鼻咽癌侵犯翼腭窝的CT研究

A study of pterygopalatine fossa involvement in nasopharyngeal carcinoma on CT

目的 加深对鼻咽癌 (NPC)侵犯翼腭窝 (PPF)CT表现的认识 ,以提高临床对NPC侵犯范围诊断的准确性。方法 回顾分析 66例颅底受侵的NPC病例 ,并对 3 0例颅底受侵的NPC病例作了前瞻性研究。回顾性病例均为常规扫描 ,前瞻性病例则加作高分辨率CT(HRCT)扫描。结果96例中 ,共有 41例PPF受累 ,经蝶腭孔累及者 2 1例 ,经颞下窝累及者 5例 ,不能确定途径者 1 5例。PPF受侵后可经蝶筛隐窝或翼管侵犯蝶窦 ,本组共有 7例。经HRCT发现翼管和蝶窦受累的病例中 ,冠状面显示分别为 1 1例和 1 0例 ,而横断面显示分别为 5例和 3例 ,二者间差异具有显著性意义(P <0 0 5)。结论 PPF是NPC易于累及的部位 ,肿瘤经此常累及相邻结构 ,其中对蝶窦的侵犯方式值得注意。横断面HRCT较常规横断面CT更能清楚显示翼管、蝶窦等结构的骨质破坏 ;而冠状面HRCT显示翼管及蝶窦受累的情况则显著优于横断面HRCT。

Objective To get deeper understanding of the CT manifestation of PPF invaded by NPC so as to enhance the diagnostic accuracy. Methods Sixty six patients with pathologically proven NPC, scanned by conventional CT, were analyzed retrospectively. Another 30 patients, scanned by both conventional CT and HRCT, were studied prospectively. Results Of all these 96 cases, 41 cases were found with PPF invasion, 21 cases being invaded through sphenoidopalatine foramen, 5 cases through infratemporal fossa, 15 cases through unidentifiable routes. After PPF involvement, the subsequent sphenoid sinus invasion via sphenoidoehtmoid recess or pterygoid canal could be found in 7 cases, 11 cases with pterygoid canal involvement and 10 cases with sphenoid sinus erosion were shown with coronal HRCT, while 5 cases and 3 cases accordingly were presented with axial HRCT ( P <0.05) . Conclusion The structures adjacent to PPF can be involved following PPF invasion, and the way through which sphenoid sinus is invaded deserves further attention. Axial HRCT is advantageous over conventional CT in showing the bone destruction of pterygoid canal and sphenoid sinus, while coronal HRCT is significantly superior to axial HRCT in presenting the involvement of the above mentioned structures.