鼻咽纤维血管瘤影像学分期研究(附94例分析)

Imaging Staging of the Nasopharyngeal Angiofibroma( 94 Cases Report)

目的系统分析鼻咽纤维血管瘤累及解剖部位,探讨肿瘤术前不同影像学分期的准确性和临床应用价值。方法 94例鼻咽纤维血管瘤患者,以Radkowski(1996)分期标准为参照,按照鼻咽部邻近易累及的18个解剖部位分别编号,记录每例患者累及的解剖结构,对照临床手术分期结果,评价CT分期、MRI分期以及CT结合MRI分期3种模式的准确性。结果与手术分期对照(括号内为对应手术分期例数),70例CT检查分期结果:Ⅰa期4例(4例),Ⅰb期11例(3例);Ⅱa期5例(13例),Ⅱb期17例(19例),Ⅱc期21例(16例);Ⅲa期8例(9例),Ⅲb期4例(6例)。74例MRI检查分期结果是:Ⅰa期6例(6例),Ⅰb期2例(2例);Ⅱa期5例(5例),Ⅱb期21例(20例),Ⅱc期14例(18例);Ⅲa期17例(13例),Ⅲb期9例(10例)。50例CT联合MRI检查分期结果是:Ⅰa期2例(2例),Ⅰb期1例(1例);Ⅱa期4例(4例),Ⅱb期16例(17例),Ⅱc期11例(12例);Ⅲa期9例(7例),Ⅲb期7例(7例)。CT分期、MRI分期以及CT结合MRI分期3种模式中,经Kappa一致性检验,三者的Kappa值分别为0.81、0.92和0.95。结论以解剖结构为基础的CT结合MRI影像分期模式在鼻咽纤维血管瘤术前分期中准确性高,可作为术前分期依据。

Objective To evaluate the accuracy and clinial value of different imaging staging in nasopharyngeal angiofi broma by systematiely analysis of preoperative CT, MR imaging findings. Methods Ninety four patients with nasopharyn geal angiofibroma confirmed by pathology were studied. The involved sites and strutures were recorded based on the Rad kowskistage system（1996）. Compared with the clinical staging system, the accuracy of CT staging system alone, MR ima ging staging system alone and combined CT and MR imaging staging system were evaluated. Results Compared with the clinical staging system, the results of 70 cases of CT staging （number of the bracket indicated clinical staging） were： I A 4 cases（4 cases）, I B stage 11 cases（3 cases） ; Ⅱ A stage 5 cases（ 13 eases）, ⅡB stage 17 eases（ 19 cases）, Ⅱ C stage 21 cases（ 16 cases） ; ⅢA stage 8 eases（9 cases）, ⅢB stage 4 cases（6 cases）. The results of 74 eases of MR imaging mod el were： I A stage 6 cases（6 cases）, I B stage 2 cases（2 cases） ; Ⅱ A stage 5 eases（5 eases）, ⅡB stage 21 eases（20 ea ses）, ⅡC stage 14 cases（ 18 cases） ;ILIA stage 17 cases（ 13 cases）, ⅢB stage 9 cases（ 10 cases）. The results of 50 cases of the combined CT and MR imaging staging were： I A stage 2 eases（2 cases） , I B stage 1 cases（ 1 cases） ; Ⅱ A stage 4 cases （4 cases ）, Ⅱ B stage 16 cases （ 17 cases ）, Ⅱ C stage 11 cases （ 12 cases ） ; DI A stage 9 cases （7 cases ）, ⅡB stage 7 cases （7 cases）. Based on the clinical staging system, the accuracy of three models were compared, including CT imaging, MR imaging, combined CT and MR imaging, the value of Kappa is 0.81, 0.92, 0.95 respectively. Conclusion The staging of combined CT and MR imaging has a higher aceurruey, and can be regarded as the staging system before operation of nasopharyngeal angiofibroma in clinics.