Goel Varun, Parihar Pratap Singh, Parihar Akhilesh, Goel Ashok Kumar, Waghwani Kapil, Gupta Richa, Bhutekar Umesh
Post Graduate Student, Datta Meghe Institute of Medical Science , Maharashtra, India .
Associate Professor, Department of Radio-Diagnosis, Datta Meghe Institute of Medical Science , Maharashtra, India .
J Clin Diagn Res. 2016 Jun;10(6):TC01-5. doi: 10.7860/JCDR/2016/17411.7905. Epub 2016 Jun 1.
Squamous cell carcinoma of lower gingivo-buccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration.
This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence.
T1- and T2-weighted MR, diffusion-weighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm(2)). MRI findings were compared clinically and histopathologically.
Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm(2)/s in the present study.
Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.
下牙龈 - 颊黏膜复合体和舌部的鳞状细胞癌是印度次大陆最常见的癌症。口腔鳞状细胞癌（OSCC）分期中影像学的价值在于判断可切除性、评估原发性肿瘤的预后特征和大小、肿瘤浸润深度、颈部转移情况以及骨浸润的检测。
本研究基于口腔鳞状细胞癌（舌部和牙龈 - 颊黏膜复合体）的外观、软组织范围、肿瘤浸润深度和分期进行评估。此外，本研究基于扩散加权磁共振序列上的表观扩散系数（ADC）值评估MRI检测颈部淋巴结转移的准确性。
对活检证实的涉及舌部和/或牙龈 - 颊部区域的鳞状细胞癌（61例）在多个平面进行T1加权和T2加权磁共振成像、扩散加权序列以及增强后T1加权序列检查。在增强后T1加权图像的轴位图像上计算肿瘤浸润深度。使用两个b值（500和1000 s/mm²）测量表观扩散系数（ADC）。将MRI结果与临床和组织病理学结果进行比较。
MRI计算的平均浸润深度为8.47mm，组织病理学为6.85mm。Pearson相关系数为0.988。收缩因子为0.8。71%浸润深度大于9mm的患者在一个或多个层面显示颈部淋巴结转移证据。本研究中区分恶性和良性淋巴结的临界值为1.038×10⁻³ mm²/s。
MRI能够可靠地测量口腔恶性肿瘤的肿瘤浸润深度，这有助于预测颈部淋巴结转移。基于MRI扩散加权成像上的ADC值可区分颈部良性或恶性淋巴结。
