鼻咽癌颅底骨侵犯SPECT及CT检测对比研究

目的 探讨SPECT及CT以鼻咽癌颅底侵犯的检测能力及诊断价值。方法 对63例鼻咽癌初治患者，于放射治疗前同期进行全身前后位加颅底左右侧位SPECT骨显像及鼻咽、颅底连续模断CT检查，采用双盲法对两者检测结果进行比较。结果 SPECT、CT对颅底骨侵犯的阳性检出率在全部患者中分别为63.5%、25.4%；在头痛、颅神经损害及两者并存患者中分别为87.9%、93.3%、92.3%和42.4%、46.7%、46.2%；在T1＋T2期及T3＋T4期患者中分别为37.5%、90.3%和0.0%、51.6%；在N0＋N1期及N2＋N3期患者中分别为63.9%、63.0%和19.4%、33.3%。经McNemar检验，P值均＜0.05,差异有显著性意义。SPECT对鼻咽癌颅底骨侵犯的阳性检出率明显高于CT。SPECT与CT检测符合率为61.9%，不符合率为38.1%。Binary Logistic回归分析结果：头痛及T分期是SPECT阳性检出的危险因素（OR头痛＝3.864,ORT分期＝6.422），T分期及N分期是CT阳性检出的危险因素（ORT分期＝48.932，ORN分期＝2.860）。结论 SPECT对鼻咽癌颅底骨侵犯的检测敏感性优于CT，但特异性不如CT。SPECT检测结果与临床症状、体征、分期有较好的相关性，其诊断价值值得进一步研究。临床上，若结合患者头痛、颅神经损害症状及T、N分期情况，综合分析SPECT及CT结果，有可能提高鼻咽癌颅底骨侵犯的检出率和诊断准确度。

Comparison of SPECT and CT in detecting skull base invasion in nasopharyngeal

Objective To investigate the detecting ability of single photon emission computed tomography (SPECT) and CT in skull base invasion in nasopharyngeal carcinoma. Methods Sixty three patients with nasopharyngeal carcinoma were examined by whole body and skull base SPECT and CT of nasopharynx and skull base before radiotherapy. The results were double blind compared and evaluated. Results The overall positive rates of skull base invasion detected by SPECT and CT were 63.5% and 25.4%. In patients with headache, cranial nerve palsy and both, they were 87.9%,93.3%,92.3% and 42.4%,46.7%,46.2%. In patients with T 1+T 2 and T 3+T 4 lesions, they were 37.5%,90.3% and 0.0%,51.6%. In patients with N 0+N 1 and N 2+N 3 lesions, they were 63.9% ,63.0% and 19.4%,33.3%. The positive rates of SPECT were higher than those of CT (McNemar Test, P < 0.05).The conformation rate between SPECT and CT was 61.9% and the dissimilitude rate was 38.1%. Binary Logistic regression analysis showed that headache and T stages were risk factors of positive SPECT rate(ORheadache=3.864, ORTstage 6.422),while Tstage and Nstage were the risk factors for positive CT rate(ORTstage=48.932,ORNstage=2.860 ). Conclusions The detection sensitivity of SPECT in skull base invasion in nasopharyngeal carcinoma is superior to that of CT. but its specificity is inferior to that of CT. The detecting results in SPECT are better related to symptoms, signs and stage. Combining headache and cranial nerve palsy with T and N stage, we may much improve the results of SPECT and CT in the detection of skull base invasion in nasopharyngeal carcinoma. Further study is warranted.