青少年鼻咽血管纤维瘤术后早期CT扫描：残留疾病的检测
Early postoperative CT scanning for juvenile nasopharyngeal angiofibroma: detection of residual disease.
作者信息
Kania Romain E, Sauvaget Elisabeth, Guichard Jean-Pierre, Chapot René, Huy Patrice Tran Ba, Herman Philippe
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Assistance Publique-Hôpitaux de Paris, Paris VII University, Lariboisière Hospital, France.
出版信息
AJNR Am J Neuroradiol. 2005 Jan;26(1):82-8.
BACKGROUND AND PURPOSE
High recurrence rates and early recurrence have been reported for juvenile nasopharyngeal angiofibroma (JNA) involving the skull base. The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced CT scanning for the detection of residual disease (RD) in the early postoperative course after surgical excision of JNA.
METHODS
We retrospectively reviewed data in 20 male patients (mean age +/- SD, 15.4 +/- 5 years; range, 10-32 years) who underwent enhanced helical CT in the days after apparent complete surgical excision of JNA with initial expansion in the skull base. Four independent, blinded readers evaluated the occurrence of RD. Final diagnoses were rendered on the basis of histologic examination of excised specimens of RD or clinical and radiologic follow-up. The Cohen kappa test was performed to examine interreader agreement.
RESULTS
Postoperative contrast-enhanced CT had a sensitivity of 75%, a specificity of 83%, a positive predictive value of 75% and a negative predictive value of 83% for the detection of RD. The prevalence of RD was 40%. The base of pterygoids was the most frequent location of RD. Interreader agreement was high for the detection of putative RD (kappa=0.83). Variabilities in readers' interpretations were encountered for false-positive results and for disease in the foramen lacerum. False-negative results involved the base of pterygoids. Early postoperative CT scanning was well tolerated by all patients.
CONCLUSION
Contrast-enhanced helical CT is an accurate tool to evaluate excision of JNA in the days after surgery.
背景与目的
据报道，累及颅底的青少年鼻咽血管纤维瘤（JNA）复发率高且复发早。本研究的目的是评估增强CT扫描在JNA手术切除术后早期病程中检测残留疾病（RD）的诊断准确性。
方法
我们回顾性分析了20例男性患者（平均年龄±标准差，15.4±5岁；范围，10 - 32岁）的数据，这些患者在JNA明显完全手术切除且颅底最初出现扩张后的数天内接受了螺旋CT增强扫描。四位独立的、不知情的阅片者评估RD的发生情况。最终诊断基于RD切除标本的组织学检查或临床及影像学随访。采用Cohen kappa检验来检验阅片者之间的一致性。
结果
术后增强CT检测RD的灵敏度为75%，特异度为83%，阳性预测值为75%，阴性预测值为83%。RD的患病率为40%。翼突基部是RD最常见的部位。对于假定RD的检测，阅片者之间的一致性较高（kappa = 0.83）。在假阳性结果和破裂孔疾病方面，阅片者的解读存在差异。假阴性结果涉及翼突基部。所有患者对术后早期CT扫描耐受性良好。
结论
增强螺旋CT是评估JNA术后数天切除情况的准确工具。
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