Nasopharyngeal carcinoma: MRI and CT assessment

Precise assessment of the extent of nasopharyngeal carcinoma (NPC) represents the basic step towards optimal treatment. We compared the capacity of CT and MRI in assessing the extent of NPC in 67 patients. MRI was superior to CT in demonstrating lesions in the retropharyngeal node, skull base, intracranial area, carotid space, longus colli muscle and levator palatini muscle. Of 25 cases in which retropharyngeal adenopathy was recognised only on MRI, seven had been reported as showing oropharyngeal involvement and 18 as primary extension to the carotid space on CT. MRI showed skull-base involvement in 40 patients compared with 27 on CT and intracranial involvement in 38 patients versus 24 on CT. There was not a single case in which skull base invasion was seen on CT but not on MRI. MRI enabled improved recognition of tumour infiltration of longus colli muscles (34 cases compared with 15 on CT). It allowed us to clarify 12 questionable sinonasal opacities on CT. Overall, T-staging was changed in 18 of 67 patients (26.9 %), including upstaging in 15 cases and downstaging in 3 cases, after comparing CT with MRI. The nodel status was changed from negative on CT to positive on MRI in 4 of 67 patients (6 %). We believe that MRI allows more accurate evaluation of the extent of NPC than CT and should be the primary mode of investigation. Received: 18 November 1996 Accepted: 22 January 1997     

Hypoglossal nerve palsy in nasopharyngeal carcinoma

The carotid space and the last four cranial nerves are at risk when nasopharyngeal carcinoma (NPC) recurs or spreads posterolaterally. The objective of this study is to document the features of hypoglossal nerve infiltration and the appearance of the paralysed tongue. We reviewed hypoglossal nerve palsy in 16 patients with NPC. The following features were analysed: tumour morphology (submucosal spread), hypoglossal canal erosion, perineural infiltration or intracranial spread, other lower cranial nerve palsies, and appearance of the tongue. These findings were correlated with clinical records. All 16 patients had tumour recurrence following radiation therapy. In 7 patients (44 %), recurrence was submucosal. Hypoglossal canal involvement was seen in 12 patients (75 %). Isolated hypoglossal nerve palsy was noted in 5 patients (31 %) and 7 patients (44 %) had posterior cranial fossa tumour spread. Posterior displacement of the tongue was consistently well seen. In conclusion, tumour recurrence should be suspected in the presence of hypoglossal nerve palsy even when endoscopic findings are negative. Posterior displacement of the tongue, which has not been emphasised in the literature, is an easily recognisable sign and may indicate early hypoglossal nerve palsy. Received: 2 December 1997; Revision received 11 February 1998; Accepted 16 February 1998     

鼻咽癌多体素 1H-MRS表现

目的探讨鼻咽癌(NPC)多体素氢质子磁共振波谱(1H-MRS)表现及其临床价值。资料与方法对10名健康志愿者和22例NPC患者行二维多体素1H-MRS检查,采用点解析波谱(PRESS)序列。原发肿瘤、转移淋巴结及正常组织的MRS用Sun ADW4.0工作站Functool软件处理分析。结果22处原发病灶中,18处获得可析性波谱,胆碱/肌酸(Cho/Cr)的平均值为2.81±1.32;14处转移性淋巴结中,12处获得可析性波谱,Cho/Cr的平均值为3.06±1.73。原发肿瘤与转移性淋巴结的Cho/Cr比值明显高于正常肌肉(P<0.001)。结论多体素1H-MRS能无创性观察NPC病灶的代谢改变,Cho/Cr比值可以作为NPC诊断的参考指标之一。     

MSCT在鼻咽癌颅底骨侵犯的应用价值

目的：分析鼻咽癌颅底侵犯MSCT诊断价值。方法分析经病理证实28例鼻咽癌患者MSCT影像资料,比较多平面重组（ MPR）与横断面图像对颅底侵犯的检出情况。结果 MSCT多平面重组（ MPR）显示25例颅底侵犯,横断面图像显示19例。横断面表现主要为骨质破坏和颅底孔道增宽,而MPR除骨质改变外,还能清楚显示颅底侵犯的范围。结论 MSCT可精确显示鼻咽癌颅内侵犯的部位、途径及范围,有助于临床分期及指导放疗野的设置。     

Fluorine-18 fluoromisonidazole tumour to muscle retention ratio for the detection of hypoxia in nasopharyngeal carcinoma

In vivo demonstration of hypoxia is of significance for tumour patient management. Fluorine-18 fluoromisonidazole ([¹⁸F]FMISO) is a proven hypoxie imaging agent. We developed an [¹⁸F]FMISO tumour to muscle retention ratio (TMRR) for the detection of tumour hypoxia in nasopharyngeal carcinoma (NPC). Data were acquired by positron emission tomography (PET) of the nasopharynx and neck after intravenous injection of 370 MBq of [¹⁸F]FMISO. Two imaging protocols were adopted: a long protocol for comprehensive dynamic information and a short protocol for a simple, clinically convenient imaging procedure. Tomograms were reconstructed and evaluated visually. ROI analysis on the basis of time-activity curve evaluation was performed to calculate the TMRR of NPC or cervical nodal metastases (CNMs) in relation to the suboccipital muscles at 2 h. The calculation of the TMRR was exactly the same for both the long and the short protocol as two 30-min composite frames had been created immediately after intravenous injection and 2 h after injection of [¹⁸F]FMISO in the long protocol. The normal tissue to muscle retention ratio (NTMRR) was derived similarly from the normal nasopharynx. The data of 12 controls and 24 patients with NPC were analysed. The long protocol was used in 15 patients, and the short protocol in nine. In controls, the mean NTMRR±1 SD was 0.96±0.14. The mean TMRRs for NPC and CNMs were 2.56±1.50 and 1.35±0.51, respectively; these values were significantly higher than the mean NTMRR for normal controls (P<0.005 in each case). At the retention threshold value of 1.24, tumour hypoxia occurred in 100% of the primary lesions of NPC and 58% of CNMs. The TMRR for undifferentiated carcinoma was significantly lower than that for non-keratinized carcinoma (P<0.05). The [¹⁸F]FMISO TMRR is a simple and clinically useful index for detecting tumour hypoxia in NPC.     

鼻咽癌侵犯海绵窦MRI诊断

探讨鼻咽癌侵犯海绵窦的ＭＲＩ特点。材料与方法；招集病理确诊的鼻咽癌伴有前组颅神经损害为主要临床症状ＭＲＩ资料３３例。采用Ｅｌｓｃｉｎｔ ＧｙｒｅｘⅤ型磁共振仪，０．５Ｔ，超导型。ＳＥ，横断位，Ｔ１ＷＩ，Ｔ２ＷＩ计３３例；其中１７例加扫状位，Ｔ１ＷＩ；１０例进行了增强ＭＲＩ扫描。     

低强度He-Ne激光血管内照射配合放疗治疗鼻咽癌的临床研究

目的探讨低强度He-Ne激光血管内照射(intravascularlowlevellaserirradiation,ILLLI)配合放疗治疗鼻咽癌的放射反应及远期疗效。方法将122例接受放疗的鼻咽癌患者随机分为单纯放疗组(对照组)和放疗+ILLLI组(治疗组),比较两组患者的急性放射反应发生率,出现急性放射反应的放疗剂量,局部复发率,远处转移率及5年生存率。结果治疗组与对照组比较,中重度急性放射反应及并发症发生率明显减少(P<0.01),出现急性放射反应的剂量明显提高(P<0.01),局部复发率,远处转移率及5年生存率两组差异无显著意义(P>0.05)。结论ILLLI可提高鼻咽癌患者放疗耐受性,降低急性放射反应及并发症发生率,不增加远处转移,可作为鼻咽癌患者放疗的有效辅助治疗措施。     

局部晚期鼻咽癌的综合治疗

目的 探讨局部晚期鼻咽癌的综合治疗方法，以期望提高疗效。方法 自1993年1月－1998年12月，局部晚期鼻咽癌首程病人43例于本科治疗。全部经病理证实，39例为鳞癌，4例为未分化癌。采用1992年全国鼻咽癌福州会议制定的鼻咽癌分期方案进行分期：Ⅲ期24例，Ⅳ期19例。病理为未分化癌者放化疗同时进行。鳞癌患者先放疗后化疗。放疗先采用面颈联合野放疗36－42Gy，之后面颈分野，避开脊髓，鼻咽部继续放疗至根治剂量66－76Gy，对其中经鼻咽计算机体层摄影术证实有残存者25例（T4患者除外）外照射后补充近距离治疗2－4次，近距离总剂量为12－18Gy。外照射后有残存者3例，由于残存病灶位于颅底及海绵窦，所以给予伽玛刀补充放射剂量6－9Gy。放疗结束后1－2周，开始行化疗，化疗药物为顺铂或卡铂、5－氟尿嘧啶、甲酰四氢叶酸钙，共进行3－4个疗程。结果 以放疗结束计算生存期，总的3年局部控制率及生存率分别为62.8%和67.4%，总的5年控制率和生存率分别为39.1%和43.5%。随访期内未见严重并发症。结论 本文对晚期鼻咽癌采用以放疗为主的综合治疗，疗效比较满意。根治性外放疗剂量后采用近距离治疗或伽玛刀补量，只要合理设计，就不会增加严重并发症的发生率。     

鼻咽癌CT表现与癌细胞核DNA含量的关系

目的：从ＣＴ像上民鼻咽癌的恶性度。材料与方法：将８１例鼻咽癌ＣＴ表现分为：鼻咽腔生长为主型、邻近超腔生长 腔生长型。用流式细胞仪（ｆｌｏｗ ｃｙｔｏｍｅｔｒｙ，ＦＣＭ）检测癌细胞核脱氧核糖核酸（ＤＮＡ）的含量，将鼻咽癌ＣＴ分型与ＤＮ倍体和增殖周期指数是关系进行分析。结果，随着癌肿向鼻咽腔深层蔓延，其非整倍体率逐渐升高，二倍体率逐渐降低，说明鼻咽癌ＣＴ所表现的Ⅰ、Ⅱ、Ⅲ型，其恶性程度呈递增趋势。结论     

鼻咽癌颅神经周围浸润与扩散的MRI诊断

目的 探讨鼻咽癌沿颅神经周围浸润与扩散的MRI征象.资料与方法 回顾性分析经病理活检证实的15例鼻咽癌患者颅神经周围扩散的MRI表现.结果 15例鼻咽癌均显示沿着三叉神经分支浸润扩散,其中2例沿着面神经浸润扩散.6例(2例双侧)Meckel腔浸润;7例沿着三叉神经眼支(V1)扩散;10例沿上颌神经(V2)浸润,表现为圆孔扩大,上颌神经增粗;13例翼腭窝扩大,肿块占据;3例眶下神经增粗,异常强化;3例沿着下颌神经浸润,表现为卵圆孔扩大,下颌神经(V3)增粗.结论 鼻咽癌可以沿着三叉神经、面神经浸润扩散,MRI是显示扩散的重要检查方法.     

激光光动力学疗法治疗复发性鼻咽癌的研究——附191例分析

为提高复发性鼻咽癌的疗效，采用激光光动力学治疗（ＰＤＴ）１９１例复发性鼻咽癌和放射未控病例。方法是静脉滴注血卟啉衍生物（ＨｐＤ）５ｍｇ／ｋｇ后，于２４、４８和７２小时给予氩离子激光照射，输出为４８８．０～５１４．５ｎｍ多谱线，功率８００ｍＷ，通过石英导光纤维传导进入鼻咽腔。近期疗效是：完全效应率为５５．０％（１０５／１９１），明显效应率为３４．６％（６６／１９１），显著效应率为８９．５％（１７１／１９１）。随访１３０例，三年生存率４４．６％，五年生存率２５．４％。认为ＰＤＴ是鼻咽癌放射治疗的一种较好的综合治疗方法     

鼻咽癌CT表现类型与c-erbB-2蛋白表达的相关性研究

目的探讨鼻咽癌(NPC)CT表现类型与c-erbB-2的关系，更全面的认识NPC生物学特性。材料与方法搜集放疗前进行CT检查并有详细临床记录的NPC标本70例，采用S-P法进行c-erbB-2免疫组织化学染色，分析c-erbB-2表达与NPCCT表现类型和临床预后关系。结果NPC的c-erbB-2阳性率为84.29％，与病理组织学类型和病理分级无关；11I型NPC的c-erbB-2阳性率显著高于Ⅱ型(P=0、018)；c-erbB-2的表达与颈淋巴结转移和放疗后局部复发以及远处转移无关。结论远离鼻咽腔生长的NPC较邻近鼻咽腔生长者，c-erbB-2阳性率要高，恶性程度更高。     

Pneumocephalus due to nasopharyngeal carcinoma: case report

A 55-year-old man with recurrent nasopharyngeal carcinoma presented with intractable headaches and intermittent rhinorrhoea for 2 weeks. CT showed severe destruction of the skull base by the tumour. The headache persisted despite intraventricular morphine. On the 29th hospital day, sudden onset of neurological deterioration led to coma, and CT revealed tension pneumocephalus due to nasopharyngeal carcinoma breaking through the skull base. The literature on pneumocephalus is reviewed and the aetiology discussed.     

鼻咽癌放疗后复发73例CT分析

目的 探讨鼻咽癌（ＮＰＣ）放疗后复发ＣＴ表现。材料与方法 对７３例ＮＰＣ复发患者,进行回顾性分析。结果 咽旁及颈动脉鞘区复发２８例,颅底破坏、海绵窦复发２２例,原发灶复发咽旁受侵１７例,单纯咽壁复发６例。结论 ＮＰＣ放疗后复发,以向咽壁深层侵犯为主,其次是向上侵犯,放疗后ＣＴ随访对比分析。对于ＮＰＣ复发的早期诊断有重要意义。     

鼻咽癌颅底骨破坏的CT诊断

目的 研究鼻咽癌颅底骨破坏的ＣＴ征象。材料与方法 对病理证实的鼻咽癌患者１９２３例（男１４０５例,女５１８例）进行ＣＴ扫描,采用常规轴位,层厚４ｍｍ,层距４～５ｍｍ,用骨窗显示;窗宽２２００ＨＵ,窗中心２５０ＨＵ。部分病例加扫冠状位,窗技术不变,高至低依次为：翼突根部,蝶骨体、大翼、翼突,骨破坏分为成骨型、破骨型和混合型,蝶骨根部是成骨型最好发的部位。结论 成骨型破坏是鼻咽癌颅底骨破坏的一种常见类     

鼻咽部非霍奇金淋巴瘤与鼻咽癌的影像鉴别诊断

目的探讨鼻咽部非霍奇金淋巴瘤(NPNHL)及鼻咽癌(NPC)的影像学特征,以提高鉴别诊断水平。资料与方法回顾性分析经病理证实的NPNHL和NPC各30例。其中NPNHL组行CT检查者23例,增强扫描13例;行MR检查者10例,均行平扫加增强。NPC组行CT检查者18例,增强扫描15例;30例均行MR平扫加增强。分析各自特征性的CT、MRI表现,并对两者之间差异进行统计学分析。结果 30例NPNHL中,病灶呈双侧对称侵犯或位置居中者16例;形态上病灶较为表浅且呈弥漫性累及鼻咽腔者18例;口咽、鼻腔、副鼻窦、翼腭窝四个部位中至少两处同时受累者17例,且上颌窦受累多见(11例);邻近骨质受侵者2例;(患侧)咽隐窝完全消失者12例;颈部淋巴结肿大者17例。30例NPC中病灶对称者6例;弥漫性生长者8例;上述四个部位出现两处以上受累者7例,且蝶窦受累相对多见(8例);17例可见骨质破坏;28例咽隐窝消失;28例发生颈部淋巴结转移。以上几点两组间差异具有统计学意义(P<0.01)。结论 NPNHL多表现为鼻咽部对称性生长且较为弥漫的软组织影,周围组织受累广泛但较为表浅。而NPC则多为非对称局限性肿块,易累及深层组织,骨质...     

Nasopharyngeal carcinoma radiotherapy with hybrid technique

The aim of the study was to investigate the effect of the Hybrid technique which was created by combining of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for the treatment of nasopharyngeal cancer (NPC) patients. 7 to 9 field IMRT, triple arc VMAT, and Hybrid plans were generated for 10 advanced stage NPC patients. The homogeneity index (HI) and the conformity index (CI) of planning target volumes (PTVs) were calculated for each technique to evaluate the plan quality. The techniques were compared in terms of plan quality, sparing of organs at risk (OARs), monitor units (MUs), and delivery time. Hybrid technique significantly improved the target dose homogeneity and the conformity for PTV70 and PTV60 compared to IMRT and VMAT. Hybrid plans significantly reduced the maximum dose of the brainstem sparing compared to the VMAT plans and also improved the sparing of spinal cord compared to IMRT and VMAT. The MUs and the delivery time of Hybrid plans were found to be between values for IMRT and VMAT plans. Hybrid technique can be useful when IMRT and VMAT techniques are not adequate alone in the treatment of NPC patients.     

鼻咽癌CT影像与增殖细胞核抗原表达的相关性研究

目的：探讨鼻咽癌（NPC）CT影像和增殖细胞核抗原（PCNA）的关系，深入认识CT征象的意义。资料与方法：搜集放疗前进行过CT检查的NPC活检标本69例（其中3年随访36例），采用免疫组织化学S－P法检测PCNA表达情况，详细分析NPC的CT表现为PCNA表达的关系。结果：（1）69例中，PCNA阳性率为94．3％（65／69），茎内软组织增厚致密PCNA高表达率（＞50％）为68．4％（26／38），而茎内软组织正常PCNA高表达率40．7％（11／27），两者有显著性差异（P＝0．026）；（2）当肿瘤累及后鼻孔鼻腔时，其PCNA高表达率较未受累者高（P＝0．04）；（3）当茎内软组织增厚致密时，其放疗后3年无瘤生存率低于茎内软组织正常者（P＝0．005）。结论：放疗前茎内软组织增厚致密者，PCNA多呈高表达，放疗后更易发生复发。     

凋亡刺激蛋白抑制因子表达对鼻咽癌预后预测的研究

目的 探讨凋亡刺激蛋白抑制因子（iASPP）的表达水平与鼻咽癌预后的关系。方法 随访2012年1月至12月广西医科大学第一附属医院放疗科治疗的初诊鼻咽癌患者130例。临床分期依据2009 AJCC/UICC分期标准。所有患者均接受调强放射治疗,Ⅲ~Ⅳ_B期患者行铂类为基础的同步放化疗。采用免疫组织化学法检测iASPP在130例鼻咽癌组织中的表达情况,比较iASPP表达与临床病理因素的关系,并分析其表达对鼻咽癌患者疗效和生存的影响。结果 130例患者中iASPP阳性表达者86例（66.2%）,阴性表达者44例（33.8%）。不同N分期和临床分期患者的iASPP阳性表达率比较,差异有统计学意义（χ²=7.565、4.947,P<0.05）。治疗后3个月,iASPP阳性表达者与阴性表达者的近期疗效差异无统计学意义（P>0.05）。单因素分析显示,iASPP阳性表达者3年无远处转移生存（DMFS）和无进展生存（PFS）均低于iASPP阴性表达者（82.6% vs. 95.4%,χ²=4.335,P=0.037和74.4% vs. 93.1%,χ²=6.640,P=0.01）。N_2~3患者3年DMFS、PFS和总生存（OS）均低于N_0~1患者（χ²=8.058、9.554、6.987,P<0.01）。多因素分析显示,iASPP表达水平及N分期是影响PFS的独立预后因素（χ²=4.336、5.228,P<0.05）。结论 鼻咽癌患者iASPP阳性表达水平升高是影响预后的不利因素。     

青少年鼻咽癌的CT诊断

目的 探讨青少年鼻咽癌的CT诊断价值。方法 回顾性分析经病理活检证实的15例青少年鼻咽癌CT征象。结果 青少年鼻咽癌表现为咽隐窝变浅或消失，鼻咽部软组织肿块，两侧咽腔不对称，咽肌增厚和不对称，颅底骨质破坏及鼻副窦受累，颈淋巴结肿大。结论 在发现鼻咽癌并确定其浸润范围中CT具有明显优势。