Investigation of MRI Imaging in Nasopharyngeal Carcinoma Staging，Diagnosis and Treatment Advantages
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摘要: 目的 探讨鼻咽癌1992年福州分期和2008年分期差异、CT和MRI对鼻咽癌病变的检出率和原发肿瘤靶区(GTV）勾画和体积计算的影响。方法 收集89例初治鼻咽癌患者的CT和MRI图像，分别按1992年福州分期和2008年分期标准进行，比较两种检查手段对各解剖部位的检出差异，挑选出CT与MRI检出有差异的39例，在TPS下进行GTV勾画及体积计算。结果 MRI在1992年福州分期中的参与使早期(T1+T2）构成比降低，晚期(T3+T4）构成比升高。鼻咽癌2008年分期使T3 、T4期患者增多。两种分期标准对T2、T3分期差异有统计学意义(P=0.033，0.008)；在N1、N2的判断中，差异有统计学意义(P<0.05)。MRI较CT对头长肌、咽旁间隙、海绵窦、副鼻窦及颅神经的检出率明显提高；在对咽后淋巴结及颈部肿大淋巴结的形态、包膜、坏死、融合的显示方面明显优于CT。对39例CT和MRI成像有差异的病例进行靶区勾画，结果显示GTVMRI>GTVCT。结论 根据MRI图像进行1992年福州分期发现了更多的晚期病例，需要进行综合治疗(放疗+化疗）的患者增多，为治疗方案的选择提供了重要参考。以MRI为基础的2008年分期是指导鼻咽癌治疗的主要标准。按照MRI图像进行肿瘤靶区勾画能有效避免CT图像对肿瘤组织的漏诊以及对正常组织的误诊，既能加强局部控制，又能保护正常组织，对于鼻咽癌患者的治疗有利无弊。Abstract: Objective To explore the differences between 1992 Fuzhou staging and 2008 staging system，between computed tomography (CT) and magnetic resonance imaging (MRI)scans of the lesion detection，the impaction to primary tumor volume of nasopharyngeal carcinoma(GTV) and volume calculation. Methods Eighty-nine nasopharyngeal carcinoma cases with new-treated CT and MRI images were collected，staging the T，N stage respectively in 1992 Fuzhou and 2008 staging system，comparing the differences between the two means of checking the detection.Thirty-nine cases with differences between CT and MRI imaging were selected to draw the target volume of primary tumor and calculate the volume under the treatment plan system(TPS). Results Because MRI images in 1992 Fuzhou staging，the composition of early(T1+T2) was lower than the increased ratio of late(T3+T4).The 2008 staging increased T3，T4 patients.In T2 and T3 stage division，the two phases have significant difference (P=0.033，0.008)，the difference of N1，N2 was statistically significant(P<0.05).MRI was better than CT in detecting the invasion of NPC in head long muscle，parapharyngeal space，cavernous sinus，paranasal sinuses and cranial nerves.In displaying lymph nodes in retropharyngeal，the neck shape，capsule，necrosis and fusion，MRI was superior to CT.For target of the 39 cases of CT and MRI images outlined，the results showed GTVMRI>GTVCT. Conclusion According to MRI images of 1992 Fuzhou staging，we find more advanced cases，the need for comprehensive treatment(radiotherapy+chemotherapy)patients has increased，the choice of treatment provides an important reference.With MRI-based 2008 stage system is the main criterion guiding the treatment of nasopharyngeal carcinoma.MRI images of images can effectively avoid the misdiagnosis of the tumor tissue and normal tissue，both enhancing local control and protecting normal tissue，the nose pharyngeal cancer patients will be treated advantageously.
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Key words:
- Nasopharyngeal carcinoma /
- Staging /
- MRI/CT /
- Target delineation
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