Li H Y, Chen X H
Department of Otorhinolaryngology, Beijing Daxing Hospital, Capital Medical University, Beijing 102600, China.
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 May 7;52(5):372-376. doi: 10.3760/cma.j.issn.1673-0860.2017.05.010.
To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer. 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. 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, <0.05). MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid cartilage invasion by laryngeal or hypopharyngeal cancer.
评估增强CT和MRI在诊断喉癌和下咽癌侵犯甲状软骨中的价值。本研究纳入了2013年1月至2014年12月期间接受手术治疗的197例原发性喉癌或下咽癌患者。所有患者在手术前均接受了增强CT和MRI检查。采用快速恢复快速自旋回波（FRFSE）、自旋回波平面回波成像（SE-EPI）和扩散加权成像（DWI）技术进行MRI检查，评估甲状软骨侵犯情况，并将术后组织病理学检查结果作为确定甲状软骨侵犯的金标准。评估增强CT或MRI检测喉癌和下咽癌侵犯甲状软骨的敏感性、特异性、阳性预测值和阴性预测值。数据采用SPSS17.0软件进行分析。197例患者中，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。术后病理检查显示，197例患者中有63例（32.0%）肿瘤侵犯甲状软骨。根据美国癌症联合委员会（AJCC，2010年）的TNM分类，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检测甲状软骨侵犯的敏感性、特异性、阳性预测值和阴性预测值分别为57%、86%、65%和81%，MRI的分别为94%、87%、78%和97%。在诊断甲状软骨侵犯方面，CT的Kappa值为0.45，MRI的为0.77，差异有统计学意义（χ(2)=6.78，<0.05）。在诊断喉癌或下咽癌侵犯甲状软骨方面，MRI（FRFSE和SE-EPI DWI）比CT具有更多优势。
