摘要
目的:探讨 SPECT 及 CT 对鼻咽癌颅底骨侵犯的检测能力及诊断价值。方法:对63例鼻咽癌初治患者,放射治疗前同期进行全身前后位加颅底左右侧位 SPECT 骨显像及鼻咽、颅底连续横断 CT 检查。采用双盲法对两者检测结果进行比较。结果:SPECT、CT 对颅底骨侵犯的阳性检出率在全部患者中分别为63.5%、25.4%;在头痛、颅神经损害及两者并存患者中分别为87.9%、93.3%、92.3%和42.4%、46.7%、46.2%;在 T_1+T_2期及 T_3+T_4期患者中分别为37.5%、90.3%和0.0%、51.6%;在 N_0+N_1期及 N_2+N_3期患者中分别为63.9%、63.0%和19.4%、33.3%。经 Mc-Nemar 检验,P 值均<0.05,差异有显著性意义。SPECT 对鼻咽癌颅底骨侵犯的阳性检出率明显高于 CT。SPECT 与 CT 检测符合率为61.9%,不符合率为38.1%。Binary Logistic 回归分析结果:头痛及 T 分期是 SPECT 阳性检出的危险因素(OR_(头痛)=3.864,OR_(T 分期)-6.422,T 分期及 N 分期是 CT阳性检出的危险因素(OR_(T 分期)48.932,OR_(N 分期)-2.860)。结论:SPECT 对鼻咽癌颅底骨侵犯的检测敏感性优于 CT,但特异性不如 CT。SPECT 检测结果与临床症状、体征、分期有较好的相关性,其诊断价值值得进一步研究。临床上,若结合患者头痛、颅神经损害症状及 T、N 分期情况,综合分析SPECT 及 CT 结果,有可能提高鼻咽癌颅底骨侵犯的检出率和诊断准确率。
Objective:To investigate the detective ability and diagnostic value of SPECT and CT in skull base invasion of nasopharyngeal carcinoma.Methods:Sixty-three patients with nasopharyngeal carcinoma underwent SPECT of whole body and skull base bone and concomitantly underwent CT of naso- pharynx and skull base before radiotherapy.The results were double blind compared and evaluated.Re- suits:The positive rate of skull base invasion detected by SPECT and CT were 63.5%,25.4% respec- tively in all patients,were 87.9%,93.3%,92.3%,;42.4%,46.7%,46.2%,respectively in pa- tients with headache and/or cranial nerve palsy,were 37.5%,90.3%;0.0%,51.6%,respectively in patients with T_1+T_2 and T_3+T_4,were 63.9%,63.0% ;19.4%,33.3%,respectively in patients with N_0+N_1 and N_2+N_3.The positive rate of SPECT was higher obviously than CT(McNemar Test,P< 0.05).The corresponding rate between SPECT and CT was 61.9%,The incorresponding rate was 38.1%.Binary Logistic regression analyses showed that headache or T staging and T or N staging were risky factors of positive rate detected by SPECT and CT respectively(OR_(headache)=3.864,OR_(Tstage)-6.422; OR_(Tstage)-48.932,OR_(Nstage)-2.860.Conclusion:The detective sensitivity of SPECT in skull base inva- sion of nasopharyngeal carcinoma was superior to CT.but the creditability was insufficiently to CT.The detective results of SPECT were better relativity with symptom and sign and stage.There is necessary to study deepgoing the diagnostic value of SPECT.If combining headache and cranial nerve palsy with T and N stage,synthesizing the results of SPECT and CT,the positive rate and exact rate detected for skull base invasion of nasopharyngeal carinoma may be improved.
