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目的 MRI具有无辐射、软组织分辨率高、多参数及多方位成像的优点,也能进行动态增强扫描,可精细评估舌鳞状细胞癌原发灶的部位、大小形态、血供、周围结构受累和淋巴结转移情况等,对于制订临床手术方案有重要意义。本研究探讨弥散加权成像(diffusion weighted imaging,DWI)、MRI平扫及动态增强扫描等多参数MRI在舌鳞状细胞癌中的应用价值及预测颈部淋巴结转移的临床意义。方法回顾性分析经手术病理确诊的37例舌鳞状细胞癌患者的临床和影像学资料,其中有颈部淋巴结转移20例,无颈部淋巴结转移17例。所有病例术前均行头颈部DWI、MRI平扫及动态增强扫描,测量和分析肿瘤的部位、长、短径、厚度、表观扩散系数(apparent diffusion coefficient,ADC)值,比较颈部淋巴结转移组与无转移组间MRI测量参数的差异,同时分析肿瘤时间-信号强度曲线(time intensity curve,TIC)类型。结果 37例舌鳞状细胞癌患者的长径均值为(29±15)mm,短径均值为(24±13)mm,厚度均值为(19±10)mm,ADC均值为(1.067±0.137)×10~(-3) mm~2/s。有、无颈部淋巴结转移患者间,肿瘤长径、短径、厚度和ADC值的差异均有统计学意义,均P值<0.05。37例舌鳞状细胞癌患者中21例TIC为速升-平台型,16例TIC为速升-流出型。结论多参数MRI联合应用可较好评价肿瘤的部位、大小、血供、周围结构侵犯及淋巴结转移情况,ADC值与TIC类型对舌鳞状细胞癌的诊断具有重要价值。此外,肿瘤大小对预测淋巴结转移有一定的临床意义。
Purpose MRI has the advantages of no radiation, high resolution of soft tissue, multi-parameter and multi-orientation imaging, dynamic enhancement scanning, fine evaluation of the location, size and shape, blood supply and surrounding structures of tongue squamous cell carcinoma And lymph node metastasis, etc., for the development of clinical surgery program is of great significance. This study was to explore the clinical value of multi-parametric MRI such as diffusion weighted imaging (DWI), MRI plain scan and dynamic contrast-enhanced MRI in tongue squamous cell carcinoma and to predict cervical lymph node metastasis. Methods The clinical and imaging data of 37 patients with tongue squamous cell carcinoma confirmed by surgery and pathology were retrospectively analyzed. Among them, there were 20 cases with cervical lymph node metastasis and 17 cases without cervical lymph node metastasis. In all cases, head and neck DWI, MRI plain scan and dynamic contrast-enhanced scanning were performed before operation. The tumor location, length, short diameter, thickness and apparent diffusion coefficient (ADC) were measured and analyzed. The cervical lymph node metastasis Differences in MRI measurement parameters between the group and the non-metastatic group were analyzed, and the type of time intensity curve (TIC) was analyzed. Results The mean diameter of long diameter of 37 patients with squamous cell carcinoma of the tongue was (29 ± 15) mm, short axis mean was (24 ± 13) mm, mean thickness was (19 ± 10) mm, mean ADC was (1.067 ± 0.137) × 10 ~ (-3) mm ~ 2 / s. There was significant difference in the length, width, thickness and ADC value between patients with and without cervical lymph node metastasis, all P <0.05. Among 21 cases of tongue squamous cell carcinoma, TIC was 21 - Platform type, 16 cases of TIC speed up - out of type. Conclusion The combination of multi-parameter MRI can evaluate tumor location, size, blood supply, surrounding structure invasion and lymph node metastasis. ADC value and TIC type are important for the diagnosis of tongue squamous cell carcinoma. In addition, tumor size has some clinical significance for predicting lymph node metastasis.