test was used to compare the signal changes and the tendency of changes on all presurgical and postsurgical MR images.Results The MRI signal changes were detected at 92 sites of skull-base between 2 weeks and 3 months after the surgery,which was hypointense on T1 WI with moderate to marked contrast enhancement.In the follow-up period,the signal abnormalities at 36 sites of skull base had resolved or restored to the normal,and 34 sites remained stable,while in 22 sites,the MR signal changes became more obvious.The skull base bones adjacent to the region of the resection were more likely to show signal changes than nonadjacent areas (72 vs.20,x2 =33.128,P ＜0.01).The signal changes were more common on the ipsilateral skull base to the recurrent tumor in contrast to the contralateral skull base (68 vs 24,x2 =21.182,P ＜ 0.01).Conclusions The skull base signal changes after salvage surgury via endoscopic transnasal approach for local recurrent nasopharyngeal carcinoma,and it occurs in specific location.Most of sites tend to resolve or be stable at the follow up.