论文部分内容阅读
目的:探讨 SPECT 及 CT 对鼻咽癌颅底骨侵犯的检测能力及诊断价值。方法:对63例鼻咽癌初治患者,放射治疗前同期进行全身前后位加颅底左右侧位 SPECT 骨显像及鼻咽、颅底连续横断 CT 检查。采用双盲法对两者检测结果进行比较。结果:SPECT、CT 对颅底骨侵犯的阳性检出率在全部患者中分别为63.5%、25.4%;在头痛、颅神经损害及两者并存患者中分别为87.9%、93.3%、92.3%和42.4%、46.7%、46.2%;在 T_1+T_2期及 T_3+T_4期患者中分别为37.5%、90.3%和0.0%、51.6%;在 N_0+N_1期及 N_2+N_3期患者中分别为63.9%、63.0%和19.4%、33.3%。经 Mc-Nemar 检验,P 值均<0.05,差异有显著性意义。SPECT 对鼻咽癌颅底骨侵犯的阳性检出率明显高于 CT。SPECT 与 CT 检测符合率为61.9%,不符合率为38.1%。Binary Logistic 回归分析结果:头痛及 T 分期是 SPECT 阳性检出的危险因素(OR_(头痛)=3.864,OR_(T 分期)-6.422,T 分期及 N 分期是 CT阳性检出的危险因素(OR_(T 分期)48.932,OR_(N 分期)-2.860)。结论:SPECT 对鼻咽癌颅底骨侵犯的检测敏感性优于 CT,但特异性不如 CT。SPECT 检测结果与临床症状、体征、分期有较好的相关性,其诊断价值值得进一步研究。临床上,若结合患者头痛、颅神经损害症状及 T、N 分期情况,综合分析SPECT 及 CT 结果,有可能提高鼻咽癌颅底骨侵犯的检出率和诊断准确率。
Objective: To investigate the detection and diagnostic value of SPECT and CT in the invasion of skull base of nasopharyngeal carcinoma. Methods: 63 patients with nasopharyngeal carcinoma were treated with SPECT bone imaging at the anterior and posterior parts of the body and lateral CT skull imaging at the same time before radiotherapy, and CT and CT scan of nasopharynx and skull base. Using double-blind method to compare the two test results. Results: The positive rate of SPECT and CT in skull base bone invasion was 63.5% and 25.4% in all patients, 87.9%, 93.3% and 92.3% in patients with headache, cranial nerve injury and their coexistence respectively 42.4%, 46.7% and 46.2% respectively, and were 37.5%, 90.3% and 0.0%, 51.6% respectively in T_1 + T_2 and T_3 + T_4 patients; 63.9% in N_0 + N_1 and N_2 + N_3 patients %, 63.0% and 19.4%, 33.3%. The Mc-Nemar test, P values were <0.05, the difference was significant. SPECT detection of nasal pharyngeal skull base invasion was significantly higher than CT. The coincidence rate of SPECT and CT was 61.9% and the non-coincidence rate was 38.1%. Binary Logistic regression analysis showed that headache and T stage were the risk factors of positive SPECT detection (OR_ (headache) = 3.864, OR_ (T stage) -6.422, T stage and N stage were the risk factors of CT positive detection T stage) 48.932, OR_ (N stage) -2.860) .Conclusion: SPECT is superior to CT in the detection of skull base bone invasion of nasopharyngeal carcinoma, but its specificity is not as good as that of CT.SPECT and clinical symptoms, signs and staging The relevance of this method is worthy of further study.Clinical analysis of patients with headache, cranial nerve damage symptoms and T, N staging, and comprehensive analysis of SPECT and CT results may increase the risk of skull base bone invasion of nasopharyngeal carcinoma Detection rate and diagnostic accuracy.