【作者】 王继琛； 高顺禹； 蒋学祥； 唐光健；

【机构】 北京大学第一医院放射科；

【摘要】 目的探讨增强CT扫描在下咽癌和喉癌术前TNM分期中的作用,对比分析16排CT(16DCT)同单排螺旋CT(HCT)的图像质量。方法收集62例手术证实的下咽癌或喉癌病例,所有病例术前行纤维喉镜及增强CT扫描检查,其中行16DCT检查16例,行HCT检查46例。两位有多年经验的放射学专家双盲判定图像质量、肿瘤分型及TNM分期。CT肿瘤TNM分期结果同手术结果对照,采用两个相关样本Wilcoxon秩和检验,并计算两观察者对CT在下咽癌和喉癌TNM分期中的判断一致性(Kappa值)。16DCT同。HCT图像质量对比采用两个独立样本Mann-Whitney秩和检验。结果62例下咽癌或喉癌单独临床分期准确性为69.4%,单独CT肿瘤分期准确性为72.6%,将临床资料同CT检查结果相结合准确性为90.3%,明显高于临床单独分期和单独CT分期,P值分别为0.001、0.002。两位观察者对CT图像质量判断具有高度的一致性(Kappa=0.92)。轴位图像上,16D CT图像同HCT图像对各个解剖结构的显示情况及其图像质量对比,统计学上无显著差异(P>0.05)。在MPR图像上,16D CT图像质量明显优于HCT(P<0.05)。结论下咽癌及喉癌CT检查可明确肿瘤的浸润范围、甲状软骨受侵及颈部淋巴结转移的情况,结合临床资料可明显提高肿瘤分期的准确性,为临床拟定治疗方案提供可靠依据。同单排螺旋CT相比,16D cT扫描速度更快,大大减少了由于呼吸和吞咽所引起的人工伪影。且MPR图像空间分辨率也明显优于单排螺旋CT,有可能为肿瘤分期提供更准确的信息。更多还原

【Abstract】 Objective To evaluate the role of CT imaging in staging of hypopharyngeal and laryngeal carcinoma, and compare the image quality of sixteen-detector row CT (16DCT) with that of single-detector helical CT (HCT). Methods CT imaging of 62 patients with hypopharyngeal or laryngeal carcinoma were retrospectively studied, of which, 16 patients were performed with 16DCT, and 46 with HCT. Two experienced radiologists who were unknown pathologic and laryngofiberscopic results reviewed the images of all patients to make TNM staging, and to score the quality of CT images with 4-point scale. Interobserver agreement for the two radiologists was assessed by calculation of Kappa value, and Mann-Whitney rank sum test or Wilcoxon rank sum test was used for statistical analysis. A P value less than 0. 05 was considered statistically significant. Results The accuracy of the clinical staging and CT images staging alone was 69. 4% and 72. 6%. When we combined the clinical information and CT imaging together, the accuracy of the staging of the hypopharyngeal and laryngeal carcinomas reached 90. 3%, that was significant higher than that of clinical staging and CT staging alone (P = 0. 001, P = 0. 002). For image quality, almost perfect interobserver agreement was demonstrated (Kappa=0. 92). There was no significant difference between the image quality of axial views of 16DCT and of HCT, but the quality of MPR image with 16DCT was better than that with HCT. Conclusion CT imaging is useful in staging hypopharyngeal and laryngeal carcinoma, especially when it is combined with clinical examination. CT images of 16DCT has less artifacts of motion in axial images than that of HCT, and has higher resolution in MPR images than that of HCT, which may improve the accuracy of staging of hypopharyngeal and laryngeal carcinoma in the future.更多还原