锥形束计算机断层扫描（CBCT）与传统计算机断层扫描（CT）和磁共振成像（MRI）在检测口腔鳞状细胞癌（OSCC）骨侵犯中的性能比较：一项前瞻性研究。
Performance of cone-beam computed tomography (CBCT) in comparison to conventional computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone invasion in oral squamous cell cancer (OSCC): a prospective study.
机构信息
Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
Department of Oral, Maxillofacial and Plastic Surgery, University of Köln, Faculty of Medicine and University Hospital Köln, Kepenerstr. 62, 50937, Köln, Germany.
出版信息
BMC Oral Health. 2024 Mar 16;24(1):341. doi: 10.1186/s12903-024-04057-4.
BACKGROUND
Oral squamous carcinoma (OSCC) is often diagnosed at late stages and bone erosion or invasion of the jawbone is frequently present. Computed tomography (CT) and magnetic resonance imaging (MRI) are known to have high diagnostic sensitivities, specificities, and accuracies in detecting these bone affections in patients suffering from OSCC. To date, the existing data regarding the impact of cone-beam computed tomography (CBCT) have been weak. Therefore, this study aimed to investigate whether CBCT is a suitable tool to detect bone erosion or invasion in patients with OSCC.
METHODS
We investigated in a prospective trial the impact of CBCT in the diagnosis of bone erosion or invasion in patients with OSCC who underwent surgery. Every participant received a CBCT, CT, and MRI scan during staging. Imaging modalities were evaluated by two specialists in oral and maxillofacial surgery (CBCT) and two specialists in radiology (CT and MRI) in a blinded way, to determine whether a bone affection was present or not. Reporting used the following 3-point system: no bony destruction ("0"), cortical bone erosion ("1"), or medullary bone invasion ("2"). Histological examination or a follow-up served to calculate the sensitivities, specificities, and accuracies of the imaging modalities.
RESULTS
Our results revealed high diagnostic sensitivities (95.6%, 84.4%, and 88.9%), specificities (87.0%, 91.7%, and 91.7%), and accuracies (89.5%, 89.5%, and 90.8%) for CBCT, CT, and MRI. A pairwise comparison found no statistical difference between CBCT, CT, and MRI.
CONCLUSION
Our data support the routine use of CBCT in the diagnosis of bone erosion and invasion in patients with OSCC as diagnostic accuracy is equal to CT and MRI, the procedure is cost-effective, and it can be performed during initial contact with the patient.
背景
口腔鳞状细胞癌（OSCC）常被诊断为晚期，且常伴有颌骨骨质侵蚀或侵犯。CT（computed tomography）和 MRI（magnetic resonance imaging）已被证实对检测 OSCC 患者的这些骨骼病变具有较高的诊断敏感度、特异性和准确性。迄今为止，有关锥形束 CT（cone-beam computed tomography，CBCT）的现有数据一直较为薄弱。因此，本研究旨在探讨 CBCT 是否是一种适用于检测 OSCC 患者颌骨侵蚀或侵犯的工具。
方法
我们在一项前瞻性试验中调查了 CBCT 对接受手术治疗的 OSCC 患者骨侵蚀或侵犯诊断的影响。每位患者在分期时均接受 CBCT、CT 和 MRI 扫描。影像学检查由两名口腔颌面外科专家（CBCT）和两名放射科专家（CT 和 MRI）以盲法进行评估，以确定是否存在骨骼病变。报告采用以下 3 分制系统：无骨破坏（“0”）、皮质骨侵蚀（“1”）或骨髓骨侵犯（“2”）。组织学检查或随访用于计算影像学检查的敏感度、特异性和准确性。
结果
我们的结果显示 CBCT、CT 和 MRI 的诊断敏感度分别为 95.6%、84.4%和 88.9%，特异性分别为 87.0%、91.7%和 91.7%，准确性分别为 89.5%、89.5%和 90.8%。两两比较发现 CBCT、CT 和 MRI 之间无统计学差异。
结论
我们的数据支持常规使用 CBCT 诊断 OSCC 患者的骨侵蚀和侵犯，因为其诊断准确性与 CT 和 MRI 相当，且该程序具有成本效益，可在与患者初次接触时进行。
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