Sun Ying, Mao Yan-Ping, Ma Jun, Huang Ying, Tang Ling-Long, Wang Yan, Liu Li-Zhi, Lu Tai-Xiang
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, PR China.
Ai Zheng. 2007 Feb;26(2):158-63.
BACKGROUND & OBJECTIVE: The value of magnetic resonance imaging (MRI) in assessing the extension of nasopharyngeal carcinoma (NPC) is better than that of computed tomography (CT). This study was to analyze the influences of MRI on the Chinese '92 staging system and the 6(th) edition International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) staging system of NPC.
From Jan. 2003 to Jun. 2004, 250 naive patients with histologically diagnosed NPC, with no metastasis, received both enhanced spiral CT and MRI scans of the nasopharynx and cervix. Clinical stage was classified according to the Chinese '92 staging system and the 6(th) edition UICC/AJCC staging system, respectively, based on both CT/MRI imaging data and clinical information.
MRI was better than CT in detecting the invasion of NPC in the extra-nasopharyngeal cavity (the oropharyrnx, nasal cavity, and parapharyngeal spatium), retropharyngeal lymph node, base of skull, paranasal sinuses, intracranial cavernous sinus, infratemporal fossa, and cervical vertebra. There was no statistical difference between CT and MRI in detecting cervical lymph node metastasis. Compared with CT, MRI made changes in 32.0% of T stage (including 26.0% up-staging and 6.0% down-staging), 11.6% of N stage (6.4% up-staging and 5.2% down-staging), and 30.4% of clinical stage (24.0% up-staging and 6.4% down-staging) for the Chinese '92 staging system, while made changes in 39.6% of T stage (36.0% up-staging and 3.6% down-staging), 9.2% of N stage (5.6% up-staging and 3.6% down-staging), and 37.6% of clinical stage (33.6% up-staging and 4.0% down-staging) for the 6(th) edition UICC/AJCC staging system.
Compared with CT, MRI has a remarkable advantage in detecting the primary tumor extension of NPC, but has no advantage in detecting cervical lymph node metastasis. It is necessary and feasible to establish a new clinical staging system of NPC based on MRI.
磁共振成像（MRI）在评估鼻咽癌（NPC）的侵犯范围方面比计算机断层扫描（CT）更具优势。本研究旨在分析MRI对中国‘92分期系统以及国际抗癌联盟/美国癌症联合委员会（UICC/AJCC）第6版NPC分期系统的影响。
2003年1月至2004年6月，250例经组织学确诊、无转移的初治NPC患者接受了鼻咽部和颈部的增强螺旋CT及MRI扫描。分别根据CT/MRI影像数据及临床信息，按照中国‘92分期系统和UICC/AJCC第6版分期系统对临床分期进行分类。
在检测NPC侵犯鼻咽腔外（口咽、鼻腔和咽旁间隙）、咽后淋巴结、颅底、鼻窦、颅内海绵窦、颞下窝和颈椎方面，MRI优于CT。在检测颈部淋巴结转移方面，CT与MRI之间无统计学差异。与CT相比，对于中国‘92分期系统，MRI使T分期改变32.0%（包括26.0%分期上调和6.0%分期下调），N分期改变11.6%（6.4%分期上调和5.2%分期下调），临床分期改变30.4%（24.0%分期上调和6.4%分期下调）；而对于UICC/AJCC第6版分期系统，MRI使T分期改变39.6%（36.0%分期上调和3.6%分期下调），N分期改变9.2%（5.6%分期上调和3.6%分期下调），临床分期改变37.6%（33.6%分期上调和4.0%分期下调）。
与CT相比，MRI在检测NPC原发肿瘤侵犯范围方面具有显著优势，但在检测颈部淋巴结转移方面无优势。基于MRI建立新的NPC临床分期系统是必要且可行的。
