鼻咽癌的CT诊断及鉴别诊断

目的:探讨鼻咽癌的CT诊断及鉴别诊断的价值。方法:对经手术病理证实或活检病理证实的33例鼻咽癌患者行CT检查,详细分析其影像学表现。结果:鼻咽癌33例,肿块前缘弧形前凸伴有咽隐窝变浅或消失33例,腭帆提肌肿大22例,经蝶腭孔侵入翼腭窝16例,经颞下窝侵入翼腭窝8例,2例见肿块侵犯蝶窦,20例见颈部淋巴结肿大。结论:CT检查对鼻咽癌的诊断及鉴别诊断有较大价值。     

侵犯鼻咽的浆细胞瘤一例

患者　男 ,72岁。反复头痛 1年 ,伴右眼视力下降、失明2个月。查体 :右眼球外展受限 ,伸舌偏右 ,右下肢巴氏征(+)。ＣＴ平扫 :鼻咽顶后壁增厚 ,双侧咽隐窝消失 ,肿块自鼻咽顶向前至后鼻孔和右侧鼻腔 ,蝶骨体、蝶窦各壁、枕骨斜坡、双侧蝶骨大翼和破裂孔周围骨质破坏 ,肿瘤侵犯右侧眶尖和双侧筛窦后组 ,上述肿块内有散在条状钙斑 ,双侧额、颞、顶、枕骨可见多发小圆形、边界清楚的破坏区 (图 1、2 )。鼻咽病理活检诊断 :浆细胞瘤 (图 3)。图 1　鼻咽轴位ＣＴ平扫示 :鼻咽腔肿块蔓延至后鼻孔 ,双侧翼内板和斜坡骨质破坏(↑ )　图 2　头颅轴位…     

鼻咽癌放疗后腔外肿块残留或复发的MR诊断

目的 :探讨鼻咽癌放疗后腔外肿块残留或复发的MR特点。方法 :回顾性分析了鼻咽癌放疗后鼻咽腔无肿块、腔外肿块存留或复发的 2 0例MR检查资料。结果 :咽旁间隙肿块 11例 ;颅底骨质破坏 17例 ;海绵窦受侵犯 11例、后颅窝肿块 3例 ;眼眶侵犯 2例 ;副鼻窦及鼻腔异常 15例 ;放射性脑病 4例。结论 :MR是诊断鼻咽癌放疗后咽旁肿瘤残存或复发的有效方法     

鼻咽部肌上癌的CT与临床

目的：探讨鼻咽部肌上皮癌的CT表现及临床意义。方法：回顾性分析2000-2005年我院发现的8例鼻咽部肌上皮癌的临床、CT资料，并复习文献。结果：2例肿块原发于鼻咽部；2例位于软硬腭并侵犯一侧鼻咽部。1例位于软腭与咽侧壁交界处；1例位于软腭向上和向下鼻咽部和口咽部；2例位于一侧扁桃体和咽侧壁并侵犯一侧鼻咽部。肿块形态均不规则、其鼻咽腔面呈浅分叶状改变。6例平扫与邻近肌肉组织呈等密度，1例增强病变中心可见较低密度区；1例增强扫描肿瘤组织与周围组织无明显密度差别。侵犯鼻咽部的肿块均呈浸润性生长累及上下范围较大，最上达咽顶壁，最下达口咽部，前达上颌窦侧壁和鼻腔。1例上颌窦外侧壁骨质破坏、缺损；1例侵及邻近翼内板致骨质破坏、缺损。2例原发于鼻咽部者致一侧咽旁间隙变窄外移、腭帆提肌受侵犯。结论：CT检查的价值主要在于帮助确定肿瘤的部位、大小、范围、发展方向、与周围解剖结构的关系以及肿瘤的良恶性、有无淋巴转移、远处转移等，对肿瘤的分期、制定治疗方案十分重要。     

侵犯鼻咽和颅底的上颌窦软骨肉瘤一例

患者　女 ,49岁。头痛、鼻塞 2年 ,伴涕血、耳聋、耳鸣、嗅觉丧失、右眼突出、视力下降 1年。查体 :右侧中鼻甲肥厚 ,鼻腔顶被肿瘤充满 ,质硬 ,触之不易出血 ,左侧鼻腔通畅 ,下鼻甲肿胀 ,粘膜无充血 ,未见脓液。咽喉未见异常。右眼前突 16ｍｍ ,但右眼各方活动不受限。实验室检查未见异常。ＣＴ平扫见右侧上颌窦内壁、外后壁、前壁和顶部骨质破坏 ,窦腔被肿块占据 ,窦后脂肪间隙消失 ,肿瘤向下至口咽侧壁 ,破坏右中上鼻甲和鼻中隔至左鼻腔 ,向后破坏右翼突、翼内外板 ,肿瘤占据同侧咽旁间隙和鼻咽腔 ,向后上侵犯右侧筛窦和左筛窦后组、右侧…     

类似鼻咽癌的结节病一例

图１ＣＴ平扫示鼻咽后壁及左侧壁增厚的软组织肿块突向鼻咽腔，咽旁间隙清楚图２ＭＲ矢状位Ｔ１ＷＩ示鼻咽顶后壁等信号软组织肿块，表面较光滑图３横断位Ｔ２ＷＩ示鼻咽后壁及左侧壁高信号肿块突向鼻咽腔内，左侧咽隐窝及咽鼓管开口消失，咽旁脂肪间隙清晰患者女性，５３...     

鼻咽部巨大滑膜肉瘤一例

患者男 ,43岁。发现左鼻咽部包块 1年 ,味觉减退、左耳听力下降 6个月入院。体检 :鼻咽部左侧壁软组织肿块约 5ｃｍ× 5ｃｍ大小 ,左咽鼓管咽口阻塞 ,肿块无压痛 ,挤压悬雍垂偏向右侧 ,左腭咽弓、腭舌弓分辨不清 ,鼻咽腔明显狭窄 ;全身浅表淋巴结无肿大。影像检查 :咽部ＣＴ平扫示左鼻咽部软组织肿块 ,内缘凹凸不平 ,并突向内致鼻咽腔显著狭窄 ,肿块向外侵及翼内肌及咽旁间隙 ,向上侵及软腭 (图 1) ;诊断 :鼻咽癌。左颈总动脉ＤＳＡ示咽升动脉前组分支及颌内动脉分支明显增多 ,粗细极不规则 ,并可见静脉提前显影 (图 2 ) ;鼻咽部有 5ｃｍ× …     

鼻咽病变的临床CT分析

目的：为了提高ＣＴ对鼻咽病变鉴别的认识。方法：本文收集６３例鼻咽有病变者，其中鼻咽癌４６例，恶性肉芽肿４例，纤维血管瘤３例，结核２例，非何杰金氏淋巴瘤１例，慢性炎症７例，全部病例作鼻咽轴位ＣＴ平扫，３例纤维血管瘤加作增强扫描，详细地分析了其临床和ＣＴ表现。结果：鼻咽癌病人头痛和颈部淋巴结转移出现率较高，分别为３７．０％和５６．５％，且早期即向深层浸润生长；恶性肉芽肿有特征性的恶臭，病变呈中线性生长，愈向鼻咽深层，病变愈轻；纤维血管瘤肿块呈紫红或灰红色，增强检查肿块轮廓清楚，强化明显；结核和慢性炎症虽有顶后壁增厚，但咽缝存在；非何杰金氏淋巴瘤在鼻咽部形成大的肿块，腹腔和后纵隔淋巴结广泛肿大。结论：根据临床表现，结合ＣＴ特征，大多数鼻咽病变可作出正确诊断。     

鼻腔和鼻旁窦腺样囊性癌的影像学表现

目的：分析鼻腔鼻旁窦腺样囊性癌的影像学表现，评价其临床价值。资料与方法：回顾分析临床病理证实的鼻腔鼻旁窦腺样囊性癌25例，CT检查23例，其中CT平扫5例，增强扫描3例，平扫加增强扫描15例；MR扫描3例，均为平扫加增强扫描。结果；肿瘤原发于鼻腔5例，上颌4例，筛窦2例，蝶窦1例，其余3例为鼻腔筛窦和鼻腔上颌窦肿块。肿瘤侵及范围包括鼻腔，上颌窦，筛窦，蝶窦，翼腭窝，颞下窝，眼眶，硬腭，眶下裂，圆孔，海绵窦等。窦腔呈膨胀性扩大和骨壁侵蚀性吸收破坏，并沿三叉神经分支润蔓延（表现为软组织侵及翼腭窝，眶下裂，圆孔，海棉窦等）。CT检查23例，其中20例表现为肿块内有低密度囊变区，占86％；2例肿块内有钙化，占8％；1例肿块密度较均匀。结论：鼻腔鼻旁窦腺样囊性癌多表现为圆形或类圆形肿块，肿块内有大小不等低密度囊性区，窦腔呈膨胀性扩大和骨壁呈侵蚀性吸收破坏，并有沿三叉神经浸润蔓延的特性。     

以CT为中心探讨鼻咽癌的诊断

随着影像医学的发展 ,特别是ＣＴ的应用 ,为鼻咽癌的诊断提供了精确的定位和分期的依据 ,极大改善了传统诊断的落后状况 ,对重新认识和研究鼻咽癌提出了新课题。1　相关解剖与病理1.1　解剖鼻咽部 :位于蝶骨体和枕骨底部的下方 ,呈不规则的立方形 ,根据其空间形态 ,分为以下几个壁 :顶后壁 :顶壁与后壁之间不构成明显角度 ,呈穹隆状 ;两侧壁 :为鼻咽腔最重要的部分 ,两侧基本对称 ,包括咽隐窝、咽鼓管隆凸、咽鼓管口 ;前壁 :两侧后鼻孔及鼻中隔后缘 ;底壁 :鼻咽与口咽交界处。因此 ,前壁和底壁并不形成一面“壁” ,而是一解剖区域的空间划分…     

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.     

局部进展期鼻咽癌同期放化疗卡培他滨联合顺铂剂量递增的Ⅰ期临床研究

Objective To decrease radiation induced toxicities especially mucostis in patients with locally advanced nasopharyngeal carcinoma( NPC ) who underwent concurrent radiochemotherapy, the maximum tolerated dose and dose limited toxicities of capecitabine combination with cisplatin were observed. Methods From Aug 2006 to Oct 2007, 24 patients with intensity modulated radiotherapy(IMRT) and concurrent chemotherapy with capecitabine and cisplatin for nasopharyngeal carcinoma(stages Ⅲ-Ⅳ) were enrolled in this study. There were four dose-level groups of Capecitabine[625-1250 mg/(m2 ·d) , d1-14]and fixed cisplatin dose[20 mg/(m ·d) ,d1-5) ]MRI and CT scan were used for evaluation of tumor shrinkage. Treatment related toxicities were evaluated according to the common toxicity criteria( NCI-CTC Version 3.0). Results The acute side-effects include Grade 3 or Grade 4 mucosal toxicity(lasting for at least 5 d) and Grade 3 or Grade 4 non-mucosal toxicity were evaluated. Group 625 mg/m2 and Group 825 mg/m2 had none, Group 1000 mg/m2 had 6 patients and Group 1250 mg/m2 had 3 patients for mucosal toxicity, which were the main dose-limited toxicity and relevant to the dose of capecitabine apparently( P < 0. 05 ). There was also a trend of increase by the dose level of capecitabine for other toxicities. The median follow-up time for all patients was 28. 5 months. The locoregional recurrence occurred in 2 patients and distant metastasis in 2 patients. Two-year overall survival rate and locoregional control rate were 100% and 91.7%, respectively.Complete response and partialresponse were found on MRI or CT scan in patients of 29. 2% at the end of treatment and 83. 3% after three months, respectively. Conclusions The combination regimen of capecitabine and cisplatin is safe and effective according to the preliminary result. Toxicities related to radiochemotherapy for NPC were significantly associated with the dose level of chemotherapy.     

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...     

鼻咽癌放射抗拒相关的信号通路

Objective To study the difference of gene expression profile between the radioresistant human nasopharyngeal carcinoma cell line CNE-2R and CNE-2,and to screen the signaling pathway associated with radioresistance of nasopharyngeal carcinoma.Methods The radioresistant nasopharyngeal carcinoma cell line CNE-2R was constructed from the original cell line CNE-2.CNE-2R and CNE-2 cells were cultured and administered with 60Co γ-ray irradiation at the dose of 400 cGy for 15 times.Human-6v 3.0 whole genome expression profile was used to screen the differentially expressed genes.Bioinformatic analysis was used to identify the pathways related to radioresistance.Results The number of the differentially expressed genes that were found in these 2 experiments was 374.The Kegg pathway and Biocarta pathway analysis of the differentially expressed genes showed the biological importance of Toll-like receptor signaling pathway and IL-1 R-mediated signal transduction pathway to the radioresistance of the CNE-2R cells and the significant differences of 13 genes in these 2 pathways,including JUN,MYD88,CCL5,CXCL10,STAT1,LY96,FOS,CCL3,IL-6,IL-8,IL-1α,IL-1B,and IRAK2(t=13.47-66.57,P<0.05).Conclusions Toll-like receptor signaling pathway and IL-1R-mediated signal transduction pathway might be related to the occurrence of radioresistance.     

局部进展期鼻咽癌同期放化疗卡培他滨联合顺铂剂量递增的Ⅰ期临床研究

Objective To decrease radiation induced toxicities especially mucostis in patients with locally advanced nasopharyngeal carcinoma( NPC ) who underwent concurrent radiochemotherapy, the maximum tolerated dose and dose limited toxicities of capecitabine combination with cisplatin were observed. Methods From Aug 2006 to Oct 2007, 24 patients with intensity modulated radiotherapy(IMRT) and concurrent chemotherapy with capecitabine and cisplatin for nasopharyngeal carcinoma(stages Ⅲ-Ⅳ) were enrolled in this study. There were four dose-level groups of Capecitabine[625-1250 mg/(m2 ·d) , d1-14]and fixed cisplatin dose[20 mg/(m ·d) ,d1-5) ]MRI and CT scan were used for evaluation of tumor shrinkage. Treatment related toxicities were evaluated according to the common toxicity criteria( NCI-CTC Version 3.0). Results The acute side-effects include Grade 3 or Grade 4 mucosal toxicity(lasting for at least 5 d) and Grade 3 or Grade 4 non-mucosal toxicity were evaluated. Group 625 mg/m2 and Group 825 mg/m2 had none, Group 1000 mg/m2 had 6 patients and Group 1250 mg/m2 had 3 patients for mucosal toxicity, which were the main dose-limited toxicity and relevant to the dose of capecitabine apparently( P < 0. 05 ). There was also a trend of increase by the dose level of capecitabine for other toxicities. The median follow-up time for all patients was 28. 5 months. The locoregional recurrence occurred in 2 patients and distant metastasis in 2 patients. Two-year overall survival rate and locoregional control rate were 100% and 91.7%, respectively.Complete response and partialresponse were found on MRI or CT scan in patients of 29. 2% at the end of treatment and 83. 3% after three months, respectively. Conclusions The combination regimen of capecitabine and cisplatin is safe and effective according to the preliminary result. Toxicities related to radiochemotherapy for NPC were significantly associated with the dose level of chemotherapy.     

鼻咽血管纤维瘤术前供血动脉栓塞的临床应用

目的探讨鼻咽血管纤维瘤术前供血动脉栓塞的临床应用价值。方法7例患者,确诊为鼻咽血管纤维瘤。为控制术中出血,采用Seldinger技术,行供血动脉造影及栓塞治疗。栓塞剂为明胶海绵、PVA颗粒。另选7例为术前未行供血动脉栓塞直接手术切除的鼻咽血管纤维瘤患者作为对照组,对术中出血、输血量作比较。结果7例行供血动脉栓塞患者术中出血量及输血量明显减少,两者比较差异有显著性;手术见瘤周水肿明显,易于剥离。结论鼻咽血管纤维瘤术前供血动脉栓塞术对于减少术中出血具有明显疗效。     

鼻咽癌向后颅窝侵犯的途径及MRI表现

目的 探讨鼻咽癌向后颅窝侵犯的途径及ＭＲＩ表现特点。材料与方法 回顾性分析３５例鼻咽癌向后颅窝侵犯的病例。放疗前检查１２例，放疗后复发２３例，使用西门子１．０Ｔ扫描仪，ＳＥ序列横轴位、冠状位Ｔ１磁状位Ｔ２ＷＩ，增强后３个方位Ｔ１ＷＩ。全部病例经鼻咽腔活检确诊，后颅窝肿块１６例。１０例手术切除，经斜坡直接向后颅窝侵犯形成肿块的６例未手术。结果 ⑴斜坡破坏３１例，６例在桥脑前池形成肿块。⑵经舌下神经管     

乘务员鼻咽腺样囊性癌一例

一、临床资料 患者女性,32岁,乘务员,飞行时间12 000 h.2007年10月因不明原因出现持续性双侧鼻塞,在北京中日友好医院五官科就诊,检查未见异常.因症状进行性加重,涕中带血,伴枕部头痛,2008年3月5日在湖北省人民医院就诊.查体:一般情况好,否认视力下降、复视,吞咽呛咳.电子鼻咽喉镜检查:鼻咽新生物.头颅CT:蝶窦区占位,向前下突人鼻腔,双侧筛窦部分气房及鼻咽顶后壁、左侧翼腭窝可能受累,后鼻孔变窄,临近颅底广泛性骨质破坏.鼻咽部MR:鼻咽、鼻后孔、筛窦区肿瘤性病变,双侧颈部淋巴结肿大.     

鼻咽癌多层螺旋CT灌注成像技术探讨

目的探讨鼻咽癌多层螺旋CT灌注成像的临床应用技术.资料与方法 22例鼻咽镜活检病理证实的鼻咽癌行多层螺旋CT灌注扫描,经肘静脉注射对比剂,多层螺旋CT对选定的鼻咽层面进行定层连续扫描30次,将4×30帧图像输入function CT软件内,根据动脉动态增强-时间曲线和各组织强化值计算各层面内每一像素的灌注指标,并计算各指标与同层面正常肌肉的比值,以此来评价鼻咽癌和邻近组织的灌注状态.结果鼻咽癌组织血流量(BF)、强化峰值(PEI)、峰值到达时间(TTP)及血容量(BV)分别为(51.7±10.9) Ml·100g-1·min-1、(35.4±5.2) HU、(14.5±1.7) s、(853.6±245.3) ml/100g,肿瘤组织和邻近正常肌肉灌注比值分别为7.0±1.8、4.1±1.4、0.6±0.1、6.9±3.9.结论正确的检查技术是灌注成像的重要保证,多层螺旋CT灌注成像可以显示鼻咽癌微循环灌注特征.