[Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor]
- PMID: 28558457
- DOI: 10.3760/cma.j.issn.1673-0860.2017.05.010
[Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor]
Abstract
Objective: To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer. Methods: One hundred and ninety-seven patients with primary laryngeal or hypopharyngeal cancer treated with surgery between January 2013 and December 2014 were included in this study. All patients underwent enhanced CT and MRI before surgery. With MRI using the techniques of fast recovery fast spin echo (FRFSE), spin echo echo planar imaging (SE-EPI) and diffusion weighted imaging (DWI), thyroid cartilage invasion was evaluated and the results of postoperative histopathological examination was used as a gold standard for the determination of thyroid cartilage invasion. The sensitivity, specificity, positive predictive value and negative predictive value of enhanced CT or MRI in detecting thyroid cartilage invasion by laryngeal and hypopharyngeal cancer were evaluated. Data were analyzed with SPSS17.0 software. Results: Among 197 patients, there were 35 cases with supraglottic laryngeal cancer, 92 cases with glottic laryngeal cancer, 9 cases with subglottic laryngeal cancer, and 61 cases with hypopharyngeal cancer. Postoperative pathologycal examinations showed that 63 (32.0%) of 197 patients had thyroid cartilage invasion by tumor. Based on TNM classification of AJCC (American Joint Commission for Cancer, 2010), there were 36 cases at T2 stage, 109 cases at T3 and 52 cases at T4; 117 cases with N0, 46 cases with N1 and 34 cases with N2. The sensitivity, specificity, positive predictive value and negative predictive value of CT for the detection of thyroid cartilage invasion were respectively 57%, 86%, 65% and 81%, and those of MRI were respectively 94%, 87%, 78% and 97%. Kappa values were 0.45 for CT and 0.77 for MRI in diagnosis of thyroid cartilage invasion, with statistically significant difference (χ(2)=6.78, P<0.05). Conclusion: MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid cartilage invasion by laryngeal or hypopharyngeal cancer.
目的： 评估增强CT和MRI对喉癌和下咽癌患者甲状软骨受累诊断的价值。 方法： 选取2013年1月至2014年12月在北京同仁医院耳鼻咽喉头颈外科住院并行手术的197例原发性喉癌及下咽癌患者为研究对象，所有患者术前均行CT及MRI平扫及增强检查，采用快速恢复快速自旋回波(fast recovery fast spin echo，FRFSE)脉冲序列联合自旋回波平面回波成像(spin echo echo planar imaging，SE-EPI)扩散加权成像弥散(diffusion weighted imaging，DWI)序列进行MRI检查，以组织病理学的结果作为金标准，病理分期采用美国癌症联合会(American Joint Commission for Cancer，AJCC)TNM分期标准。分别计算CT、MRI两种影像学检查方法判断喉癌和下咽癌患者甲状软骨是否受累的敏感性、特异性、阳性预测值、阴性预测值，并对两种检查方法进行对比。采用SPSS 17.0统计软件对数据进行统计学分析，计数资料的比较采用χ(2)检验，以P<0.05为差异有统计学意义。判断影像诊断结果采用诊断试验的一致性检验，计算Kappa值。 结果： 197例患者均行手术治疗，术后病理示63例(32.0%)患者甲状软骨受肿瘤侵及。手术病理分期结果：声门上型喉癌35例，声门型喉癌92例，声门下型喉癌9例，下咽癌61例；T2期36例，T3期109例，T4期52例；N0期117例，N1期46例，N2期34例。CT判断肿瘤侵犯甲状软骨与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为57%、86%、65%、81%。MRI判断肿瘤侵犯甲状软骨与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为94%、87%、78%、97%。CT和MRI对于肿瘤侵犯甲状软骨诊断结果的Kappa值分别为0.45、0.77，二者在诊断肿瘤侵犯甲状软骨方面经配对资料χ(2)检验，二者诊断结果差异有统计学意义(χ(2)＝6.78，P<0.05)。 结论： 对于喉癌或下咽癌是否侵犯甲状软骨的术前诊断中，采用常规序列联合SE-EPI DWI序列的MRI优于CT。.
Keywords: Computed tomography; Hypopharyngeal cancer; Laryngeal neoplasm; Magnetic resonance imaging; Thyroid cartilage.
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