目的 探讨增强MRI联合DWI序列对喉癌和下咽癌患者的甲状软骨受累诊断价值,为制定合理的治疗方案及术中的具体处理提供重要的参考价值.方法 选取自2013年1月～2014年12月在首都医科大学附属北京同仁医院头颈外科197例住院并行手术的原发喉癌及下咽癌患者,所有患者术前均行增强MRI检查,以组织病理学的结果作为金标准,计算增强MRI对喉癌和下咽癌患者的甲状软骨是否受累判断的敏感性、特异性、阳性预测值及阴性预测值,如果MRI判断为甲状软骨受累,还进一步判断肿瘤侵犯甲状软骨范围;影像学结果与病理对比分析并计算敏感性、特异性、阳性预测值及阴性预测值.所得数据并进行统计学分析.结果 197例患者均行手术治疗,术后病理示63例患者(32.0％)甲状软骨受肿瘤侵及.MRI判断肿瘤侵犯甲状软骨与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为94％、87％、78％、97％.MRI判断肿瘤侵犯甲状软骨内板与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为90％ 、82％、61％、96％.MRI判断肿瘤侵犯甲状软骨外板与病理结果比较其敏感性、特异性、阳性预测值、阴性预测值分别为89％ 、84％、57％、97％.MRI对于甲状软骨内板和外板受累诊断结果的Kappa值分别为0.62和0.60.结论 对于局部晚期喉癌或下咽癌是否侵犯甲状软骨的术前诊断中,可以采用常规序列联合SE-EPI扩散加权成像弥散序列的MRI诊断.同时应用MRI对肿瘤侵犯甲状软骨范围进行诊断具有可行性.%Objective To discuss the diagnostic value of magnetic resonance imaging (MRI) united with diffusion weighted imaging (DWI) sequence for thyroid cartilage invasion in patients with laryngeal and/or hypopharyngealcarcinoma,therefor to provide surgeons with significant image information to accurately assess the stage of tumor and develop rational treatment plan.Methods 197 patients suffering from primary laryngeal and/or hypopharyngeal carcinoma were included in this study.All the patients were surgically treated in Dept.of Otolaryngology-Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University from Jan 2013 to Dec 2014.Preoperative enhanced MRI was performed in all the patients to observe thyroid cartilage invasion.Regarding pathological results as golden standard,the sensitivity,specificity,positive predictive value and negative predictive value of enhanced MRI for detecting thyroid cartilage invasion were calculated.In patients with thyroid cartilage invasion confirmed via MRI,the invasion scope of the cartilage (inner and/or outer panels) was further determined.And the sensitivity,specificity,positive predictive value and negative predictive value of enhanced MRI for invasion scope determination were also calculated.All the obtained data were statistically analyzed.Results All 197 patients underwent surgical treatment.Postoperative pathology showed thyroid cartilage invasion in 63 cases (32.0％).Regarding pathological results as golden standard,the sensitivity,specificity,positive predictive value and negative predictive value of enhanced MRI for detecting thyroid cartilage invasion were 94％,87％,78％ and 97％ respectively.The sensitivity,specificity,positive predictive value and negative predictive value for judging the invasion of inner panel of thyroid cartilage were 90％,82％,61％ and 96％,while those of outer panel were 89％,84％,57％ and 97％.The Kappa values of enhanced MRI in the diagnosis of invasion of inner and outer thyroid panels were 0.62 and 0.60 respectively.Conclusion Enhanced MRI united with fast recovery fast spin echo (FRFSE) SE-EPI (Spin echo echo planar imaging) DWI can be adopted for the preoperative diagnosis of thyroid cartilage invasion in advanced local laryngeal or hypopharyngeal carcinoma.At the same time,preoperative estimate of invasion degree of thyroid cartilage via MRI is feasible.
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