1100例鼻咽癌的CT表现

目的:分析鼻咽癌原发肿瘤的CT表现,探讨鼻咽癌原发肿瘤的侵犯规律。方法:分析1991年～2006年有完整临床及CT资料且经病理证实的鼻咽癌1100例,男807例,女293例,年龄11～85岁,平均年龄48岁。由二位有经验的影像诊断科医生对CT资料进行分析,分析鼻咽癌原发肿瘤侵犯部位、范围,尤其是肿瘤与颅底及颈部诸间隙的关系。将所有资料输入SPSS11.5统计软件系统,对相关资料进行统计学处理。结果:1100例中,Ⅰ型(鼻咽腔内生长)336例(30.54%),Ⅱ型(邻近超腔生长)317例(28.82%),Ⅲ型(远腔生长)447例(40.64%)。445例侵犯颅底结构,占全部病例的40.45%。其中蝶窦侵犯比例最高,为330例(30%),其次分别为破裂孔293例(26.64%)、翼突276例(25.09%)、翼管268例(24.36%)、斜坡226例(20.55%)、翼腭窝205例(18.64%)、卵圆孔201例(18.27%)、棘孔195例(17.73%)、海绵窦154例(14%)、眶下裂147例(13.36%)、岩枕缝137例(12.45%)等。205例共228侧翼腭窝受侵,肿瘤经蝶腭孔侵入143例161侧(70.61%)。鼻咽癌侵犯翼腭窝后肿瘤侵及眶下裂144侧(63.16%)、经眶下裂侵及眶尖44侧(19.30%)、眶上裂28侧(12.28%)、海绵窦27侧(11.84%)、侵及圆孔91侧(39.91%)。结论:鼻咽与颅底贴邻,容易破坏颅底结构并经颅底孔道侵入颅内。蝶窦侵犯比例最高,其次分别为破裂孔、翼突、翼管、斜坡、翼腭窝、卵圆孔、棘孔、海绵窦、眶下裂等。鼻咽癌容易侵犯翼腭窝,受侵后需注意观察肿瘤是否通过与其相连的管道结构向周围蔓延,尤其需注意翼腭窝受侵后通过眶下裂侵犯眶尖、眶上裂、海绵窦。

The CT manifestations of nasopharyngeal carcinoma in a series of 1100 cases

Objective:The purpose of this study was to recognize tumor spreading patterns of nasopharyngeal carcinoma(NPC)at the primary sites on the initial CT scans.Methods:CT scans of 1100 patients with histologically proven NPC,who were treated in our hospital from 1991 to 2006 with intact clinical and imaging files,were retrospectively reviewed by two experienced radiologists.Those patients included 807 men and 293,women with ages ranging from 11 to 85 years(median 48 years).The location and extension of the primary tumors on the initial CT scans were analysed,especially whether or not and in which way the tumors involved in the skull base or grew into any of the adjacent neck spaces.All the data were statistically processed with SPSS 11.5 software.Results:The tumor spreading patterns of the 1100 cases were classified into 3 types.336 cases(30.54%)were type 1,superficial growing type,which meant that tumor was confined to the nasopharyngeal cavities.317 cases(28.82%)were type 2,adjacent invasion type,which was defined as that the tumors only invaded the adjacent spaces.447 cases(40.64%)belonged to type 3,ultra-cavity invasive type,which indicated that tumor grew beyond the adjacent spaces.The skull base was involved in 445 cases(40.45%).The leading site involved was sphenoid sinus in 330 cases(30%),followed by foramen lacerum in 293(26.64%),the pterygoid process in 276(25.09%),the pterygoid canal in 268(24.36%),clivus in 226(20.55%),the pterygopalatine fossa in 205(18.64%),foramen ovale in 201(18.27%),foramen spinosum in 195(17.73%),the cavernous sinus in 154(14%),the infraorbital fissure in 147(13.36%),and the petrooccipittal fissure in 137(12.45%).A total of 228 sides of the pterygopalatine fossa in 205 cases were involved.And among them,161 sides(70.61%)in 143 cases were via the sphenopalatine foramen.From the pterygopalatine fossa,tumors grew further into the infraorbital fissure on 144 sides(63.16%).And from the infraorbital fissure,tumors invaded the supraorbital fissure on 28 sides(12.28%),the cavernous sinus on 27 sides(11.84%),the round foramen on 91 sides(39.91%),and the orbital apex on 44 sides(19.30%)respective-ly.Conclusion:The common sites to be invaded by the primary tumors of nasopharyngeal carcinoma in descending order were the sphenoid sinus,the foramen lacerum,the pterygoid process,the pterygoid canal,clivus,the pterygopalatine fossa,foramen ovale,foramen spinosum,cavernous sinus,infraorbital fissure and others.When the pterygopalatine fossa was involved,special attention should be paid to the possible further extensions into the adjacent structures through the connected canals,such as to the orbital apex,the supraorbital fissures or the cavernous sinus via the infraorbital fissures.