增强CT对下咽癌患者甲状软骨受累诊断的价值

Value of Enhanced CT in the Diagnosis of Thyroid Cartilage Involvement in Patients with Hypopharyngeal Carcinoma

目的分析增强CT诊断下咽癌患者甲状软骨受累的临床价值。方法研究对象为我院自2015年1月-2018年1月收治的86例下咽癌患者,均经手术病理证实,术前增强CT影像资料无缺失;以手术病理结果为对照,比较增强CT诊断下咽癌患者甲状软骨受累的临床价值。结果 86例下咽癌患者中,54例病灶位于梨状涡,表现为环形黏膜下浸润形态,其中29例侵犯至杓会厌皱襞及喉腔,19例侵犯至喉旁间隙,6例舌根部及口咽部受侵;32例位于咽后壁,27例肿瘤外突生长,5例浸润性生长,14例肿瘤沿咽后壁向上浸润,18例向下浸润。71例可见不规则软组织密度团结块,15例咽壁广泛增厚,常规CT平扫66例为等密度或低密度,增强扫描呈明显不均匀强化表达,且边界清晰;70例伴颈淋巴结转移,增强扫描时可见环形强化,9例病灶较大患者可见颈部弥漫性低密度影。与病理结果对照,增强CT诊断下咽癌患者甲状软骨受累的灵敏度为64.28%、特异度为89.65%、准确率为81.39%、阳性预测值为75.00%、阴性预测值为83.87%,kappa值0.560。结论增强CT诊断下咽癌患者甲状软骨受累具一定临床价值,值得进一步深入探究。

Objective To analyze the clinical value of enhanced CT in the diagnosis of thyroid cartilage involvement in patients with pharyngeal carcinoma.Methods 86 cases of patients with hypopharyngeal carcinoma who were treated in our hospital from January 2015 to January 2018were selected for the study and were confirmed by surgical pathology,and there were no missing CT imaging data before operation.The results of surgical pathology were taken as controls to compare the clinical value of enhanced CT in the diagnosis of thyroid cartilage involvement in patients with hypopharyngeal carcinoma.Results Among the 86 patients with hypopharyngeal carcinoma,54 lesions were located in the pear-shaped vortex and showed a ring-shaped submucosal infiltration,of which 29 cases were invaded to aryepiglottic fold and laryngeal cavity and 19 cases were invaded to the paralaryngeal space and 6 cases were invaded to tongue root and pharynx oralis.32 cases were located in the posterior pharyngeal wall with 27 cases of tumor outgrowth and 5 cases of invasive growth,and 14 cases infiltrated upward along the posterior pharyngeal wall and 18 cases infiltrated downward.The irregular soft tissue density unity block was seen in 71 cases,and extensively thickened pharyngeal wall was shown in 15 cases,and conventional CT plain scan showed 66 cases were of equal density or low density,and enhanced scan showed obvious uneven enhancement expression and clear boundary.70 cases were with cervical lymph node metastasis and circular enhancement was seen in the enhanced scan,and 9 patients with larger lesions were with diffuse low-density shadow of neck.Compared with pathological results,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and kappa value of enhanced CT in the diagnosis of thyroid cartilage involvement in patients with pharyngeal carcinoma were 64.28%,89.65%,81.39%,75.00%,83.87%and 0.560.Conclusion Enhanced CT has certain clinical value in the diagnosis of thyroid cartilage involvement in patients with pharyngeal carcinoma,and it deserves further investigation.