从MRI表现探讨鼻咽癌颅底和颅内侵犯途径

Basicranial and Intracranial Involvement of Nasopharyngeal Carcinoma: Estimation by MRI

目的： 探讨鼻咽癌颅底颅内侵犯途径及其规律。材料与方法： １２７ 例鼻咽癌经ＭＲＩ 检查和病理证实，其中４９ 例确定有颅底和颅内侵犯。观察癌肿的主要扩散方向及其颅内侵犯途径。结果： 癌肿的主要扩散途径以经咽鼓管向后外侵犯最常见（３４ ．７ ％ ） ，其次依次为向前（２５ ．６ ％ ） 、向上（１６ ．３ ％ ） 、向外上（１４ ．３ ％ ） 、向后（６ ．１ ％ ） 和经颈内静脉淋巴结（２ ％ ） ，同一病例常有几种扩散方向，并与原发癌肿的部位和侵入颅内有一定关系；颅内侵犯途径以经破裂孔最常见，其次为卵圆孔、蝶窦侧壁和中颅窝底；４９ 例中Ｔ４ 期４１ 例，Ｔ３ 期８ 例。结论： 鼻咽癌的扩散方向与原发癌肿部位、颅内侵入途径和局部的解剖学特点相关，ＭＲＩ 提供研究的新方法，也为治疗计划的制定提供某些依据。

Objective: To study the infiltrating route to skull base and intracranial part and spreading rule of nasopharyngeal carcinoma (NPC).Materials and Methods:MRI fingdings of 49 NPC cases with basicranial or intracranial involvement were analyzed. The main spreading direction and intracranial involvement pathway were observed and classified.Results:Posterolateral involvement via Eustachian tube was most commonly seen (34.7%), followed in turn by anterial (26.5%), upward (16.3%), superolaterally (14.3%), posteriorly (6.1%) and through jugular nodes (2%). A couple of spreading pathways could be seen in same case, with a certain relation to the site of the primary tumor. Intracranial involvement happened most commonly via the lacerated foramen spreading.Conclusion: Spreading of NPC via the anatomic structure is related to primary tumor site, pathway of intracranial involvement and local anatomic features. MRI provides a new imaging means to demonstrate the extension of NPC, and, thus, is useful for the planning of radiation therapy.