摘要
目的 观察各向同性容积MRI显示鼻咽癌脑神经(CN)周围扩散(PNS)的价值.方法 前瞻性纳入87例经病理证实的鼻咽癌患者,采集鼻咽及颈部各向同性三维肝脏容积加速采集(3D LAVA_Flex)序列图像、脂肪抑制T2WI(T2WI-FS)、T1WI及增强T1WI-FS,分别于患者水平、CN组水平及单支神经水平比较各序列显示鼻咽癌CN PNS的价值.结果 对于鼻咽癌CN PNS,3D LAVA_Flex序列阳性率为49.43％(43/87),高于常规MRI的34.48％(30/87,P=0.001).在59例常规序列诊断为中晚期鼻咽癌患者中,3D LAVA_Flex序列显示CN PNS的阳性率为71.19％(42/59),常规MRI为50.85％(30/59),前者高于后者(P=0.001);在患者及后组CN水平,3D LAVA_Flex序列与T2WI-FS、T1WI、增强T1WI-FS显示CN PNS阳性率差异均有统计学意义(P均＜0.05);而在单支CN水平,3D LAVA_Flex序列显示下颌神经、颈静脉孔CN Ⅸ～Ⅺ、颈动脉鞘间隙CN Ⅸ～Ⅻ PNS的阳性率均高于T2WI-FS、T1WI及增强T1WI-FS(P均＜0.05),显示海绵窦CN Ⅲ～Ⅴ PNS的阳性率高于T2WI-FS(P＜0.05),显示舌下神经PNS阳性率高于T2WI-FS及T1WI(P均＜0.05).结论 3D LAVA_Flex序列可较好地显示鼻咽癌CN PNS.
Abstract
Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal carcinoma were prospectively enrolled.MR scanning,including three-dimensional liver acquisition with volume acceleration-flexible(3D LAVA_Flex)image,T2WI with fat suppression(T2WI-FS),T1WI,contrast enhancement(CE)T1WI-FS of nasopharynx and neck region were performed.The displaying rates of CN PNS were evaluated and compared between 3D LAVA Flex and T2WI-FS,T1WI,CE-T1WI-FS at patient level,CN group level and neural level,respectively.Results The displaying rate of CN PNS in all 87 nasopharyngeal carcinoma patients by 3D LAVA_Flex sequence was 49.43％(43/87),higher than that of conventional MRI(30/87,34.48％,P=0.001).Among 59 patients with advanced nasopharyngeal carcinoma diagnosed with conventional sequences,the displaying rate of CN PNS was 71.19％(42/59)by 3D LAVA-Flex sequence,higher than that of conventional MRI(30/59,50.85％,P=0.001).At both patient level and posterior CN level,significant differences of the displaying rate of CN PNS were found between 3D LAVA-Flex sequence and T2WI-FS,T1WI,CE-T1WI-FS,while at CN level,the displaying rates of mandibular nerve PNS,CN Ⅸ-Ⅺ PNS in jugular foramen(P＜0.05)and CN Ⅸ-Ⅻ PNS in carotid space of 3D LAVA_Flex sequence were all significantly higher than that of T2WI-FS,T1WI and CE-T1WI-FS(all P＜0.05),of PNS of CN Ⅲ-Ⅴ in cavernous sinus were higher than that of T2WI-FS(P＜0.05),while of PNS of hypoglossal nerve were significantly higher than that of T2WI-FS and T1WI(both P＜0.05).Conclusion 3D LAVA_Flex sequence could be used to effectively display CN PNS of nasopharyngeal carcinoma.
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