CT扫描在喉及下咽癌术后评价中的应用价值

目的 探讨CT扫描在评价喉及下咽癌术后状况中的应用价值。材料与方法 回顾性分析45例（术后1－120个月共作了69次CT扫描）经喉镜、活检或手术病理证实的喉及下咽癌术后正常和异常的CT表现。结果 10例患者呈喉及下咽癌术后正常改变,8例水肿或瘢痕形成,2例术后滞留囊肿。25例有术后肿瘤复发和／或转移,包括局部肿瘤复发18例、颈部淋巴结转移13例及远处转移2例。结论 CT扫描能很好地显示喉及下咽癌术后的正常和异常改变,判断有无肿瘤复发及其侵犯范围,为临床治疗提供重要的帮助。     

喉及下咽癌的MRI评价(兼与CT比较)

目的：探讨MRI对喉及下咽癌术前分期及术后评价中的临床应用价值。方法：26例喉及下咽癌患者(原发性肿瘤23例、术后复发3例)进行MRI扫描，分析其MRI表现，将结果与手术病理及CT扫描作比较。结果：MRI能较好地显示肿瘤的部位、大小及其侵犯范围。MRI对术前肿瘤分期及诊断颈部淋巴结转移的准确性为91％。高于CT扫描的87％及83％。结论：MRI扫描喉及下咽癌术前分期及术后评价有较大的帮助。     

喉及下咽癌螺旋CT三期增强扫描的临床应用价值

目的:探讨螺旋CT三期增强扫描在喉及下咽癌术前分期及术后评价中的临床应用价值。方法:64例喉及下咽癌患者(原发肿瘤49例、术后评价15例)进行螺旋CT平扫及三期增强扫描。将结果并与纤维喉镜、手术所见对照分析。结果:螺旋CT平扫结合三期增强扫描图像对术前肿瘤分期和诊断颈部淋巴结转移的准确性分别是93.8%及95.9%;增强后肿瘤边界较增强前清晰,有助于肿瘤侵犯范围的判断,对颈部淋巴结转移的检测和判定增强扫描也明显优于平扫图像,静脉期图像对肿瘤的分期帮助最大;螺旋CT三期增强扫描有利于评价喉及下咽癌的术后状况。结论:螺旋CT平扫结合静脉期增强扫描可以更完整地提供喉及下咽癌术前分期及术后评价的全面资料。     

喉及下咽癌采用螺旋CT增强扫描及多平面重组的应用价值

目的 探讨螺旋CT增强扫描及多平面重组(MPR)在喉及下咽癌术前分期及术后评价中的临床应用价值。方法 50例喉及下咽癌患者(原发肿瘤40例、术后评价10例)进行轴位螺旋CT平扫及三期增强扫描，同时做MPR成像。将结果与纤维喉镜、手术所见对照分析。结果 螺旋CT增强扫描轴位结合MPR图像对术前肿瘤分期和诊断颈部淋巴结转移的准确性分别是95％及97.5％；25％的病例MPR显示肿瘤侵犯的范围优于轴位；增强图像有助于判断肿瘤的侵犯范围及颈部淋巴结转移，静脉期图像对肿瘤的分期帮助最大；螺旋CT三期增强扫描有利于评价喉及下咽癌的术后状况。结论 螺旋CT增强扫描轴位结合MPR图像，可以更完整地提供喉及下咽癌术前分期及术后评价的全面资料。     

CT对下咽癌的诊断及鉴别诊断价值

目的 分析CT对下咽癌的诊断及鉴别诊断价值。资料与方法 回顾性分析经手术或局部活检病理证实的下咽癌40例。结果 主要CT表现：(1)病灶位置：下咽上区癌5例(12．5％)，梨状窝癌27例(67．5％)，咽后壁癌或环后癌6例(15％)，混合型2例(5％)。(2)病变密度：平扫呈等或略低密度，增强扫描后明显不均匀强化。(3)梨状窝变窄或消失。(4)咽后软组织增厚：杓-椎距或环-椎距增宽。(5)喉移位及邻近结构受累。(6)喉软骨破坏(30％)。(7)颈部淋巴结转移(77．5％)。(8)食管及其他结构受累。结论 CT可较准确地显示肿瘤侵犯范围，包括喉软骨、声门旁间隙及会厌前间隙，以及颈部淋巴结转移。下咽癌主要须与喉癌鉴别，病变发生的部位、声门旋转移位情况、杓-椎距或环-椎距是否增宽及颈部淋巴结转移的情况有助于鉴别诊断。     

甲状腺癌术后复发的CT表现

目的 分析甲状腺癌术后复发的ＣＴ表现,了解甲状腺术后复发的特点。方法 回顾性分析经手术及病理证实的甲状腺癌主后复发患者４２例,包括乳头状癌２５例,滤泡癌９例,髓样癌６例,透明细胞癌２例。结果 甲状腺床局部复发２３例,其中侵犯颈动脉１０例,气管、食管１７例,喉及下咽２例,９例滤泡癌中８例局部复发,７例肿特明显强化。对侧甲状腺复发１２例,病理类型与原发甲状腺癌一致。颈部淋巴结转移３１例,乳头状癌颈剖淋     

CT在下咽癌及喉癌术前分期中的作用

目的 探讨增强CT扫描在下咽癌和喉癌术前TNM分期中的作用.方法 收集85例手术证实的下咽癌及喉癌病例,术前行增强CT扫描检查.2位有多年临床工作经验的放射学专家在不知道手术病理结果的情况下分析CT影像资料,同临床资料相结合,共同判定肿瘤TNM分期,结果同手术结果相对照,行2个相关样本Wilcoxon秩和检验,P<0.05具有统计学意义.结果 85例下咽癌或喉癌在没有CT检查结构仅根据临床资料分期的准确性为70.1%,将临床资料同CT检查结果相结合准确性为87.1%.诊断准确率显著提高,P值为0.001.结论 下咽癌及喉癌术前CT检查可明确肿瘤的浸润范围、甲状软骨受侵及颈部淋巴结转移的情况,结合临床资料可明显提高肿瘤分期的准确性.     

下咽癌的CT检查

目的：确定ＣＴ扫描对下咽癌的诊断价值。材料与方法：７例下咽癌行ＣＴ检查。所有病例均经手术和病理证实为鳞癌。对下咽癌的ＣＴ表现进行了分析。结果：下咽癌表现为等密度或混杂密度的实性肿块，无囊变、坏死或钙化，多位于梨状窝或环状软骨后区。由肿瘤所致杓状软骨－椎体距离和环状软骨－椎体距离明显增大。与６０例正常成人对照，统计学表明有非常显著性差异（Ｐ＜０．０１）。杓－椎距和（或）环－椎距测量值大于１０ｍｍ为下咽癌的特征性改变，可用来作为下咽癌的定性诊断指标，并可与喉癌进行鉴别。下咽癌的间接表现包括有：患侧梨状窝变形或消失，喉旁间隙受侵犯、杓会厌皱襞肿胀和甲状软骨板破坏等。结论：薄层ＣＴ扫描可提供下咽癌大小、部位、范围等有用的信息，这对肿瘤的临床分期及手术计划的制定是非常重要的。     

下咽癌的CT诊断

下咽癌是指原发于喉以外的喉咽或下咽区域的恶性肿瘤,临床发病率较低。其发病部位隐蔽,临床发现时多属中晚期。随着影像学的普及,CT已经成为下咽癌的常用检查方法。笔者回顾分析17例经手术或局部活检证实的下咽癌的CT表现,以增强对该病的认识。1资料与方法本组下咽癌患者17例,男12例,女5例;年龄40~85岁,平均63·3岁。检查使用GE公司His-pped或GE公司Prospeed CT扫描机。患者取仰卧位,扫描层面与硬腭平行,扫描范围从舌骨到环状软骨下方,层厚5 mm。10例行平扫,7例行增强扫描,所用造影剂为非离子型,用量为100 ml。观察肿瘤的位置、形态、…     

单期增强CT扫描在下咽癌和喉癌检查中的作用

目的探讨能否用单期增强CT扫描即可对下咽癌和喉癌进行准确的TNM分期。方法收集47例下咽癌喉癌病例的双期增强CT扫描资料。分别测量并比较肿瘤组织CT平扫及早期、晚期增强扫描的密度差异、边界及图像伪影情况。并比较16排CT与单排螺旋CT扫描时,病人所接受的放射剂量。结果47例病人中CT平扫肿瘤组织密度与声带的密度无显著差别。早期增强扫描图像易出现黏膜伪影和/或小血管伪影,增强扫描晚期图像病变边界及浸润范围显示情况与早期增强图像大致相同或更加清晰。相同扫描范围内,16排CT扫描放射剂量是单排螺旋CT剂量的1.5倍。结论下咽癌及喉癌术前CT检查直接行晚期(80s)增强扫描既可清晰显示肿瘤浸润范围,判定肿瘤TNM分期,又可减少病人接受的有效放射剂量。     

Correlation of local outcome after partial laryngectomy with cartilage abnormalities on CT

BACKGROUND AND PURPOSE: The prognostic significance of laryngeal cartilage abnormalities, as seen on CT or MR imaging, in laryngeal or hypopharyngeal cancer, is unclear. The purpose is to determine whether cartilage abnormalities as seen on preoperative CT in laryngeal and pyriform sinus cancer are predictive of local outcome after partial laryngectomy. METHODS: The preoperative CT studies in a consecutive series of 16 patients who underwent extended hemilaryngectomy for squamous cell carcinoma of the glottis (n = 12), supraglottis (n = 1), or pyriform sinus (n = 3) were reviewed retrospectively. Cartilage abnormalities were defined as asymmetric cartilage sclerosis, lysis of ossified cartilage, or tumor visible on both sides of the cartilage. Tumor volume was calculated by using the summation-of-areas technique. Seven patients underwent postoperative radiation therapy. All patients had a follow-up of at least 24 months after treatment or until local recurrence. RESULTS: Eleven patients showed cartilage abnormalities. In six patients, only a single cartilage was abnormal, whereas three patients showed involvement of two cartilages and two patients of three cartilages. The overall average tumor volume was 2.7 mL; the average tumor volume was 1.5 mL in the patients without and 3.3 mL in those with cartilage involvement on CT (P > .05). Two patients suffered a local recurrence. One patient (tumor volume, 1.5 mL) did not show any cartilage abnormalities. The other patient (tumor volume, 1.9 mL) showed abnormalities in all three cartilages and also had evidence of early transcartilaginous tumor spread. CONCLUSION: In patients whose cancer is anatomically suitable for partial laryngectomy, cartilage abnormalities on CT do not preclude speech-preserving surgery.     

Cyclin D1、PCNA、Ki-67细胞周期相关蛋白在喉复发癌组织芯片中的表达和意义

目的研究Cyclin D1、PCNA、Ki-67细胞周期相关蛋白的表达与喉癌复发的关系,并评价其对预后评估的作用.方法回顾分析1958～1999年喉癌手术病例574例,术后随访3年,确诊术后复发56例;正常喉对照标本39例.标本制成组织芯片,采用免疫组化SABC法,对芯片标本进行染色.结果 Cyclin D1、PCNA、Ki-67在喉癌组织及正常喉组织中均有表达,且在喉癌组织的表达强于正常喉组织(P<0.01),在喉癌复发组强于未复发组(P<0.01),与喉癌复发呈正相关.结论 Cyclin D1、PCNA、Ki-67细胞周期相关蛋白的表达可作为估计喉癌预后的指标.     

CT在下咽和喉部肿瘤及肿瘤样病变定性诊断中的价值

目的探讨增强CT扫描在下咽及喉部病变定性诊断中的作用。方法收集76例经手术病理证实的下咽和喉部肿瘤及肿瘤样病变的完整临床资料,其中恶性病变66例,良性病变10例。先行客观定量CT影像征象分析,数据采用逻辑回归分析,以判定能否用CT影像征象来鉴别下咽和喉部病变的良恶性。然后由2位放射学专家双盲判定全部病例,及由另2位放射学专家判断从中挑选的20例病例(10例良性病例与随机选取的10例恶性病例)的病变性质,判断观察者间CT在下咽和喉部病变定性诊断中的准确性及其一致性(Kappa值)。结果逻辑回归分析结果显示在所选取的12个变量中,只有病变发生部位及病变对邻近结构的侵犯情况有统计学意义,可用于诊断病变为恶性。其中病变对周围结构侵犯诊断下咽及喉部病变为恶性的敏感性为53%,特异性为80%,准确性为55%。当大部分病变为恶性时,2位观察者对病变性质的判断有中度一致性(Kappa=0.54),其准确性为84%。当20例中良恶性病例各半时,2位观察者对病变性质的判断一致性很差(Kappa=0.20),且其准确性略好于随机选择的概率。结论用CT影像特征难以判定下咽和喉部病变的性质。     

Barium examination of the pharynx after vertical hemilaryngectomy

Vertical hemilaryngectomy (VHL) is an effective treatment for localized true-vocal-cord carcinoma. Single- and double-contrast barium pharyngoesophagrams in 13 post-VHL patients (11 with dysphagia or suspected tumor recurrence, and two asymptomatic volunteers) were reviewed retrospectively. The two asymptomatic volunteers illustrated the normal postoperative appearance, demonstrating an unaltered pharynx, with no barium aspiration. Barium aspiration into the laryngeal vestibule or trachea was seen in 10 cases and was the only abnormal radiographic finding in four such patients. Three instances of tumor recurrence were identified. In two such cases, aspirated barium revealed a narrowed, irregular lumen of the residual laryngeal vestibule with a mass protruding into the subglottic part of the airway. The third example of recurrent malignancy was manifested by a tracheoesophageal fistula. Findings on the barium examination mimicked recurrent tumor in four cases. In one instance, a mound of granulation tissue protruding into the subglottic airway was confused with tumor recurrence. In three cases, the radiographs demonstrated apparent narrowing and mucosal irregularity of the residual laryngeal vestibule. This appearance was due to early postoperative edema or to transient deformity of the pliable residual hemilarynx during deglutition, as shown by videotaped fluoroscopy.     

Imaging of tumors of the larynx and hypopharynx

Evaluation of patients with laryngeal and hypopharyngeal tumors is based on multidetector CT imaging. The cervicomediastinal CT protocol and general guidelines with regards to planning and acquisition will be detailed. The primary role of imaging is accurate tumor staging but also detection of possible tumor extension to the superior aerodigestive tract and nodal areas. Therefore, images are acquired from the skull base to the cervicomediastinal junction. A chest CT must also be performed to look for distant metastases or other primary tumor. Deep tumor extension, detected only by imaging, is very important to consider for therapeutic planning: surgery or chemoradiotherapy. In case of surgery, accurate evaluation of tumor extension is of great importance to determine whether to perform partial or total surgery. Cervical nodal metastases are very common with laryngeal and hypopharyngeal carcinomas, and accurate staging of nodal disease is important.     

黏附分子E-cadherin、CD44和Tenascin在喉复发癌组织芯片中的表达和意义

目的　研究E cadherin、CD4 4和Tenascin黏附分子的表达与喉癌复发的关系 ,以对预后进行评估。方法　回顾分析 195 8～1999年喉癌手术病例 5 74例 ,术后随访 3年 ,确诊术后复发 5 6例 ;正常喉对照标本 39例。标本制成组织芯片 ,采用免疫组化SABC法 ,对芯片标本进行染色。结果　E cadherin、CD4 4和Tenascin在喉癌组织中有表达 ,其阳性率各有不同。E cadherin蛋白的表达在喉癌复发组明显降低 ,与未复发组比较差异显著 (P <0 0 0 1) ,与喉癌复发呈负相关。而CD4 4、Tenascin蛋白的表达在喉癌复发组明显升高 ,与未复发组比较差异显著(P <0 0 0 1) ,与喉癌复发呈正相关。E cadherin、CD4 4和Tenascin黏附蛋白在喉癌组织的表达与正常组织比较差异有统计学意义 (P <0 0 0 1)。结论　黏附分子E cadherin、CD4 4和Tenascin的表达可作为喉癌预后估计的指标。