鼻咽癌颅底侵犯的临床及影像学分析

目的分析鼻咽癌(NPC)颅底侵犯的临床特征和影像学诊断价值。方法对病理确诊的67例NPC病例资料进行回顾性分析,所有资料均有CT、MRI平扫和增强扫描。CT常规采用横断面扫描,MRI采用横断面、矢状面、冠状面扫描,扫描层面自口咽到鞍上池水平。结果① MRI扫描显示52例有颅底侵犯,CT显示35例。CT和MRI对颅底结构侵犯显示例数如下:翼板8 例,14例;斜坡22例,25例;岩尖25例,28例;蝶骨体或蝶窦19例,25例;蝶骨翼9例,12例;海绵窦14例,17例。两者的显示差异有显著意义(x2=9．47,P=0．02)。②颅底侵犯的CT表现主要为孔道的骨质破坏和吸收,而MRI除骨质改变外,还能清楚显示通过孔道的肿瘤。③头痛、颅神经受累及两症状均出现的发生率分别为82．7％(43／52)、67．3％(35／52)和57．7％(30／52)。结论头痛和颅神经损害症状是NPC颅底侵犯的主要特征;MRI诊断颅底和脑组织受侵优于CT。

Clinical and imageologicai analysis of the skull base erosion in nasopharyngeal carcinoma

Objective To investigate and analyze the clinical and imageological features of skull base erosion in nasopharyngeal carcinoma( NPC). Methods 67 NPC patients proved by pathology were retrospectively reviewed. All patients underwent both CT and MRI plain plus enhancement scan. Scan slices were performed from oral pharynx (lower border of second cervical vertebra) to suprasellar cistern by axial CT scans and axial, sagittal and coronal MRI scans. Results (1) 52 patients with skull base erosion were found with MRI, and only 35 patients with CT. The following structures and figures were difined with CT and MRI respectively: pterygoid plates 8,14; clivus 22,25 ; petrous apex 25 ,28 ; sphenoid body or sinus 19,25; sphenoid wing 9, 12; cavernous sinus 14,17. The display difference between CT and MRI had statistical significance ( x2= 9. 47 , P = 0. 02). (2) CT- defined skull base erosion was most bone destruction , however, not only bone destruction but also tumor crossing skull base structure could be defined by MRI. (3) The incidence of headache was 82.7% (43/52) , cranial nerve palsy was 67. 3% (35/52) , both headache and cranial nerve palsy was 57. 7% (30/52). Conclusion Headache and cranial nerve palsy are primary characteristics of the skull base erosion in NPC. MRI is superior to CT in defining both bone erosion and brain tissue abnormality.