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。

Evaluation of CT in Diagnosis and Differentiation of Hypopharyngeal Carcinoma:An Analysis of 40 Cases

Objective To evaluate CT scanning in diagnosing and differentiating hypopharyngeal carcinoma. Materials and Methods CT findings in 40 patients with pathologically proved hypopharyngeal carcinoma were retrospectively analyzed. Results The main CT manifestations of hypopharyngeal carcinoma were as follows. (1) Location: the lesion was located at the superior part of hypopharynx in 5 cases (12.5%), at pyriform sinus in 27 cases (67.5%), at retropharynx or postcricoid area in 6 cases (15%) and mixed in 2 cases (5%). (2) Lesion's density: iso- or slight low- density on plain scans, and obvious inhomogeneous enhancement on enhanced scans. (3) Narrowing or disappearing of pyriform sinus. (4) Thickening of retropharyngeal soft tissue and widening of cricoid cartilage-vertebra or arytenoid cartilage-vertebra distance. (5) Displaced larynx and involvement of neighboring structures. (6) Destructed laryngeal cartilage (30%). (7) Metastasis of cervical lymph nodes (77.5%). (8) Involvement of the esophagus and other organs.Conclusion CT scanning can correctly display the extent of the lesion, including the involvement of laryngeal cartilage, para-glottal space, pre-epiglottal space and cervical lymph nodes. Hypopharyngeal carcinoma should be differentiated from laryngeal carcinoma. Based on The lesion's location, the rotation and displacement of the vocal cord as well as the widening of the cricoid cartilage-vertebra or arytenoid cartilage-vertebra distance are all helpful for the differentiation.