增强CT对下咽癌甲状软骨受累情况的诊断价值

Diagnostic value of enhanced CT in the involvement of thyroid cartilage in hypopharyngeal carcinoma

目的探讨增强电子计算机X射线断层扫描技术对下咽癌甲状软骨受累情况的诊断价值。方法回顾性分析2016年1月至2020年10月江西省九江市第一人民医院收治的下咽部不适可疑下咽癌患者137例,增强CT检查所使用仪器为GE 64排CT仪器,统计分析符合纳排标准的59例下咽癌患者的增强CT影像学检查情况,统计增强CT与病理组织活检对诊断下咽癌的价值。结果59例下咽癌患者中,38例其病变部位位于梨状窝,21例病变部位位于咽后壁;50例CT扫描可见不规则软组织密度不均团块影,13例存在咽腔壁的广泛增厚。常规CT平扫提示,47例以等密度或低密度影为主,增强CT扫描提示不均匀强化表达,但边界尚清,38例病变部位位于梨状窝者,均存在环形黏膜下浸润影,另外59例患者中存在45例合并颈部淋巴结转移,增强CT扫描提示环形强化影,14例存在颈部弥漫性低密度影。咽部不适可疑下咽癌患者137例,经分析增强CT诊断敏感度为83.6%,特异度为95.7%,误诊率为4.3%,漏诊率为16.4%。结论增强CT扫描诊断下咽癌甲状软骨受累具有较高的诊断敏感度与特异度,是一种较为理想的临床诊断手段。

Objective To explore the diagnostic value of enhanced x-ray computed tomography(CT)on the involvement of thyroid cartilage in hypopharyngeal carcinoma.Methods A total of 137 patients with hypopharyngeal discomfort suspected hypopharyngeal carcinoma admitted to Jiujiang NO.1 People′s Hospital in Jiujiang Province from January 2016 to October 2020 were retrospectively analyzed.The GE 64-slice CT scanner was used for enhanced CT examination in 59 patients with hypopharyngeal carcinoma and the imaging manifestations of enhanced CT were analyzed retrospectively.The value of enhanced CT and pathological biopsy on the diagnosis of hypopharyngeal carcinoma was counted.Results In the 59 hypopharyngeal carcinoma patients,38 patients had lesions in the pyriform fossa and 21 patients had lesions in the posterior pharyngeal wall.50 patients had irregular soft tissue masses with uneven density on CT scanning and 13 patients had extensive thickening of the pharyngeal cavity wall.The conventional CT plain scanning suggested that 47 patients were mainly isodensity or low-density shadow,and the enhanced CT scanning suggested inhomogeneous enhancement expression with clear boundary.38 patients with lesions located in the pyriform fossa had circular submucosal infiltrative shadow.In addition,out of the 59 patients,there were 45 patients had combined lymph node metastasis in the neck,and the enhanced CT scanning suggested circular enhancement shadow.Another 14 patients had diffuse low-density shadow in the neck.The diagnostic sensitivity,specificity,misdiagnosis rate and missed diagnosis rate of enhanced CT scanning were respectively 83.6%,95.7%,4.3%and 16.4%in 137 patients with hypopharyngeal discomfort suspected hypopharyngeal carcinoma.Conclusion Enhanced CT scanning has high diagnostic sensitivity and specificity in diagnosing hypopharyngeal carcinoma with thyroid cartilage involvement,which is an ideal diagnostic tool in clinic.