多层螺旋CT及后处理技术在喉癌及下咽癌侵犯中的诊断价值

目的：探讨多层螺旋CT及后处理技术二维多平面重建（MPR）、三维仿真内镜（CTVE）和三维容积再现技术（VRT）成像对喉癌及下咽癌局部侵犯范围的诊断价值。方法：51例喉癌及下咽癌的患者行术前前瞻性16层螺旋CT检查并行图像后处理（MPR、CTVE和VRT）。采用盲法阅片，分别将CT横断面、MPR及联合图像（横断面结合MPR）与手术病理所见侵犯范围进行对照分析，三维后处理技术CTVE、VRT与喉镜所见侵犯范围进行对照分析，采用多个样本率的≯检验。结果：喉癌81例，下咽癌20例，CT横断面、MPR及联合图像与手术病理对评价会厌、室带、杓会厌襞、声带、前联合、声门下区、喉旁间隙、梨状窝、喉软骨、淋巴结结构侵犯基本一致（P〉0．05）。CTVE图像与喉镜对评估会厌、室带、杓会厌襞、声带、前联合及梨状窝结构侵犯和CTVE图像、VRT图像与喉镜对评估梨状窝、喉室和气管结构侵犯亦基本一致（P〉0．05）。结论：多层螺旋CT及后处理技术能够从二维、三维的角度真实地反映肿瘤部位、形态、大小、浸润范围、淋巴结转移等情况，尤其对肿瘤周围的侵犯、淋巴结转移的判断具有无法比拟的优越性，同时，CTVE可作为电子喉镜很好的补充手段。

The diagnostic value of multi-slice helical CT and image post-progressing technique in laryngeal and hypopharyngeal carcinoma

Objective： To evaluate the diagnostic value of multi-slice helical CT and post-processing tech-nique of two dimension MPR （multi-planar reconstruction）, three-dimensional CTVE （CT virtual endoscopy） and three-dimensional transparent VRT （volume rendering technique） for the extent of regional invasion of laryn- geal and hypopharyngeal carcinoma. Methods： Fifty-one patients with the laryngeal and hypopharyngeal carci- noma were prospectively examined with 16-slice helical CT, then MPR, CTVE, VRT images were reconstructed. The axial images, MPR and the combined image were respectively compared with the pathological results, and the CTVE, VRT image compared with electronic laryngoscope results. These results were studied in a blind way. Results： There were 31 patients with laryngeal carcinoma and 20 patients with hypopharyngeal carcinoma. The results were basic identical （P〉0.05） when assessing the epiglottis, ventricular bands, aryepiglottic fold, vocal cord, anterior commissure, subglottic region, paralaryngeal space, sinus piriformis, cartilage laryngeal and lymph node between the axial, MPR, the combined image and pathological finding of operation. The results were also basic identical （P〉0.05） when assessing the epiglottis, ventricular bands, aryepiglottic fold, vocal cord, anterior commissure, sinus piriformis between the CTVE image and electronic laryngoscope and assessing the sinus piriformis, ventricle of larynx and distortion of airway between the CTVE, VRT image and electronic laryngoscope. Conclusion： The multi-slice helical CT and post-processing technique can display the position, the shape, thesize, the affected extent and metastasis of lymph node comprehensively, especially in the affected extent and metastasis of lymph node. The CTVE is simultaneously good complementary methods to conventional electronic laryngoscope.