腭部腺样囊性癌的CT诊断与预后的相关性

CT Diagnosis of Adenoid Cystic Carcinoma of the Palate and Its Correlation with Prognosis

目的探讨CT对腭部腺样囊性癌(ACC)的诊断价值,分析影像学表现与生存预后(总生存期、无病生存期)之间的关系,提高对腭部ACC的认识。资料与方法回顾性分析92例经病理确诊的腭部ACC患者的临床及影像学资料。所有患者术前均行颌面部增强CT检查,并行手术切除治疗,术后行辅助放疗及定期随访。结果CT平扫示腭部软组织密度影,边界不清,CT值18~51 Hu。增强扫描示不均匀强化58例(63.0%),部分呈筛孔状;均匀强化21例(22.8%);无强化13例(14.2%)。55例(59.8%)肿瘤CT表现为邻近多个神经解剖孔道结构侵犯,翼腭窝受累(33/92,35.9%)同时累及腭大孔(55/92,59.8%);圆孔受累(25/92,27.1%)同时累及腭大孔(55/92,59.8%)、翼腭窝(33/92,35.9%)。92例ACC患者的五年总生存期和无病生存期分别为95.2%和86.4%。多因素COX比例分析示圆孔受累是影响腭部ACC总生存期(HR=7.8,P=0.05)及无病生存期的变量因素(HR=4.1,P=0.004),而翼腭窝、腭大孔为非变量因素(P>0.05)。Kaplan-Meier生存分析显示CT上圆孔有无受累与患者总生存期(P=0.02,95%CI 81.6~96.3)和无病生存期(P=0.001,95%CI 76.3~81.6)差异有统计学意义。结论腭部ACC具有沿周围神经孔道腭大孔、翼腭窝、圆孔侵袭性生长的CT特征,当CT显示圆孔受侵犯时可能会影响腭部ACC的预后。

Purpose To explore the diagnostic value of CT in the diagnosis of adenoid cystic carcinoma of the palate,and to analyze the relationship between imaging findings and survival prognosis(overall survival,disease-free survival),in order to improve the understanding of ACC of the palate.Materials and Methods The clinical and imaging data of 92 patients with ACC of the palate diagnosed pathologically were retrospectively analyzed.All patients underwent enhanced maxillofacial CT examination before operation,and received surgical resection,then underwent adjuvant radiotherapy and regular follow-up after operation.Results On plain CT scan,the soft tissue density of the palate was not clear,and the CT value was 18-51 Hu.There were 58 cases(63.0%)with nonuniform enhancement,some of them were ethmoidal,21 cases(22.8%)with uniform enhancement and 13 cases(14.2%)without enhancement.A total of 55 cases(59.8%)of tumor CT showed that the adjacent multiple neuroanatomical pore structures were involved,when pterygopalatine fossa was involved(33/92,35.9%),the greater palatine foramen was involved(55/92,59.8%);when foramen rotundum was involved(25/92,27.1%),the greater palatine foramen was involved(55/92,59.8%)and the pterygopalatine fossa was involved(33/92,35.9%).Five-year overall survival and disease-free survival of 92 ACC patients were 95.2%and 86.4%,respectively.Multivariate Cox analysis indicated that the involvement of foramen rotundum on CT was a variable factor(HR=7.8,P=0.05)affecting the overall survival and disease-free survival of ACC in the palatine region(HR=4.1,P=0.004),while the involvement of pterygopalatine fossa and greater palatine foramen were non-variable factors(P>0.05).Kaplan-Meier survival analysis showed that there was a significant difference between the overall survival(P=0.02,95%CI 81.6-96.3)and disease-free survival(P=0.001,95%CI 76.3-81.6)in the presence or absence of foramen rotundum on CT.Conclusion ACC of the palate has the CT characteristics of growth along the foramen of the peripheral nerve,such as palatal foramen,pterygopalatine fossa and foramen rotundum.When CT shows that the foramen rotundum is invaded,it may affect the prognosis of ACC patients in the palate.