多层螺旋CT增强扫描在喉癌诊断及临床分期中的应用价值

The value of multislice spiral CT in the diagnosis and staging of laryngeal carcinoma

目的:探讨将多层螺旋CT增强扫描的横断面图像、多平面重建图像(MPR)和仿真喉镜(VE)图像结合起来(联合图像)在喉癌术前诊断及TNM分期中的应用价值。方法:①32例拟诊喉癌患者行术前前瞻性多层螺旋CT增强扫描并行MPR和VE处理。②采用双盲法阅片,将单一横断面图像、MPR和VE联合图像分别作出CT诊断。③临床医师结合CT图像,分别进行国际抗癌协会(UICC)TNM临床分期。④完成喉癌手术,根据病理和电子喉镜确定病理学分期,将2种方法(横断面图像和MPR)的分期结果进行比较。结果:32例喉癌中,联合图像对评价室带、声带、前连合、声门下、声门旁间隙、会厌前间隙、甲状软骨、喉外结构受侵的准确率为98.3%,而横断面图像为91.3%,两者比较其准确率有统计学意义(χ2=20.624,P<0.01);横断面图像对喉癌分期的准确率为81.3%,联合图像为93.8%,两者比较差异无统计学意义(P>0.05)。结论:多层螺旋CT增强扫描的MPR和VE是横断面图像很好的补充,能够帮助提高喉癌诊断水平,横断面图像和联合图像对于喉癌术前临床分期无明显差别。

Objective：To our knowledge,no date are available comparing the impact of multislice spiral CT, and multiplanar reconstruction （MPR） and Virtual endoscopy （VE） on pretherapeutic staging accuracy. The purpose of our study was to determine which imaging should be used as an adjunt to other clinical examinations in the pretherapeutic diagonosis and staging of laryngeal carcinoma. Method：Thirty-two patients with laryngeal carcinoma who were treated surgically, were prospectively underwent by contrast-enhanced multislice spiral CT, and MPR and VE were subsequently done. CT slice thickness 5 mm, table feed was 5 mm,and 100 ml of intravenous contrast material was administered at a flow of 3.0 ml/s. Two radiologists evaluated axial image and the combined image, the results were studied in a blind way. UICCTNM stages were determined by the axial image findings and the combined image findings of axial image, MPR, and VE , were compared and correlated with postoperative pathology and microlaryngoscopy. Result：In the evaluation of the neoplastic invasion of ventricular fold, vocal cord, the anterior commissure, subglottic region,paraglotic space （PGS）, preepiglottic space （PES）, thyroid cartilage, and tissue beyond the larynx, the combined imags were better than axial images in accuracy（98. 3% vs 91. 3%, P〈0.01） ;The accuracy of the combined images staging was 81. 3% and the accuracy of axial image staging was 93.8% ,the difference was not statistically significant（ P〈0.05）. Conclusion： Axial image combined with subsequent MPR and VE could improve the diagnosis in the evaluation of the neoplastic invasion,neither axial image or the combined imags could significantly improve pretherapeutic staging of laryngeal carcinoma.