增强MRI联合DWI序列对恶性肿瘤侵犯甲状软骨的诊断价值研究

目的探讨增强MRI联合DWI序列对喉癌和下咽癌患者的甲状软骨受累诊断价值，为制定合理的治疗方案及术中的具体处理提供重要的参考价值。方法选取自2013年1月~2014年12月在首都医科大学附属北京同仁医院头颈外科197例住院并行手术的原发喉癌及下咽癌患者，所有患者术前均行增强MRI检查，以组织病理学的结果作为金标准，计算增强MRI对喉癌和下咽癌患者的甲状软骨是否受累判断的敏感性、特异性、阳性预测值及阴性预测值，如果MRI判断为甲状软骨受累，还进一步判断肿瘤侵犯甲状软骨范围；影像学结果与病理对比分析并计算敏感性、特异性、阳性预测值及阴性预测值。所得数据并进行统计学分析。结果197例患者均行手术治疗，术后病理示63例患者（32.0%）甲状软骨受肿瘤侵及。MRI判断肿瘤侵犯甲状软骨与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为94%、87%、78%、97%。MRI判断肿瘤侵犯甲状软骨内板与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为90%、82%、61%、96%。MRI判断肿瘤侵犯甲状软骨外板与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为89%、84%、57%、97%。MRI对于甲状软骨内板和外板受累诊断结果的Kappa值分别为0.62和0.60。结论对于局部晚期喉癌或下咽癌是否侵犯甲状软骨的术前诊断中,可以采用常规序列联合SE EPI扩散加权成像弥散序列的MRI诊断。同时应用MRI对肿瘤侵犯甲状软骨范围进行诊断具有可行性。

Diagnostics value of enhanced MRI united with DWI sequence in thyroid cartilage invasion by malignant tumor

ObjectiveTo evaluate the significance of Chinese version of sinonasal outcome test 22 (SNOT 22) in the evaluation of posterior paranasal sinus lesions and to guide the perioperative care.Methods50 patients with posterior paranasal sinus lesions were included, and 50 healthy ones were chosen as control. The quality of life (QOL) statuses of the controls and those of the patients before operation, one, 3, 6 and 9 months after treatment were evaluated with Chinese version of SNOT 22. The total scores and scores of each dimension between the controls and the patients before treatment, and those between the patients before and after treatment were compared. The correlations between QOL statuses, Jorgensen CT staging scores and SNOT 22 scores of the patients were analyzed respectively.ResultsAfter treatment, the QOL in patients with posterior paranasal sinus lesions got improved significantly. There was a weak positive correlation between the preoperative scores of sinonasal Jorgensen CT staging and the Chinese version of SNOT 22.ConclusionThe Chinese version of SNOT 22 can be applied to effectively evaluate the preoperative QOL of patients with posterior paranasal sinus lesions, therefore provide references for treatment options and guide perioperative care.