肿瘤侵犯食管入口的影像学表现

Imaging appearances of tumors invading esophageal inlet

目的 分析肿瘤侵犯食管入口 (环咽 )的X线、CT和MRI表现 ,探讨肿瘤侵犯食管入口的影像诊断标准。方法 回顾分析 2 7例经临床、病理证实的侵犯食管入口病变的X线、CT和MRI表现。包括原发于食管环咽段的鳞癌 4例 ,颈段食管癌侵犯食管入口 5例 ,梨状窝癌侵犯食管入口 7例 ,喉癌侵犯食管入口 6例 ,甲状腺癌侵犯食管入口 5例。结果 2 7例常规X线均见钡剂通过食管入口受阻 ,16例见食管入口狭窄、黏膜破坏等征象。 2 3例经CT或MRI发现食管环咽段增厚伴杓 椎间距或环 椎间距增大 ,14例MRI均发现肿块与食管入口的界限模糊、消失 ,7例CT发现杓状软骨破坏 ,6例甲状软骨破坏。结论 CT或MRI发现食管环咽段增厚伴杓 椎间距或环 椎间距增大 ,MRI发现肿块与食管入口的界限模糊、消失 ,X线吞钡检查食管入口狭窄、黏膜破坏等征象是食管入口受侵的特征性改变。

Objective To study the imaging appearances of tumors invading esophageal inlet and evaluate the diagnostic criteria of tumor invasion of esophageal inlet. Methods Radiography, CT, and MRI findings of 27 cases with tumors infiltrating esophageal inlet proved by surgery and pathology were analyzed, including 4 primary carcinoma of cricopharyngeas, 5 carcinoma of esophageal, 7 carcinoma of the pyriform sinus, 6 carcinoma of larynx, and 5 carcinoma of thyroid. Results Plain films could display that delayed passage of barium in all 27 cases, 16 cases could show constriction of the esophageal inlet and destruction of the mucosa. CT and MRI could display the distance between arytenoid cartilage and vertebra or the distance between cricoid cartilage and vertebra were increased and cricopharyngeal were thickened in 23 cases. MRI could show the limit between tumor and esophageal inlet were blurred and disappeared in all 14 cases. CT could display destruction of arytenoid cartilage in 7 cases, and destruction of the thyroid lamina in 6 cases. Conclusion The distance between arytenoid cartilage and vertebra or the distance between cricoid cartilage and vertebra were increased and cricopharyngeal was thickened by CT and MRI, the limit between tumor and esophageal inlet was disappeared by MRI, the mucosa of the esophageal inlet was shown constriction and destruction by radiography. These were the characteristic features of tumors invading esophageal inlet.