MRI in recurrent nasopharyngeal carcinoma

In this study, we retrospectively reviewed the MRI features of recurrent nasopharyngeal carcinoma (NPC) in 72 patients who underwent MRI before and after gadolinium injection. Recurrent NPC exhibited a high degree of regional spread and a variety of signal intensities and contours. MRI showed a nasopharyngeal mass in 50 patients (69.4 %); other sites of involvement included the parapharyngeal space (44.4 %), nasal cavity (12.5 %), paranasal sinuses (27.8 %), oropharynx (4.2 %), orbit (8.3 %), infratemporal fossa (18.1 %), skull base (59.8 %), intracranial area (51.4 %) and regional lymph nodes (15.3 %). On T2-weighted images, the nasopharyngeal mass gave high signal in 9 of 50 cases (18 %), intermediate in 27 (54 %), mixed in 8 (16 %) and low signal in 6 (12 %). Contrast enhancement was strong in 12 cases (24 %), moderate in 29 (58 %) and heterogeneous in 9 (18 %). The lesion was convex in 31 cases (62 %) and concave or straight in 19 (38 %). Recognition of the distribution and the appearance of recurrent NPC on MRI is essential for timely diagnosis and appropriate treatment. Received: 20 August 1998 Accepted: 2 February 1999     

鼻咽癌侵犯周围结构与肿瘤分期关系的MRI研究

目的 应用MRI探讨鼻咽癌侵犯周围结构的规律及其与肿瘤T分期的关系.方法 回顾性分析1573例经病理证实的鼻咽癌初诊患者,根据2008年鼻咽癌T分期,观察鼻咽癌向周围结构侵犯的MRI表现和规律.对鼻咽癌周围不同方向结构的侵犯率均采用Z检验分析.结果 鼻咽癌对周围结构的侵犯:咽颅底筋膜1299例(82.58%)、咽旁间隙1090例(69.29%)、鼻腔304例(19.33%)、口咽49例(3.12%)、颈动脉间隙514例(32.68%)、翼内肌661例(42.02%)、翼外肌210例(13.35%)、颅底骨质943例(59.95%)、颅神经630例(40.05%)、鼻窦242例(15.38%).T分期分布:T1期为242例(15.38%),T2期为288例(18.31%),T3期为410例(26.06%),T4期为633例(40.24%).鼻腔受累的病例中90.46%(275/304)合并T3以上的结构受累;口咽受累均伴有T3以上结构受累;翼内肌受累的病例中69.14%(457/661)伴有T4结构侵犯;鼻窦受累的病例中92.15%(223/242)伴有T4结构侵犯.鼻咽癌侵犯周围结构的模式为向侧方(1299例)多于向上(943例)侵犯(Z=14.025,P＜0.01);向侧方侵犯多于向下(49例)(Z=45.032,P＜0.01);向上侵犯多于向下(Z=34.301,P＜0.01);向前侵犯(304例)多于向下(Z=14.404,P＜0.01).结论 鼻咽癌侵犯周围结构的模式为向侧方侵犯多于向上;向侧方侵犯多于向下;向上侵犯多于向下;向前侵犯多于向下.     

MRI在鼻咽癌放疗后随访中的应用价值

目的:探讨MRI在鼻咽癌放疗后随访中的应用价值。方法:72例鼻咽癌放疗后病人,均行MRI扫描,其中32例行Gd-DTPA强化扫描。结果:局部软组织肿块33例,颅底骨质破坏49例,肌肉受累23例,淋巴结增大25例,放射性脑病12例,27例鼻咽部出现放疗后纤维化表现。结论:MRI在鼻咽癌放疗后随访中具有明显优势。     

鼻咽癌放疗后脑干损伤的MRI诊断

目的 :提高对鼻咽癌放疗后脑干损伤MRI表现的认识与诊断水平。方法 :分析鼻咽癌放疗后脑干损伤的 17例患者MRI检查资料 ,本组病例在放疗后 0 .5～ 12年出现不同程度颅神经损伤症状。结果 :病变好发于脑干 ,表现为稍长或长T1、长T2 信号。注射Gd DTPA后大多数病例强化。结论 :鼻咽癌放疗后脑干损伤的MRI表现具有一定特点 ,MRI是诊断该病的有效方法。     

Extension patterns of nasopharyngeal carcinoma

The nasopharynx represents an intersection between the nasal choanae, the oropharynx, the deep facial spaces, the skull base and the intracranial cavity. Most nasopharyngeal neoplasms are malignant tumors showing aggressive local infiltration along well-defined routes. The primary role of imaging is accurate tumor mapping and detection of possible tumor extension, especially to the skull base and the deep facial spaces. The aim of this paper is to illustrate these extension patterns of nasopharyngeal carcinomas on imaging and to show the particular implication of imaging in the correct staging of the lesion.     

Magnetic resonance imaging staging of nasopharyngeal carcinoma in the head and neck

Magnetic resonance imaging (MRI) is the modality of choice for staging nasopharyngeal carcinoma in the head and neck. This article will review the patterns of primary and nodal spread on MRI with reference to the latest 7th edition of the International Union Against Cancer/American Joint Committee on Cancer staging system.     

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     

鼻咽癌侵犯前中颅窝的MRI表现

目的探讨鼻咽癌向前、中颅窝侵犯的ＭＲＩ征象。方法回顾分析３９例有颅神经损伤并经病理确诊的鼻咽癌病例,用１．０Ｔ磁共振机,行头颅、鼻咽部轴位和冠状面Ｔ１ＷＩ、Ｔ２ＷＩ和矢状面Ｔ２ＷＩ扫描,应用钆喷替酸葡甲胺（ＧｄＤＴＰＡ）增强后,分别行轴位、冠状面、矢状面Ｔ１ＷＩ扫描。结果（１）前颅窝受侵１３例,筛窦受侵３例,眶尖、球后受侵４例,两者同时受侵６例。（２）中颅窝受侵３８例,蝶骨体破坏３２例,蝶窦肿块２５例,破裂孔异常２０例,卵圆孔异常２８例,蝶鞍破坏６例,海绵窦受侵３５例。结论鼻咽癌经破坏颅底骨质、进出颅腔的自然骨性通道和两者并存的３种途径向前、中颅窝侵犯,ＭＲＩ能准确显示侵犯途径和程度     

鼻咽癌脑膜侵犯的MRI研究

目的 探讨鼻咽癌脑膜侵犯的途径,MRI表现及其病理基础。方法 搜集25例鼻咽癌脑膜侵犯病例的MRI检查资料,全部病例经平扫加钆喷替酸葡甲胺（Gd-DTPA）增强扫描,9例经手术病理结果与MRI对比分析,1例脑脊液细胞学检查阳性。结果 （1）鼻咽癌侵犯脑膜主要有3条途径：①经颅底自然骨性通道侵犯11例;②经颅底骨侵犯10例;③经血行转移43例。（2）鼻咽癌脑膜侵犯表现为硬膜型24例,柔脑模型1例。（3）MRI表现为大片状脑膜增厚,可呈“花边状”、结节状甚至肿块形成,增强后有明显的对比增强,脉络膜转移1例,表现为侧脑室增大,室管膜下结节及条片状增厚的转移灶。结论 MRI为鼻咽癌脑膜侵犯的重要检查方法,增强扫描对显示病灶的部位、范围有重要意义。     

鼻咽癌咀嚼肌间隙侵犯的MRI表现

目的：探寻鼻咽癌咀嚼肌间隙侵犯的各种MRI表现。方法：100例病理确诊无远处转移NPC病例放疗前MRI检查。结果：100例中咀嚼肌间隙受侵犯58例。按咀嚼肌间隙侵犯途径及各部分受侵情况分为由内向外侵犯53例：翼内肌侵犯53例,翼内肌及间隙受侵33例,翼内外肌受侵21例,翼肌及颞肌受侵2例,翼肌、颞肌及咬肌受侵1例。经咽颅底筋膜与中颅窝底之间隙直接侵犯翼外肌3例;肿大淋巴结侵犯颞肌及咬肌各1例。按信号改变分为同时表现为T1WI信号降低,T2WI信号升高,增强后异常强化47例;MRI平扫未显示,仅增强后异常强化11例。结论：咀嚼肌间隙侵犯一般沿从内到外的途径。MRI咀嚼肌间隙侵犯的主要表现为T1WI信号降低,T2WI信号升高及增强后异常强化。     

F-18 FDG PET in detecting renal cell carcinoma

Purpose: To assess the role of F-18 FDG imaging with a dual head coincidence mode gamma camera (Co-PET) in the detection of renal cell carcinoma (RCC) in patients with renal masses.

Material and Methods: An F-18 FDG Co-PET study was performed in 19 patients (7 F, 12 M; mean age 58.15±2.5 years, age range 45-79 years) with suspected primary renal tumors based on conventional imaging techniques, including computed tomography (CT) and ultrasonography (US) before nephrectomy or surgical resection of the mass.

Results: Histologically documented RCC was present in 15 patients. Of the 19 patients with suspected primary renal tumors, F-18 FDG Co-PET was true-positive in 13, false-negative in 2, true-negative in 3, and false-positive in 1 patient. Two angiomyolipomas and one renal mass due to infarction and hemorrhage showed a true-negative Co-PET result. The patient with false-positive FDG Co-PET study was diagnosed as xantogranulomatous pyelonephritis. Overall sensitivity, specificity, and accuracy of FDG Co-PET for RCC were 86% (13/15), 75% (3/4), and 84% (16/19), respectively. Positive predictive value for RCC was 92% and negative predictive value 60%.

Conclusion: These findings suggest that F-18 FDG Co-PET may have a role in the diagnostic evaluation of patients with RCC and primary staging of disease. Positive F-18 FDG study may be predictive of the presence of RCC. However, a negative study does not exclude the RCC.     

多参数MRI影像组学模型对进展期鼻咽癌局部复发的预测价值

目的：探讨多参数磁共振成像（magneticresonanceimaging,MRI）影像组学模型对进展期鼻咽癌（nasopharyngeal carcinoma,NPC）局部复发的预测价值。方法：回顾并分析经病理学检查证实的86例进展期NPC的临床及影像学资料,将35例经病理学检查证实复发的患者列入复发组,51例随访无复发的患者列入无复发组。所有患者均行MRI扫描,采集初诊、放疗结束时及放疗后6个月共3个时间点的轴位T1加权成像（T1-weighted imaging,T1WI）增强扫描、T2加权成像（T2 weighted imaging,T2WI）-短时间反转恢复（short time inversion recovery,STIR）,采用Spearman相关分析提取特征参数,回归特征消除（recursive feature elimination,RFE）算法对冗余特征进行降维,再通过Ridge Classifier分类器学习得到预测模型,5折交叉验证法训练并验证模型。结果：进展期NPC复发组的复发间隔时间为7～61个月,中位时间为24个月。基于3个时间点T2WI-STIR及T...     

鼻咽癌侵犯鼻窦的MRI表现(附86例病例分析)

目的：分析鼻咽癌侵犯鼻窦的磁共振（MRI）表现,探讨MRI在诊断鼻咽癌侵犯鼻窦中的作用。方法：回顾分析鼻咽癌并鼻窦侵犯的86例患者的MRI表现。结果：MRI表现为窦壁破坏100%,窦壁黏膜增厚52.3%,窦腔内软组织肿块65.1%,鼻窦内侵犯病灶与鼻咽肿瘤相连97.7%,合并积液25.6%。横断面T1WI、T2WI、CE-T1WI所示病灶三者间差异无显著性意义,矢状面T1WI、冠状面FSIR和冠状面CE-T1WI示肿瘤侵犯蝶窦为100%,横断面T2WI和CE-T1WI对显示筛窦、上颌窦受侵最佳。结论：窦壁骨质破坏、连续性中断;窦壁黏膜不均匀性增厚;窦腔内肿块与鼻咽肿瘤主体相连,且有相同程度的强化;T1WI呈等或稍低信号,T2WI为等或稍高信号;增强扫描明显强化,是诊断鼻窦受侵犯的要点。因此,MRI的横断面T2WI、矢状面T1WI、冠状面FSIR及增强扫描在鼻咽癌鼻窦受侵犯的诊断中作用较大。     

Orbital Metastases as Presenting Sign of Lung Carcinoma: Detection of Primary Malignancy and Disease Burden by F-18 FDG PET/CT

Metastases to orbit occur rarely but are the most common form of malignant orbital tumors. Usually the orbital metastases occur in disseminated disease. Very rarely orbital metastases can be the presenting feature of systemic malignancy. We report here a case with orbital metastases as the presenting feature of lung malignancy and describe the utility of FDG PET/CT as one-stop-shop imaging modality in this setting.     

鼻咽癌放疗后放射性脑病的1H-MR波谱研究

目的　探讨鼻咽癌放疗后放射性脑病的磁共振氢波谱 (1H MRS)表现 ,了解N 乙酰天门冬氨酸 (NAA)、肌酸 (Cr)和胆碱 (Cho)这 3种物质的代谢规律 ,为放射性脑病的早期诊断提供方法。方法　对照组 10例健康志愿者 ,病例组 2 1例病理诊断为鼻咽癌并进行根治性放疗后经症状及影像学诊断为放射性脑病的病人 ,用化学位移成像法 (CSI)行1H MRS检查。观察各像素中NAA、Cr和Cho的含量、代谢图及它们之间比例。结果　放射性脑病MRI可见病灶中的液化坏死区 3种物质含量基本为零 ,代谢图中无信号 ;可见病灶中非液化坏死区NAA轻度升高 ,Cr和Cho明显降低或为零 ,NAA代谢图呈高信号 ,Cr和Cho低信号 ;可见病灶周边存在 1个区域性的NAA降低、Cr和Cho升高 ,NAA/Cr和NAA/Cho <1,代谢图中信号区分不明显 ;远离可见病灶的区域NAA、Cr和Cho含量及比例正常。结论　1H MRS发现物质代谢变化是有规律的 ,变化的区域大于MRI中可见病变区 ,为早期诊断提供了可能性。     

High-dose gadolinium-enhanced MRI for diagnosis of meningeal metastases

We compared high-dose (0.3 mmol/kg) and standard-dose (0.1 mmol/kg) gadolinium-enhanced MRI for diagnosis of meningeal metastases in 12 patients with suspected meningeal metastases. They were imaged with both standard-dose and high-dose gadolinium. All patients with abnormal meningeal enhancement underwent at least one lumbar puncture for cerebrospinal fluid (CSF) cytology, while patients with normal meningeal enhancement were followed clinically. All patients with negative CSF cytology also were followed clinically. A single observer reviewed all the images, with specific attention to the enhancement pattern of the meninges. Abnormal leptomeningeal enhancement was present in three cases, and abnormal pachymeningeal enhancement in three other patients. All of these patients had abnormal CSF analyses. In two of the three cases of abnormal leptomeningeal enhancement the disease was more evident on high-dose than on standard-dose imaging; in one case the abnormal enhancement was visible only on high-dose imaging. In one of the three cases with abnormal pachymeningeal enhancement, the disease was evident prospectively only with high-dose imaging. Received: 5 June 1997 Accepted: 12 June 1997     

鼻咽癌MRI动态增强曲线及其时间窗

目的：探讨MRI动态增强曲线及时间窗对鼻咽癌及其放疗后改变的诊断价值。方法：原发或经放射治疗后的鼻咽癌患者57例,将其分为3组,其中未经治疗组33例,放疗后纤维化组18例,放疗后复发组6例,所有病例治疗前的病理诊断均为鳞状细胞癌。观察和分析3组病例增强前后的MRI表现,采用FLASH序列获取3组病例的时间-信号强度曲线...     

鼻咽癌鼻咽后部筋膜间隙受累的影像学分析

目的:分析鼻咽癌鼻咽后部筋膜间隙受累的影像学表现,探讨椎前肌侵犯与颅底枕骨侵犯的相关性.方法:搜集行鼻咽及颈部MRI检查且未经治疗的新发鼻咽癌患者152例,总结其病变周围组织结构侵犯的规律,并结合文献分析鼻咽癌鼻咽后部筋膜间隙受累的相关性.结果:鼻咽癌鼻咽周围组织结构侵犯以椎前肌(62.50％,95/152)最常见,其...     

鼻咽癌放射治疗后颞叶放射性脑病低场MR诊断

目的分析鼻咽癌(NPC)放疗后颞叶放射性脑病(REP)的低场强MRI表现,探讨其影像学特征性改变。方法分析25例鼻咽癌放疗后诊断为颞叶放射性脑病(REP)患者MRI表现和临床资料及随诊观察。结果 25例REP中累及单侧颞叶9例,累及双侧颞叶16例。表现为局限性脑水肿并局灶性坏死:病灶为斑片状或不规则形,T1WI呈低信号或等信号;T2WI呈高信号或等高混杂信号。T1WI+Gd-DTPA增强扫描可见脑回状或不规则环形强化。12例经治疗后行MRI复查,2例症状改善,MRI异常信号明显减少,9例病灶无变化,其中3例症状有改善,6例症状体征无变化,1例病灶增大。结论鼻咽癌放射治疗后REP的MRI表现有一定的特征性,可作为REP诊断的主要方法。     

Calcified brain metastases from ovarian carcinoma

A case of calcified brain metastases from ovarian carcinoma is reported. Lesions developing during chemotherapy were thought on Ct to be parasitic and, to avoid dissemination of pathogens, biopsy was postponed. When neurological deficits progressed, MRI showed perifocal oedema and contrast enhancement. It also showed a new noncalcified focus which was biopsied, proving to be a metastasis.