【摘要】：目的：提高對(duì)鼻咽癌(NPC)放療后改變及復(fù)發(fā)的CT和MRI表現(xiàn)的認(rèn)識(shí)。 方法：詳細(xì)分析經(jīng)臨床和病理證實(shí)的NPC放療后復(fù)查的118例CT資料和49例MRI資料。 結(jié)果：1、CT檢查組118例中,放療后復(fù)發(fā)53例,其中鼻咽壁增厚/腫塊28例,莖內(nèi)增厚致密40例,顱底侵犯24例；無復(fù)發(fā)65例中,鼻咽壁增厚35例,鼻咽壁腫塊5例,莖內(nèi)增厚致密18例,顱底殘留骨質(zhì)破壞6例。經(jīng)統(tǒng)計(jì)學(xué)處理,對(duì)于莖內(nèi)增厚致密,復(fù)發(fā)與無復(fù)發(fā)之間有顯著性差異(P0.05)；而在鼻咽壁增厚/腫塊方面,兩者之間則無顯著性差異(P0.05)。復(fù)發(fā)病例中,23例增強(qiáng)掃描均顯示明顯強(qiáng)化；而無復(fù)發(fā)病例中,25例增強(qiáng)掃描表現(xiàn)為無強(qiáng)化、輕微強(qiáng)化或環(huán)形強(qiáng)化。 2、MRI檢查組49例中,放療后無復(fù)發(fā)28例,其中鼻咽腔正常2例,鼻咽腔變形15例,鼻咽壁增厚19例,莖內(nèi)增厚7例,咽旁間隙變窄3例,顱底殘留破壞缺損5例。復(fù)發(fā)21例,鼻咽壁和莖內(nèi)增厚各12例,顱底骨質(zhì)破壞18例,顳下窩腫塊4例,口咽腫塊2例,眼眶、上頜骨/上頜竇骨質(zhì)破壞2例,顳頜關(guān)節(jié)骨質(zhì)破壞1例,乳突骨質(zhì)破壞、雙側(cè)腮腺腫塊及環(huán)繞頸部浸潤腫塊1例,咽旁間隙變窄/消失9例。經(jīng)統(tǒng)計(jì)學(xué)處理,在莖內(nèi)增厚、咽旁間隙變窄/消失方面,兩者間均有顯著性差異(P0.05)。無復(fù)發(fā)病例中,7例莖內(nèi)增厚在T1WI和T2WI上均表現(xiàn)為莖內(nèi)軟組織等信號(hào)或低信號(hào)腫塊影,5例無強(qiáng)化,2例輕度強(qiáng)化；復(fù)發(fā)病例中,12例莖內(nèi)增厚在T1WI和T2WI上表現(xiàn)為形態(tài)不規(guī)則的等信號(hào)或略高號(hào)腫塊影,11例行增強(qiáng)掃描,明顯強(qiáng)化9例,輕度強(qiáng)化2例。 結(jié)論：1、CT和MRI可較好地顯示NPC放療后變化。 2、莖內(nèi)改變是判斷復(fù)發(fā)與否的重要征象。 3、CT和MRI對(duì)放療后纖維化斑塊與腫瘤復(fù)發(fā)鑒別有重要作用。
[Abstract]:Objective: to improve the understanding of CT and MRI findings of nasopharyngeal carcinoma (NPC) after (NPC) radiotherapy. Methods: the data of 118 cases of CT and 49 cases of MRI confirmed by clinical and pathological NPC were analyzed in detail. Results among 118 cases of CT inspection group, 53 cases recurred after radiotherapy, including 28 cases of nasopharyngeal wall thickening / mass, 40 cases of thickening and compactness of stem, 24 cases of skull base invasion, 35 cases of nasopharyngeal wall thickening and 5 cases of nasopharynx wall mass, among 65 cases without recurrence, 35 cases with nasopharyngeal wall thickening and 5 cases with nasopharyngeal wall mass. There were 18 cases of thickening and compaction in stem and 6 cases of skull base residual bone destruction. Statistical analysis showed that there was a significant difference between the thickening and densification of stem, recurrence and no recurrence (P0.05), but there was no significant difference in thickening / mass of nasopharyngeal wall between them (P0.05). In 23 cases of recurrence, enhanced scan showed obvious enhancement, while in 25 cases of no recurrence, the enhanced scan showed no enhancement, slight enhancement or ring enhancement. 2 in 49 cases of MRI inspection group, 28 cases had no recurrence after radiotherapy. The nasopharynx cavity was normal in 2 cases, nasopharyngeal cavity deformation in 15 cases, nasopharyngeal wall thickening in 19 cases, stem thickening in 7 cases, parapharyngeal space narrowing in 3 cases, skull base residual destruction in 5 cases. Recurrence occurred in 21 cases, thickening of nasopharynx wall and stem in 12 cases, skull base destruction in 18 cases, subtemporal fossa mass in 4 cases, oropharyngeal mass in 2 cases, orbital and maxillary / maxillary sinus bone destruction in 2 cases, temporomandibular joint bone destruction in 1 case, mastoid bone destruction in 1 case. Bilateral parotid masses and infiltrating masses around the neck in 1 case, parapharyngeal space narrowing / disappearance in 9 cases. Statistical analysis showed that there was significant difference between the two groups in thickening of stem and narrowing / disappearance of parapharyngeal space (P0.05). In 7 cases of no recurrence, the thickening of stem in both T1WI and T2WI showed iso-signal in stem soft tissue or low signal mass in 5 cases, and no enhancement in 2 cases. In 12 cases of recurrence, the thickening of the stem showed irregular iso-signal on T1WI and T2WI in 11 cases, obvious enhancement in 9 cases and slight enhancement in 2 cases. Conclusion CT and MRI can show the changes of NPC after radiotherapy. 2Stem change is an important sign to judge recurrence or not. 3CT and MRI play an important role in differentiating fibrosis plaques from tumor recurrence after radiotherapy.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R739.63

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