^(99m)Tc-MDP全身骨扫描中颌面部示踪剂浓集灶分布与鼻咽癌颅底骨侵犯的关系

The relationship between maxillofacial imaging distribution characteristics in ^(99m)Tc-MDP whole-body bone scanning and skull base invasion in nasopharyngeal carcinoma

目的:分析99m Tc-MDP全身骨扫描(WBS)中颌面部示踪剂浓集灶的分布特点及与鼻咽癌颅底骨侵犯的关系,并通过SPECT/CT分析颌面部示踪剂浓集灶的形成原因。方法:93例初诊为鼻咽癌的患者在治疗前均行全身平面骨扫描和鼻咽部SPECT/CT局部骨显像。在全身平面骨扫描的前位颌面部影像中,相对颅骨本底摄取稍高区形成近似五角星区域。五角星的2个下角除外,其余部分分成6个部位,顶部、左连接部、右连接部、左肩部、右肩部、底部。记录这些部位出现示踪剂浓集灶的情况,并与颅底骨侵犯定性结果和SPECT/CT进行对比。分析颌面部6个部位出现示踪剂浓集灶与颅底骨侵犯的关系。结果:93例样本中89例在颌面部共计177个部位出现示踪剂浓集灶,4例未出现示踪剂浓集。这89例中,37例仅累及1个部位、25例累及2个部位、27例累及3个及以上部位,其中分别有24例、20例、24例存在颅底骨侵犯,示踪剂浓集灶累及部位的数量与颅底骨侵犯整体上不存在显著性差异(χ2=5.247,P=0.073)。出现示踪剂浓集的各部位中,顶部75.00%(27/36)、左连接部90.00%(27/30)、右连接部86.49%(32/37)、左肩部82.61%(19/23)、右肩部85.00%(17/20)、底部80.65%(25/31)存在颅底骨侵犯,整体上不存在显著性差异(χ2=5.082,P=0.406)。最高浓集水平所在的部位中,顶部36.36%(4/11)、左连接部94.12%(16/17)、右连接部89.29%(25/28)、左肩部66.67%(6/9)、右肩部60.00%(3/5)、底部73.68%(14/19)存在颅底骨侵犯,整体上存在显著性差异(χ2=16.616,P=0.005)。左连接部和右连接部之间、左肩部和右肩部之间均不存在显著性差异(χ2=0.305,P=0.581;χ2=0.062,P=0.803),故分别合并为连接部、肩部。顶部、连接部、肩部、底部4个部位之间整体上存在显著性差异(χ2=16.400,P=0.001),其中顶部与连接部、顶部与底部、连接部与肩部之间均存在显著性差异(χ2=16.785,P=0.000;χ2=4.043,P=0.044;χ2=5.944,P=0.015),其余每两者间不存在显著性差异。结论:鼻咽癌颅底骨侵犯与WBS颌面部示踪剂浓集灶的最高浓集水平所在的部位有关,特别是当最高浓集水平出现在连接部或底部时,临床上要首先考虑颅底骨侵犯的可能。

Objective： To analyse the relationship between maxillofacial imaging distribution characteristics in ^99mTc-MDP whole-body bone scanning and skull base invasion in nasopharyngeal carcinoma （NPC） and detect its formation reasons by using SPECT/CT. Methods： Ninety-three patients of NPC underwent ^99Tc-MDP whole-body bone scanning and nasopharyngeal SPECT/CT bone scanning before treatment. In the maxillofacial imaging of whole-body bone scanning, a pentagram region with slightly higher radioactivity distribution than skull base was chosen. Except for 2 corners of the pentagram, the rest part was divided into 6 parts, including top part, left connecting part, fight connecting part, left shoulder part, fight shoulder part and bottom part. Abnormal radioactive concentration in these 6 parts was recorded and made comparisons between them. The SPECT/CT and clinical data were considered as the qualitative standard of skull base invasion. Then the relationship between radioactive concentration distribution characteristics of maxillofaeial 6 parts and skull base invasion were analyzed. Results： Eighty-nine cases with 177 lesions were shown radioactive concentration and four cases without in ninety-three cases. Thirtyseven cases with one lesion, twenty-five cases with two lesions and twenty-seven cases with more than three lesions in eighty-nine cases. Skull base invasion was shown 24, 20, 24 cases respectively among that. There was no significantly statistically difference between the amount of lesions and skull base invasion among the radioactive concentration areas （χ^2=5.247, P=0.073）. In the 6 parts of abnormal radioactivity, skull base invasion was confirmed in top part 75.00%（27/36）, left connecting part 90.00%（27/30）, right connecting part 86.49%（32/37）, left shoulder part 82.61%（19/23）, right shoulder part 85.00%（17/ 20）, bottom part 80.65%（25/31）. There was no significantly statistically differences （χ^2=5.082, P=0.406）. In the parts of highest level radioactivity, skull base invasion was confirmed in top part 36.36%（4/11）, left connecting part 94.12%（16/17）, right connecting part 89.29%（25/28）, left shoulder part 66.67%（6/9）, right shoulder part 60.00%（3/5）, bottom part 73.68%（14/19）. Thewas significantly difference （χ^2=16.616, P=0.005）. Left and right connecting parts, left and right shoulder parts were no statistically differences respectively （χ^2=0.305, P=-0.581; χ^2=-0.062, P=-0.803） and merged into connecting part and shoulder part. There was significantly difference among 4 parts（top part, connecting part, shoulder part, bottom part）（χ^2=16.400, P=0.001）. There was significant statistically difference among top and connecting part（χ^2=16.785, P=0.000）, top and bottom part（χ^2=4.043, P=0.044）, connecting and shoulder part （χ^2=5.944, P=0.015）, and no significantly differences between the rest. Conclusions： In wholebody bone scanning of NPC, some characteristics of the skull base invasion is shown in maxillofacial imaging. These features are helpful to make diagnosis of skull base invasion.