鼻咽癌颅底侵犯的影像学诊断与临床分析

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

目的探讨鼻咽癌颅底侵犯的临床特征和影像学诊断价值。方法对67例鼻咽癌资料进行回顾性分析,所有资料均经病理确诊并行CT、MRI平扫和增强扫描。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,两者的显示差异有统计学意义(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扫描除显示骨质改变外,还能清楚显示通过孔道的肿瘤。3)头痛、脑神经受累及两症状均出现的发生概念分别为84.6%(44/52)、69.2%(36/52)、57.7%(30/52)。结论MRI显示颅底和脑组织受侵优于CT;头痛和颅神经症状是鼻咽癌颅底侵犯的主要特征。

Objective The purpose of this work was to investigate and analyze the clinical and imageological features of skull base erosion in nasopharyngeal carcinoma （NPC）. Methods Sixty-seven NPC patients proved by pathology wen retrospectively reviewed, which underwent both CT and MRI plain plus enhancement scan. Scan slices were. done from oral pharynx （lower border of second cervical vertebra） to suprasellar cistern. Results 1） 52 patients with skull base erosion were found on MRI, and only 35 on CT. The display percentage had statistical difference（x^2=9.47, P=0.02）. 2） Skull base erosion on CT scan was mostly bone destruction, however, not only bone destruction but also tumor crossing skull base structure could be seen on MRI scan. 3） The incidence of headache was 84.6%（44/52）, cranial nerve palsy 69.2%（36/52）, headache or cranial nerve palsy in skull base erosion 57.7%（30/52）. Conclusions MRI is superior to CT in demonstrating both skull base and soft tissue abnormality. Headache and cranial nerve palsy are primary characteristic of the skull base erosion in nasopharyngeal carcijoma.