耳、鼻、咽、喉

伽玛刀治疗听神经瘤,内窥镜辅助显微切除巨大听神经瘤15例,奥沙利铂对人低分化鼻咽癌细胞系CNE2体外增殖的影响,X射线照射诱导鼻咽癌细胞hMSH2的表达，应用MRI动态增强技术鉴别鼻咽癌放疗后枕骨斜坡纤维化与肿瘤复发，从鼻咽癌放疗后复发探讨放疗设野范围，鼻咽癌前期病变中的EB病毒感染，咽后淋巴结转移在鼻咽癌分期中的意义，     

动态增强MRI成像在鼻咽癌诊疗中的应用价值

动态增强磁共振成像(Dynamic contrast enhanced MRI,DCE-MRI)是一种非常有价值的定量MRI技术,在提高肿瘤诊断的敏感度、良恶性肿瘤的鉴别、肿瘤分级等方面有良好的应用价值。本文就鼻咽癌分期、疗效评价、鉴别鼻咽癌放疗后瘢痕纤维化与肿瘤复发的DCE-MRI研究现状进行综述,供同道们在工作中参考。     

MRI在鼻咽癌诊断与随访中的应用研究

MRI在鼻咽癌分期、疗效评价、鉴别鼻咽癌放疗后瘢痕纤维化与肿瘤复发及诊断放射性脑病等方面有重要应用价值.     

鼻咽癌放疗后磁共振灌注成像43例临床分析

目的探讨鼻咽癌放疗后随访磁共振灌注成像（PWI）的临床意义。方法前瞻性分析43例放疗后鼻咽癌随诊患者均行PWI,其中经病理学证实的鼻咽癌复发患者9例,3例影像学证实颅底骨质侵犯,并观察纤维化组和复发组的Slope max伪彩图和SI—T曲线。结果纤维化组Slope max伪彩图显示ROI为蓝色,复发组为红色,两组Slope max均值差异具有统计学意义（P〈0．05）。结论PWI对于鼻咽癌放疗后复发和纤维化鉴别具有一定意义,可作为鼻咽癌综合治疗后随访首选的影像学检查。     

MR表观扩散系数阈值对鼻咽癌诊断价值的研究

目的：分析鼻咽癌治疗前瘤灶、复发瘤及放疗后非复发瘤的MR表观扩散系数（apparent diffusion coefficient, ADC）值差异,探讨磁共振扩散加权成像（diffusion-weighted imaging,DWI）对鼻咽癌及其复发瘤的诊断价值,并研究其ADC诊断阈值对鼻咽癌的诊断效能。方法收集鼻咽癌治疗前患者（初诊组）103例、放疗后局部复发患者（复发组）39例和放疗后非复发患者（非复发组）51例,分别行常规MR平扫、增强扫描及DWI序列（b=0、800 mm2/s）扫描检查,采用单因素方差分析3组ADC值的差异性;绘制受试者工作曲线（ROC）并对3组病例数据进行分析,确定鼻咽癌初诊组和复发组的ADC诊断阈值,分别计算其诊断鼻咽癌治疗前瘤灶、放疗后鼻咽部复发瘤和放疗后非复发瘤的敏感性、特异性以及约登指数,比较二者ADC诊断阈值的诊断效能。结果非复发组与初诊组、复发组患者的ADC值比较,差异均有统计学意义（P均约0.05）;复发组与初诊组患者ADC值的差异无统计学意义（P跃0.05）。采用常规MRI检查诊断鼻咽癌复发瘤时,其诊断的敏感性和特异性分别为71.8%和74.5%;取0.851×10-3 mm2/s作为初诊组的ADC诊断阈值时,其对治疗前瘤灶诊断的敏感性、特异性和约登指数分别为98.0%、94.9%和0.929,对复发瘤诊断的敏感性、特异性和约登指数分别为76.9%、98.0%和0.749;取0.887×10-3 mm2/s作为复发组ADC诊断阈值时,其对复发瘤诊断的敏感性、特异性和约登指数分别为87.2%、94.1%和0.813。采用Z检验对3种检查法诊断鼻咽癌复发瘤的结果进行差异性分析,显示其中MR DWI复发组ADC诊断阈值对鼻咽癌复发瘤的诊断效能最高（Z=2.044,P=0.041）。结论 DWI有助于鼻咽癌及其复发瘤的检出及诊断,且较常规MRI具有更高的诊断效能;通过鼻咽癌复发组获得的ADC诊断阈值较通过鼻咽癌初诊组获得的ADC诊断阈值对?     

PET-CT和MRI在诊断鼻咽癌放疗后复发中的价值

目的:探讨PET-CT和MRI在诊断鼻咽癌放疗后复发中的价值.方法:21例鼻咽癌放疗后患者均行PET-CT和MRI检查.依据病理组织活检和临床随访分别评价PET-CT和MRI对鼻咽癌放疗后复发检出的灵敏度、特异性、漏诊率、误诊率和准确度,并对两者的准确度比较.结果:PET-CT诊断鼻咽癌放疗后复发的灵敏度、特异性、漏诊率、误诊率和准确度分别为92.3%、100.00%、7.7%、0.00%和95.2%,MRI分别为100.00%、87.5%、0.00%、12.5%和95.2%,两者间准确度的差异没有统计学意义(P﹥0.05).结论:PET-CT和MRI在诊断鼻咽癌放疗后复发中均有较高的价值,两者间没有明显差别,两种诊断方法有各自的优缺点,应将两者结合起来,以提高诊断鼻咽癌放疗后复发的准确度.     

鼻咽癌放疗后局部复发和纤维化的增强CT鉴别诊断价值

目的探讨鼻咽癌放疗后出现块影时,ＣＴ检查对鉴别肿瘤局部复发和放射性纤维化的价值。方法收集１５９例经ＣＴ检查的鼻咽癌,其中放疗后局部复发（ＲＴ）３７例,放射性纤维化（ＲＦ）５４例,以６８例未经放疗的鼻咽癌（ＰＴ）作对比。使用ＥＬＳｃｉｎｔｓｐｒｉｎｔ２０００型ＣＴ机,测量放疗后出现的块影平扫和强化的ＣＴ值,用统计学的方差分析法处理增强前后的ＣＴ值差异。结果ＲＴ组平扫ＣＴ值为５０．４０±８．１０Ｈｕ,增强为７３．７４±７．３７Ｈｕ;ＲＦ组平扫为４８．６２±１０．１５Ｈｕ,增强为５６．７４±８．６９Ｈｕ;对照组（ＰＴ）病变区平扫为４８．３２±９．２０Ｈｕ,增强为７２．３８±７．７５Ｈｕ。测量表明ＲＴ组有明显强化,ＲＴ组与ＲＦ组强化后ＣＴ值差异有非常显著性（Ｐ＜０．０１）。结论鼻咽癌放疗后出现块影时,ＣＴ增强扫描可作为鉴别诊断的重要方法。     

磁共振扩散加权成像在鉴别鼻咽癌放疗后鼻咽坏死与复发中的价值

目的评价磁共振扩散加权成像（DWI）以及表观扩散系数（ADC）值测量在鼻咽癌放疗后鼻咽坏死与复发鉴别诊断中的应用价值。方法2008年7月至2010年12月,35例经我院治疗并经病理诊断证实的鼻咽癌放疗后鼻咽坏死和同期随机选取的35例鼻咽癌放疗后复发的患者,均接受了常规MRI检查及DWI（扩散敏感系数,即b值采用：0s／mm2及800s／mm2）,分别测量放疗后鼻咽坏死灶及肿瘤复发区的ADC值,计算其平均值。结果鼻咽坏死灶在DWI上表现为不均匀的低信号,而肿瘤复发病灶表现为高信号。鼻咽坏死组及复发组ADC平均值分别为（1.073±0．0383）×10^-3mm2／s和（0．844±0．0309）×10^-3mm2／s;最大值分别为（1．728±0．0527）×10^-3mm2／s和（1．477±0．0675）×10^-3mm2／s。鼻咽坏死组ADC平均值及最大值均大于复发组,差异有统计学意义（t1=4．645,P〈0．001;t2=2．932,P〈0．005）。结论DWI以及ADC值测量在鼻咽癌放疗后鼻咽坏死与复发的鉴别诊断中具有重要价值,可作为常规MR序列的重要补充。     

扩散加权成像在鉴别鼻咽癌局部复发和放疗后改变中的应用

[目的]探讨扩散加权成像（DWI）在鉴别鼻咽癌局部复发与放疗后改变中的价值。[方法]放射治疗后常规MRI发现异常病变的100例NPC入组,分析DWI表现,测量病变处的表观扩散系数（ADC）,并对不同性质病变的ADC值进行比较。[结果]59例局部复发,3例颅内复发灶DWI图像呈等信号,余均呈高信号。26例放疗后水肿/纤维炎症反应2例DWI呈稍高信号,余均呈低信号。8例放射性坏死DWI均呈明显高信号。局部复发、放疗后水肿/纤维炎症反应及放射性坏死的平均ADC值分别为0.84±0.12（×10-3mm2/s）、1.93±0.13（×10-3mm2/s）及0.41±0.10（×10-3mm2/s）,三组ADC值有显著性差异（F=292.548,P〈0.01）。以平均ADC值〈1.0×10-3mm2/s及〉1.5×10-3mm2/s,分别作为诊断局部复发和放疗后水肿/炎症反应的阈值,敏感度、特异性分别为84.2%、71.4%及86.6%、100%。[结论]DWI表现及病变的ADC值差异有助于鼻咽癌局部复发与放疗后水肿/纤维炎症反应等的鉴别诊断。     

治疗前血红蛋白水平对鼻咽癌患者调强放疗预后的影响

目的探讨治疗前血红蛋白水平(HBC)对鼻咽癌患者(NPC)调强放疗(intensity-modulated radiation thera-py,IMRT)预后的影响。方法将250例鼻咽癌患者,根据放疗前血红蛋白水平分为3组(HBC<120 g/L组,HBC 120～150 g/L组,HBC≥150 g/L组)。结果 HBC<120 g/L、HBC 120～150 g/L、HBC≥150 g/L 3组3年局控率分别为92.9%、94.6%和93.2%,3年无远处转移生存率分别为92.9%、85.1%和90.0%,3年无瘤生存率分别为64.3%、76.4%和86.4%(P<0.01),3年总生存率分别为78.6%、83.8%和94.3%(P<0.01)。COX回归分析结果表明,治疗前血红蛋白水平是影响鼻咽癌患者预后的独立因素。结论 NPC患者放疗前HBC>150 mg/L,是影响患者无瘤生存率及总生存率的独立因素。     

鼻咽癌放疗后局部复发和纤维变的动态CT增强特征

目的 探讨鼻咽癌放疗后局部复发和纤维变的螺旋ＣＴ动态增强特征。方法 放疗后纤维变组（ＲＦ组）５０例,复发组（ＲＮＰＣ组）４６例。先平扫,然后选择兴趣区支动态增强扫描。采用ＥＬＳＩＮＴＣＴ－ＦＬＡＳＨ双螺旋ＣＴ扫描要,自动压力注射器药。分别测量两组平扫与增强后不同时刻的ＣＴ值,进行统计学处理,并描绘密度时间曲线。结果 ＲＦ组于增强后２１０秒时达峰值,基动态增强曲线特征叶缓升一级降型。ＲＮＰＣ组于增强     

动态增强MRI监测乳腺癌新辅助化疗疗效的应用价值

目的 探讨动态增强MRI监测乳腺癌新辅助化疗疗效及评估化疗后残留病灶的价值.方法 对43例患者的44个浸润性导管癌病灶行术前新辅助化疗,分别于化疗前、1个疗程化疗后和化疗结束时行动态增强MRI扫描,比较化疗有效与无效患者的肿瘤组织形态学变化、肿瘤体积变化和血流动力学变化特点.以手术病理为对照,评价术前MRI判断病灶残留情况的效果.结果 44个乳腺癌病灶中,治疗有效36个病灶,无效8个病灶.治疗有效组经1个疗程化疗后,肿瘤体积缩小不明显,化疗结束后肿瘤体积较治疗前明显缩小(P<0.01),缩小中位数为18.5 cm3.治疗有效组病灶呈向心型缩小29个,树枝型缩小7个.新辅助化疗前,有效组与无效组的早期强化率(E1)、峰值强化率(Emax)和达峰时间(Tmax)差异均有统计学意义(均P<0.05).化疗1个疗程后,有效组的E1和Emax降低,而Tmax升高,与化疗前比较,差异均有统计学意义(均P<0.01);而无效组的E1、Emax和Tmax未发生明显变化.新辅助化疗前,有效组的时间信号强度曲线以廓清型、平台型为主(占86.1%);化疗后,强化峰值明显下降,时间-信号强度曲线转为以持续强化型为主;化疗结束时,持续强化型占63.9%.无效组的时间-信号强度曲线化疗前后变化不大.新辅助化疗后动态增强MRI监测乳腺癌残留病灶与手术病理结果高度相关(r=0.866,P<0.01).结论 动态增强MRI可在乳腺癌新辅助化疗疗程中监测瘤体变化,评价、预测新辅助化疗疗效,并可用于术前评估化疗后病灶的残留情况.     

动态增强MRI监测乳腺癌新辅助化疗疗效的应用价值

Objective

The aim of our study was to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DMRI) in predicting early response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) and to assess the accuracy of DMRI in evaluating residual disease after NAC.

Methods

DMRI were performed in 43 women with LABC (44 lesions, all were invasive ductal carcinoma) before, after the first and final cycle of NAC. Tumour volume, early enhanced ratio (E1), maximum enhanced ratio (Emax), and maximum enhanced time (Tmax), dynamic signal intensity-time curve were obtained during treatment. Residual tumour volumes obtained using DMRI were compared with pathological findings to assess the accuracy of DMRI.

Results

After 1st cycle of NAC, the mean volume of responders decreased insignificantly, P > 0.05, but after NAC, mean volume of residual tumor decreased significantly (P < 0.01). Morphology change: 29 cases showed a concentric shrinkage pattern while 7 cases showed a dendritic shrinkage pattern. Significant differences were found in E1, Emax and Tmax between responders and non-responders (P < 0.05). After 1st cycle of NAC, E1, Emax and Tmax of responders changed significantly (P < 0.001); while there is no significant change in non-responders (P > 0.05). After NAC, dynamic signal intensity-time types were changed in responders, and tended to be significantly flattening, while no significant change was found in non-responders. The residual tumour volume correlation coefficient between DMRI and pathology measurements was very high (r = 0.866, P = 0.000).

Conclusion

DMRI is useful to evaluate the early response to NAC in LABC. The presence and volume of residual disease in LABC patients treated with NAC could be accurately evaluated by DMRI.     

Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors

To evaluate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) in salivary gland tumors, thirty-five patients (47 lesions) who underwent MR examinations and were histopathologically diagnosed with salivary gland tumors in Okayama University Hospital, between April 1998 and March 2005, were entered in the present study. The parameters included CI(max300) or CI(max600), which was the contrast index (CI) at maximal contrast enhancement upon 300 s or 600 s, and Tmax, which was the time that corresponded to the CI(max300). Washout ratio (WR(300) or WR(600)) was defined as follows: CI(max300)-CI(300s)/CI(max300) or CI(max600)-CI(600s)/CI(max600)x100 (%), where CI(300) or CI(600) was the CI at 300s or 600s after contrast medium administration. We obtained the following results from the analysis of DCE-MRI parameters; (a) The salivary gland tumors were categorized into three CI curve types according to Tmax and WR300; Pleomorphic adenoma; Tmax > 210 s and WR300 < 10%, Warthin tumor; Tmax < 60 s and WR300 > 40%, and malignant tumor; 60s < Tmax < 210 s and 10% < WR300 < 30%; (b) On the basis of the relationship between Tmax and CImax or WR, all pleomorphic adenomas were successfully differentiated from Warthin tumor lesions. Of the 20 pleomorphic adenomas, 18 (90.0%) were successfully differentiated from malignant tumors. All Warthin tumor lesions were successfully differentiated from pleomorphic adenomas and malignant tumors. Of 12 the malignant tumors, 11 (91.7%) were successfully differentiated from pleomorphic adenomas. All malignant tumors were successfully differentiated from Warthin tumors. Thus, DCE-MRI parameters are useful in diagnosing salivary gland tumors on the basis of the combined assessment of Tmax and CImax or WR.     

Study of relationship of concha bullosa to nasal septal deviation and sinusitis

Objectives

To study the etiological role of concha bollosa in deviated nasal septum (DNS) and sinusitis.

Materials and methods

In this retrospective study 419 consecutive CT scans of paranasal sinuses done between October 2005 and September 2007 were serially evaluated for the presence of concha, DNS and sinusitis.

Results

Out of 419 CT scans evaluated, concha bullosa was present in 40.3% of patients. Among these, concha co-existent DNS was found in 87.5%, air column between DNS and concha was found in 88.5% and sinus disease was present in 69.2% of patients.

Conclusion

Presence of air column between DNS and concha excludes the etiological role of concha in DNS. Concha bullosa may predispose to sinusitis.     

螺旋CT与MRI评价鼻咽癌颅底侵犯

背景与目的：随着螺旋CT与MRI的普遍应用,研究哪种方法对鼻咽癌发生颅底侵犯的诊断更有价值,是临床上亟待解决的问题。本研究拟探讨用CT与MRI诊断鼻咽癌颅底侵犯的价值。方法：选取1993年8月--2001年9月经病理证实为鼻咽癌的患者6l例,全组患者治疗前均行螺旋CT及MRI检查。此外,螺旋CT薄层扫描三维重建8例。CT扫描采用Elscient CT Twin Flash,常规横断面平扫,部分加冠状面扫描,13例加增强扫描。MRI扫描采用Philips T5-Ⅱ型0.5 Tesla超导成像系统,标准头部正交线圈。常规SE序列,扫描方向为横断面、矢状面和冠状面,扫描范围由鞍上池至第二颈椎下缘水平,6l例中55例患者进行增强扫描。结果：CT发现颅底骨质侵犯17例,MRI扫描发现颅底侵犯26例,其中6例MRI扫描发现斜坡、翼突基底部和蝶骨基底部早期的骨髓浸润,而CT检查未见有这些部位的骨质破坏,另外3例MRI见肿瘤沿三叉神经向颅内侵犯,而CT未见明确的卵圆孔破坏。结论：CT与MRI均可显示鼻咽癌通过破坏骨质侵犯颅底,也可以通过自然孔道进入颅内。MRI较CT对颅底骨质破坏的检出更敏感,MRI可以发现肿瘤沿三叉神经向颅内侵犯,而卵圆孔没有骨质破坏。MRI较CT可以更准确地界定肿瘤的侵犯范围;螺旋CT薄层三维重建,可以较为直观地显示病灶。     

鼻腔淋巴瘤病理分析

目的：探讨鼻腔淋巴瘤的病理特点及诊断要点。方法：对17例鼻腔淋巴瘤的临床病理资料及病理切片进行回顾性分析。结果：男14例，女3例，中位年龄52岁。组织学类型包括NK／T细胞淋巴瘤7例(41％)，外周T细胞淋巴瘤(非特殊型)8例(47％)，弥漫性大B细胞淋巴瘤2例(12％)。5例肿瘤旁鳞状上皮组织呈假上皮瘤样增生。结论：鼻腔淋巴瘤绝大部分为T细胞及NK／T细胞淋巴瘤，在病理诊断中应注意与小细胞癌等疾病鉴别。     

Association of rectal toxicity with thermal dose parameters in treatment of locally advanced prostate cancer with radiation and hyperthermia

PURPOSE: Although hyperthermia has been used for more than two decades in the treatment of pelvic tumors, little is known about the potential impact of heat on rectal toxicity when combined with other treatment modalities. Because rectal toxicity is a concern with radiation and may be exacerbated by hyperthermia, definition of the association of thermal dose parameters with rectal toxicity is important. In this report, we correlate rectal toxicity with thermal dose parameters for patients treated with hyperthermia and radiation for prostate cancer. METHODS AND MATERIALS: Thirty patients with T2b-T3b disease (1992 American Joint Committee On Cancer criteria) enrolled in a Phase II study of external beam radiation +/- androgen-suppressive therapy with two transrectal ultrasound hyperthermia treatments were assessed for rectal toxicity. Prostatic and anterior rectal wall temperatures were monitored for all treatments. Rectal wall temperatures were limited to 40 degrees C in 19 patients, 41 degrees C in 3 patients, and 42 degrees C in 8 patients. Logistic regression was used to estimate the log hazard of developing National Cancer Institute Common Toxicity Criteria Grade 2 toxicity based on temperature parameters. The following were calculated: hazard ratios, 95% confidence intervals, p values for statistical significance of each parameter, and proportion of variability explained for each parameter. RESULTS: Gastrointestinal toxicity was limited to Grade 2. The rate of acute Grade 2 proctitis was greater for patients with an allowable rectal wall temperature of >40 degrees C. In this group, 7 of 11 patients experienced acute Grade 2 proctitis, as opposed to 3 of 19 patients in the group with rectal wall temperatures limited to 40 degrees C (p = 0.004). Preliminary assessment of long-term toxicity revealed no differences in toxicity. Hazard ratios for acute Grade 2 proctitis for allowable rectal wall temperature, average rectal wall Tmax, and average prostate Tmax were 9.33 (p = 0.01), 3.66 (p = 0.03), and 2.29 (p = 0.08), respectively. A model combining these three parameters explained 48.6% of the variability among groups. CONCLUSION: Rectal toxicity correlates with maximum allowable rectal wall temperature, average rectal wall Tmax, and average prostate Tmax for patients undergoing transrectal ultrasound hyperthermia combined with radiation for treatment of advanced clinically localized prostate cancer. Further definition of this association of thermal dose parameters with rectal toxicity in treatment of pelvic malignancies with hyperthermia should advance the goal of delivering thermal therapy in an effective yet safe manner.     

Endoscopic and Computed Tomographic Evaluation of Influence of Nasal Septal Deviation on Lateral Wall of Nose and Its Relation to Sinus Diseases

To correlate symptoms of deviated nasal septum (DNS) and chronic rhinosinusitis with the findings of nasal endoscopy and computed tomographic (CT) imaging. To evaluate the influence of degree of septal angle deviation on the severity of lateral nasal wall abnormalities. A prospective study was conducted on 67 patients with clinical evidence of DNS and chronic sinusitis attending ENT OPD between January 2012 and September 2013. All these patients underwent nasal endoscopy and CT scan PNS coronal sections. Direction and degree of DNS was recorded. Range of sinus mucosal thickening on CT scan films was also recorded. Chronic sinusitis is common in the age group between 21 and 40 years (50.74 %) with male preponderance (55.22 %), chief symptoms being nasal obstruction (86.56 %), headache (73.13 %) and nasal discharge (52.23 %). Left sided DNS is more common (64.17 %). Most of the patients have moderate DNS, i.e. 6°–10° (56.7 %), followed by severe (22.4 %) and then mild (20.9 %). DNS results in compensatory structural changes in the turbinates and/or lateral nasal wall which causes ostiomeatal complex (OMC) obstruction resulting in sinusitis. Contralateral concha bullosa and ethmoid bulla prominence was noted. Maxillary sinus is most commonly affected sinus (73.13 %). Patients with increasing septal angles were associated with a higher incidence of maxillary sinus mucosal changes (p < 0.05). Present study reemphasized the concept that septal deviation causes obstruction at OMC which results in an increased incidence and severity of bilateral chronic sinus disease.