Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 May 28;49(5):698-704. doi: 10.11817/j.issn.1672-7347.2024.230574.
Radiotherapy is the primary treatment for nasopharyngeal carcinoma, but it frequently leads to radiotherapy-induced temporal lobe injury (RTLI). Magnetic resonance imaging (MRI) is the main diagnostic method for RTLI after radiotherapy for nasopharyngeal carcinoma, but it is prone to missed diagnoses. This study aims to investigate the causes of missed diagnoses of RTLI in nasopharyngeal carcinoma patients undergoing MRI after radiotherapy.
Clinical and MRI data from nasopharyngeal carcinoma patients diagnosed and treated with radiotherapy at Xiangya Hospital of Central South University, from January 2010 to April 2021, were collected. Two radiologists reviewed all head and neck MRIs (including nasopharyngeal and brain MRIs) before and after radiotherapy of identify cases of late delayed response-type RTLI for the first time. If the original diagnosis of the initial RTLI in nasopharyngeal carcinoma patients did not report temporal lobe lesions, it was defined as a missed diagnosis. The first diagnosis of RTLI cases was divided into a missed diagnosis group and a non-missed diagnosis group. Clinical and imaging data were compared between the 2 groups, and multivariate logistic regression analysis was used to identify independent risk factors for MRI missed diagnoses of initial RTLI.
A total of 187 nasopharyngeal carcinoma with post-radiotherapy RTLI were included. The original diagnostic reports missed 120 cases and accurately diagnosed 67 cases, with an initial RTLI diagnosis accuracy rate of 35.8% and a missed diagnosis rate of 64.2%. There were statistically significant differences between the missed diagnosis group and the non-missed diagnosis group in terms of lesion size, location, presence of contralateral temporal lobe lesions, white matter high signal, cystic degeneration, hemorrhage, fluid attenuated inversion recovery (FLAIR), and examination site (all <0.05). Multivariate logistic regression analysis showed that lesions ≤25 mm, non-enhancing lesions, lesions without cystic degeneration or hemorrhage, lesions located only in the medial temporal lobe, and MRI examination only of the nasopharynx were independent risk factors for missed MRI diagnosis of initial RTLI (all <0.05).
The missed diagnosis of initial RTLI on MRI is mainly related to lesion size and location, imaging characteristics, and MRI examination site.
放射治疗是鼻咽癌的主要治疗方法，但它常导致放射性颞叶损伤（RTLI）。磁共振成像（MRI）是鼻咽癌放射治疗后 RTLI 的主要诊断方法，但易漏诊。本研究旨在探讨鼻咽癌患者放射治疗后 MRI 漏诊 RTLI 的原因。
收集 2010 年 1 月至 2021 年 4 月在中南大学湘雅医院诊断和治疗的鼻咽癌患者的临床和 MRI 数据。两位放射科医生首次回顾了所有鼻咽癌患者放疗前后的头颈部 MRI（包括鼻咽和脑部 MRI），以识别迟发性延迟反应型 RTLI 病例。如果鼻咽癌患者的初始 RTLI 原始诊断未报告颞叶病变，则定义为漏诊。将 RTLI 病例的首次诊断分为漏诊组和非漏诊组。比较两组的临床和影像学数据，采用多因素逻辑回归分析识别初始 RTLI MRI 漏诊的独立危险因素。
共纳入 187 例鼻咽癌伴放疗后 RTLI。原始诊断报告漏诊 120 例，准确诊断 67 例，初始 RTLI 诊断准确率为 35.8%，漏诊率为 64.2%。漏诊组与非漏诊组在病变大小、位置、对侧颞叶病变存在、脑白质高信号、囊性变性、出血、液体衰减反转恢复（FLAIR）以及检查部位等方面差异均有统计学意义（均<0.05）。多因素逻辑回归分析显示，病变≤25mm、非增强病变、无囊性变性或出血病变、仅位于内侧颞叶的病变以及仅对鼻咽部进行 MRI 检查是初始 RTLI 漏诊的独立危险因素（均<0.05）。
MRI 对初始 RTLI 的漏诊主要与病变大小和位置、影像学特征以及 MRI 检查部位有关。
