磁共振弥散加权成像对鼻咽癌放疗后颈部淋巴结复发早期诊疗的临床价值

Clinical value of magnetic resonance diffusion-weighted imaging in early diagnosis and treatment of cervical lymph node recurrence after radiotherapy of nasopharyngeal carcinoma

目的探讨磁共振弥散加权成像(MR-DWI)对鼻咽癌放疗后颈部淋巴结复发的早期诊断价值,为此类患者行针对性诊疗提供依据。方法回顾分析2005-2016年间放疗后17例颈部淋巴结复发患者MR-DWI特点,总结淋巴结复发后诊疗结果。结果17例患者复发淋巴结MR-DWI均呈高信号或高低不等混杂信号,其敏感性为100%,而T2压脂序列的敏感性为60%。对高度怀疑单颈部单区复发患者行PET-CT或穿刺活检协助诊断,早期手术治疗具有更好的预后。结论MR-DWI对鼻咽癌放疗后复发颈部淋巴结的敏感性极高,尤其是易被忽视的5~10mm淋巴结,对该类单颈部单发患者行PET-CT检查,通过多模态影像学诊断证实其性质,及时手术对提高颈部淋巴结复发患者的治疗效果及生活质量有重要临床意义。

Objective To explore the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in the early diagnosis of cervical lymph node recurrence after radiotherapy of nasopharyngeal carcinoma, aiming to provide reference for targeted diagnosis and treatment of these patients. Methods The MR-DWI features of 17 patients with recurrent cervical lymph nodes after radiotherapy from 2005 to 2016 were retrospectively analyzed. The results of diagnosis and treatment after lymph node recurrence were summarized. Results The recurrent lymph nodes of 17 patients showed a high signal or mixed signal on MR-DWI images. The sensitivity of MR-DWI and T2WI fat suppression sequence was 100% and 60%. Positron emission tomography-computed tomography (PET-CT) or biopsy was performed to validate the diagnosis in patients with highly suspected single cervical recurrence. Besides, surgical treatment yielded better clinical prognosis. Conclusions MR-DWI is highly sensitive to recurrent cervical lymph nodes of nasopharyngeal carcinoma after radiotherapy, especially for the small lymph nodes of 5-10 mm in diameter, which are easily ignored. PET-CT examination should be performed, the nature of the lymph nodes should be confirmed by multi-modality imaging diagnosis, and timely operation has important clinical significance in improving the therapeutic effect and quality of life for patients with cervical lymphnode recurrence.