论文部分内容阅读
目的:应用磁共振成像(MR)评价鼻咽癌局部侵犯的规律性,探讨临床靶区(CTV)勾画。方法:连续收集具备鼻咽及颈部MR扫描的初诊鼻咽癌患者345例。由两位影像学医师独立阅片,根据受侵的发生率,将各解剖结构划分为高危组(≥35%)、中危组(≥5%～35%)和低危组(<5%)3个等级。结果:高危组解剖结构毗连于鼻咽腔,中危组和低危组解剖结构与鼻咽腔间隔解剖屏障。高危组解剖结构受侵时,毗连中危组解剖结构受侵发生率高达54.3%。高危组解剖结构未受侵时,毗连中危组解剖结构受侵的发生率<10.0%。高危组或中危组解剖结构受侵时,毗连低危组解剖结构受侵的发生率高达40.0%。鼻咽癌非中线结构双侧同时受侵的发生率较低(<10%),椎前肌除外(11.9%)。结论:鼻咽癌遵循从近到远逐步进行局部侵犯,跳跃性扩散较为罕见,神经孔道是重要的扩散途径。鼻咽癌非中线结构双侧同时受侵的发生率较低,鼻咽周围解剖结构的选择性CTV勾画是可行的。
Objective: To evaluate the regularity of local invasion of nasopharyngeal carcinoma by using magnetic resonance imaging (MR), and to explore the outline of clinical target area (CTV). Methods: A total of 345 nasopharyngeal carcinoma patients with nasopharyngeal and cervical MR scan were collected continuously. According to the incidence of invasion, the two anatomical structures were divided into high-risk group (≥35%), middle-risk group (≥5% -35%) and low-risk group (≤5% ) 3 levels. Results: The high-risk group anatomical structure adjacent to the nasopharyngeal cavity, intermediate-risk group and low-risk group anatomy and nasopharyngeal space dissection barrier. When the high risk group of anatomical structures were infiltrated, the incidence of anatomic structures adjacent to the intermediate risk group was as high as 54.3%. When the anatomical structure of high-risk group was not invaded, the incidence of anatomic invasion in adjacent intermediate-risk group was less than 10.0%. In the high-risk group or intermediate-risk group, the invasion rate of anatomical structures in adjacent low-risk group was as high as 40.0%. Nasopharyngeal non-central structure of bilateral bilateral invasion at the same time the incidence was lower (<10%), except for the anterior vertebral muscle (11.9%). CONCLUSIONS: Nasopharyngeal carcinoma follows a gradual and localized invasion from near to far. It is rare for the nasopharyngeal carcinoma to spread diffusely. The nerve channel is an important diffusion route. Nasopharyngeal non-central structure of bilateral bilateral invasion at the same time the incidence of low, nasopharyngeal anatomical selective CTV outlined is feasible.