SPECT/CT同机融合显像在口腔鳞癌前哨淋巴结定位中的应用

目的　探索一种准确、实用的口腔鳞癌前哨淋巴结定位方法。方法　术前运用SPECT/CT同机融合显像技术对30例cN0期口腔鳞癌患者的SLN进行定位,术中对定位的SLN活检,术后比较SLN与颈淋巴清扫的病理结果。结果　全组病例中,SPECT/CT同机融合图像对SLN定位的准确度为100%, 8例患者的前哨淋巴结和颈清扫淋巴结病理结果证实有癌转移,前哨淋巴结活检对颈部淋巴结转移状况评价的敏感度、特异度和准确度均为100%。结论　SPECT/CT同机融合显像技术可以在术前准确定位前哨淋巴结,客观评价cN0期口腔鳞癌患者颈部淋巴结的真实状况。     

口腔鳞癌哨位淋巴结融合显像定位的初步研究

目的：探索一种准确、实用、经济的口腔鳞癌哨位淋巴结定位方法。方法：选择拟行一侧选择性颈淋巴清扫术的T1/T3N0M0口腔鳞癌患者25例,术前行平面淋巴显像和SPECT/CT融合显像,联合术中蓝染法定位哨位淋巴结,分别比较平面淋巴显像和融合显像的结果,以及哨位淋巴结和颈清标本的病理结果。结果：术前平面淋巴显像的25例患者中,23例显示哨位淋巴结;应用SPECT/CT同机融合显像技术,25例患者均能显示哨位淋巴结（25/25）。融合显像发现,平面显像未能显示的哨位淋巴结7枚,其中1枚存在肿瘤转移。所有出现核素浓聚的淋巴结,均能在融合图像中获得较为准确的解剖定位。哨位淋巴结对颈淋巴结状况预测的敏感度为85.7%,特异度及阳性预测值为100%,阴性预测值为94.7%,准确度为96%。结论：SPECT/CT同机融合显像技术能提供比平面淋巴显像更多的信息,降低了哨位淋巴结活检的假阴性率;是一种较为准确、实用、经济的定位口腔鳞癌哨位淋巴结的新方法。     

成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节单光子发射型CT/CT同机融合骨显像的比较研究

目的 采用单光子发射型(single-photo Emission CT,SPECT)CT/CT同机融合骨显像技术对成人骨性下颌偏斜患者与正常人下颌骨及颞下颌关节的生长差异进行比较研究.方法 选取成人骨性下颌偏斜患者20例和正常成人志愿者15例,进行SPECT/CT同机融合骨扫描检查,以分析比较下颌偏斜患者与正常人两侧下颌骨及颞下颌关节骨血流和骨代谢的差异性.结果 成人骨性下颌偏斜患者下颌骨不同部位的骨血流和骨代谢存在特定性差异,正常人下颌骨不同部位的骨血流和骨代谢存在特定性差异;正常人下颌骨不同部位左右两侧放射性计数值比值均接近于1,对称性较好;与正常对照组相比,骨性下颌偏斜患者放射性强度均为对侧高于偏斜侧;髁状突差异最大(P＜0.01),其次为下颌角(P＜0.01),下颌升支中份差异最小(P＜0.05);不同部位两侧差异均有统计学意义.结论 SPECT/CT同机融合骨显像在精确解剖定位的基础上,能更加准确显示颞下颌关节的功能变化.

Abstract：

Objective To investigate mandible and temporomandibular joint (TMJ) in adults with and without mandible deviation using SPECT/CT fusion imaging. Methods SPECT/CT fusion imaging over bilateral mandible and TMJ was performed in 20 adult patients with mandibular deviation and 15 adult volunteers without mandibular deviation. Results Compared with the control group, the radioactive intensity of contralateral side was higher than that of the deviated side in patients with mandibular deviation. The biggest difference was found in the condyle process (P＜0. 01) and the mandibular angle (P＜0. 01). Conclusions Based on accurate anatomical localization, SPECT/CT fusion imaging was very sensitive in detecting functional alteration in TMJ.     

CT和SPECT对下牙龈癌侵犯下颌骨诊断价值的比较

目的:评价CT和SPECT在检测下颌牙龈鳞状细胞癌侵犯下颌骨中的价值.方法:收集2002年2月-2006年10月间青岛大学医学院附属医院21例下颌牙龈鳞状细胞癌住院患者,以组织病理学检查结果为对照,对CT、SPECT资料进行比较,评价CT和SPECT的诊断价值.结果:21例患者中,SPECT的灵敏度、准确度、阴性预测值、正确指数分别为100.00%、95.24%、100.OO%、1.00,CT的灵敏度、准确度、阴性预测值、正确指数分别为80.00%、80.95%、20.00%、0.80,CT有80.00%(4/5)的假阴性,而SPECT无假阴性.结论:与CT相比,SPECT的诊断效能高,故可作为牙龈癌侵犯下颌骨的筛查方法.     

口腔诊断学

Steiner综合征的诊断与治疗：附2例报告；涎腺肿块的细针吸取细胞学诊断研究；曲面断层片在评价下颌骨生长发育时下颌骨线性指标的作用；老年人口腔鳞癌颈淋巴结转移CT诊断标准的病理学再评价；舍格伦综合征磁共振涎腺造影图像分析     

SPECT／CT同机融合在恶性肿瘤侵犯下颌骨中的诊断价值

目的:研究SPECT/CT同机融合骨扫描在恶性肿瘤侵犯下颌骨中的诊断价值.方法:选择43 例口腔恶性肿瘤侵犯下颌骨而行下颌骨节段性或半侧下颌骨切除的患者,分为A(外周侵犯型)、B(中心侵犯型)2 组,对比研究SPECT/CT骨扫描和组织病理学检查的下颌骨病变范围.结果:A组:SPECT/CT显示的下颌骨受侵犯的范围较病理检查高估(1.02±0.20) cm,二者的差异有高度统计学意义(P<0.01).B组:SPECT/CT比病理检查高估(1.3±0.39) cm,二者的差异亦有高度统计学意义(P<0.01).A、B组相比较, SPECT/CT和病理检查之间的差异并无统计学意义(t=1.656,0.446,P>0.05).结论:SPECT/CT显示的病变范围符合手术需要切除的合理范围,对下颌骨病变的定位及定量等方面具有明显的优势,是临床检查的理想工具.     

鳞癌侵犯下颌骨的检查方法评价

对鳞癌浸润范围的确定,颌骨全景片、CT和单光子发射CT(SPECT)并未显示较高的精确性。本研究旨在揭示提高病例检查手段精确度的临床选择原则。 选择诊断为口底、下牙槽或磨牙后三角鳞癌并疑累及下颌骨的患者67例(男47女20),平均年龄为61.8岁。肿瘤靠近下颌骨的舌侧,之前并未作治     

荷瘤裸鼠口腔鳞状细胞癌乏氧状况的初步研究

目的检测荷口腔鳞状细胞癌裸鼠肿瘤组织乏氧区域分布,明确厌氧菌能否在肿瘤乏氧区内生长,为认识和开发利用肿瘤乏氧区域提供依据。方法荷瘤裸鼠尾静脉注射^99mTc-HL91,应用SPECT检测鳞癌组织及正常组织乏氧区域分布。荷瘤裸鼠尾静脉注射青春双歧杆菌菌悬液,切取鳞癌组织及其它正常组织,匀浆后厌氧培养。结果^99mTc-HL91在肿瘤组织内高浓度聚集,与肿瘤体积呈线性相关;肿瘤区域、肿瘤对侧部位及头胸部位平均像素^99mTc-HL91吸收值有显著性差异。肿瘤组织内可见青春双歧杆菌生长,其它正常组织内未见青春双歧杆菌生长。结论口腔鳞癌组织中乏氧区域分布广泛,且与肿瘤体积密切相关。口腔鳞癌组织乏氧微环境适合严格厌氧菌-青春双歧杆菌的生长。     

口腔鳞癌淋巴转移的临床病理危险因素

目的：探讨口腔鳞癌淋巴转移的预告危险因素。方法：随切口腔鳞癌术后４年以上的１９３例患者,用单因素分析、多因素回归分析及显著性检验,观察肿瘤ＴＮ分期、部位、浸润方式、厚度、病理分化、肿瘤细胞有丝分裂数、细胞角化及核分化程度、淋巴细胞浸润等对淋巴结转移和术后淋巴结转移的影响程序。结果：单因素分析肿瘤ＴＮ分期、浸润方式和厚度、淋巴细胞浸润均显著影响颈清扫标本病理确诊淋巴结转移率,多因素分析只有肿瘤浸润方式是显著性因素,并显著影响术后淋巴结转移。结论：肿瘤浸润方式是影响口腔鳞癌淋巴结转移的重要因素。     

淋巴显像技术在口腔鳞癌哨位淋巴结活检中的应用

目的:评价淋巴显像技术在口腔鳞癌哨位淋巴结活检中的价值。方法:应用颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术,对21例临床NO(cNO)口腔鳞癌患者的哨位淋巴结(sentinel lymph node,SLN)进行研究。结果:全组患者SLN检出率为100％,21例中有7例SLN活检阳性,颈清术后标本同样证实有颈淋巴结转移,无假阴性结果,SLN活检对全组病例颈淋巴结转移状况预测的准确性为100％。结论:颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术能有效地对口腔鳞癌SLN进行定位,从而准确预测颈淋巴结转移状况。     

Computer-aided 3-D 99mTc-DPD-SPECT reconstruction to assess mandibular invasion by intraoral squamous cell carcinoma: diagnostic improvement or not?

OBJECTIVE: A prospective study was designed to compare computer-aided 3-D 99mTc-DPD-SPECT (Technetium-Dicarboxy propan-single photon emission CT) reconstruction with clinical examination, panoramic radiography, CT scan and conventional 99mTc-DPD-SPECT investigation in the assessment of mandibular bone invasion by squamous cell carcinoma. PATIENTS AND METHODS: Between October 1997 and December 1999, 88 patients with intraoral squamous cell carcinoma of the regions adjacent to the mandible were enrolled in this study. In 50 cases, mandibular resection (segmental or marginal) was performed based on the pre-treatment diagnostic results. Imaging studies were read independently by four experienced observers. RESULTS: No differences could be found between presurgical 3-D 99mTc-DPD-SPECT reconstruction and conventional 99mTc-DPD-SPECT investigation. Both techniques revealed a sensitivity of 100% whereas CT scan showed the greatest specificity (93.8%). SPECT investigation had a specificity of 91.6% and the greatest efficiency (95.4%). The greatest predictive positive value was found for CT scan (92.3%). Clinical examination and panoramic radiography displayed the lowest sensitivity, 82.5% vs. 85.0%, and specificity, 79.2% vs. 89.5% respectively. CONCLUSION: This investigation does not provide evidence that 3-D 99mTc-DPD-SPECT reconstruction has any advantages when compared to conventional 99mTc-DPD-ECT investigation in the assessment of mandibular invasion by squamous cell carcinoma. Despite a sensitivity of 100% the specificity is still in need of improvement. Until newer methods or techniques become available the combination of CT scanning and conventional 99mTc-DPD-SPECT investigation appears to be the best means of detecting tumour invasion preoperatively and is thus helpful in directing appropriate surgical procedure.     

Computer-aided 3-DTc-DPD-SPECT reconstruction to assess mandibular invasion by intraoral squamous cell carcinoma: diagnostic improvement or not?

Objective: A prospective study was designed to compare computer-aided 3-D^99mTc-DPD-SPECT (Technetium-Dicarboxy propan-single photon emission CT) reconstruction with clinical examination, panoramic radiography, CT scan and conventional^99mTc-DPD-SPECT investigation in the assessment of mandibular bone invasion by squamous cell carcinoma. Patients and Methods: Between October 1997 and December 1999, 88 patients with intraoral squamous cell carcinoma of the regions adjacent to the mandible were enrolled in this study. In 50 cases, mandibular resection (segmental or marginal) was performed based on the pre-treatment diagnostic results. Imaging studies were read independently by four experienced observers. Results: No differences could be found between presurgical 3-D^99mTc-DPD-SPECT reconstruction and conventional^99mTc-DPD-SPECT investigation. Both techniques revealed a sensitivity of 100% whereas CT scan showed the greatest specificity (93.8%). SPECT investigation had a specificity of 91.6% and the greatest efficiency (95.4%). The greatest predictive positive value was found for CT scan (92.3%). Clinical examination and panoramic radiography displayed the lowest sensitivity, 82.5% vs. 85.0%, and specificity, 79.2% vs. 89.5% respectively. Conclusion: This investigation does not provide evidence that 3-D^99mTc-DPD-SPECT reconstruction has any advantages when compared to conventional^99mTc-DPD-ECT investigation in the assessment of mandibular invasion by squamous cell carcinoma. Despite a sensitivity of 100% the specificity is still in need of improvement. Until newer methods or techniques become available the combination of CT scanning and conventional^99mTc-DPD-SPECT investigation appears to be the best means of detecting tumour invasion preoperatively and is thus helpful in directing appropriate surgical procedure.     

原发性下颌骨鳞状细胞癌-附2例报道

目的：探讨原发性下颌骨鳞状细胞癌的临床特点,为其早期诊治提供参考。方法：对2006-2009年原发于下颌骨的2例鳞状细胞癌的临床表现、治疗及预后进行回顾性分析。结果：2例原发性下颌骨鳞状细胞癌的患者均为老年男性,分别有下颌骨病变区域肿胀、疼痛、患侧下唇感觉异常病史。临床检查病变区域牙龈无红肿,无增生物。全口曲面断层片可见下颌骨病变区为界限不清的溶骨性改变。骨扫描未见全身其它骨骼病变。胸片及腹部B超检查均未见其它病灶。结论：原发性下颌骨鳞状细胞癌的临床特点不明确,应提高对该病的认识,以达到早期诊断和治疗的目的。     

口腔粘膜鳞癌顺铂诱导化疗剂量与疗效关系的研究

目的 :探讨口腔粘膜鳞状细胞癌顺铂诱导化疗剂量与疗效的关系。方法 :总结 1986～ 2 0 0 0年 6月间行计划性高剂量 (10 0～ 12 0mg/m2 )顺铂诱导化疗的 99例治疗经验。以同期非常规剂量 (5 0mg/m2 )的 2 7例作对比研究。结果 :高剂量组和对比组的近期疗效分别为 85 .85 % (85 / 99)和 5 5 .5 5 % (15 / 2 7) ,经统计学处理有高度显著性差异 (P <0 .0 1) ;毒副反应 (肾、血液和胃肠毒性 )本组实验的对照观察中均无显著性差异 (P >0 .0 5 )。结论 :顺铂剂量和疗效之间呈正相关和正态剂量依赖关系 ,高剂量组的 10 0～ 12 0mg/m2 的剂量是合适和符合人体耐受的 ,毒副反应尚未影响到本疗法的临床应用     

Imaging of mandible invasion by oral squamous cell carcinoma using computed tomography,cone-beam computed tomography and bone scintigraphy with SPECT

Objectives

The objective of this paper is to evaluate the predictability of preoperative tumour bone invasion of the mandible by squamous cell carcinoma of the oral cavity using CT, cone-beam CT and bone scintigraphy with SPECT.

Material and methods

Eighty-four patients who had received CT, SPECT or cone-beam computed tomography (CBCT), as well as a further 48 patients who undergone all these investigations for preoperative evaluation of bone invasion were included in the study. A case–control analysis and the receiver operating characteristics were performed. Histological results of bone specimens served as the gold standard for assessment of bone invasion.

Results

CBCT and SPECT showed a comparable sensitivity for bone invasion (93 % [CI 0.816–0.972] and 96 % [CI 0.867–0.990], respectively) which was significantly higher than that of CT (63 % [CI 0.488–0.752]). Further, CBCT obtained higher specificity than SPECT (62 % [CI 0.478–0.743] and 48 % [CI 0.342–0.614], respectively), whereas CT showed the best specificity among the investigation methods (81 % [CI 0.677–0.896]).

Conclusions

CT scan provides by its high specificity and positive predictive value a precise imaging technique for clinical routine. However, CBCT shows a much higher sensitivity for cortical bone invasion and a better negative predictive value. With a significantly lower exposure dose it can rule out this invasion effectively and prevent overtreatment.

Clinical relevance

Considering the high-resolution images delivered by CBCT along with minimized artefacts in the mandible it provides an alternative imaging technique, which could be combined and accomplished with another soft-tissue imaging modality like MRI to obtain optimal hard and soft-tissue visualisation in patients with squamous cell carcinoma of the oral cavity.     

Mandibular invasion of lower gingival carcinoma in the molar region: its clinical implications on the surgical management

The spread pattern of a tumour and its extent in the mandible are important in the management of gingival cancer. Sixteen patients with gingival squamous cell carcinoma (SCC) involving the mandible in the molar region were included in this study. Resection specimens of the mandibular bone and adjacent cancer were histologically analysed to identify the type and characteristics of invasion and were compared with the radiological features. Our results showed that the actual width of invasion was underestimated to a greater extent than the actual depth of invasion. For horizontal aspects, four dentate cases had horizontal intramedullary spread underneath intact mucosa or cortical bone extended from the main foci of tumour that infiltrated through the occlusal surface. For vertical aspects, nerve invasion took place in only one of 16 specimens, while five cases showed downward infiltration beyond the inferior alveolar canal without nerve involvement, so that the pattern of tumour spread was mostly transmedullary rather than perineural in previously non-irradiated cases. These cases with deep infiltration showed the infiltrative type of invasion in the dentate mandible. And when the tumour was related with previous dental extractions or curettage, it tended to be more extensive than what was predicted from an imaging point of view. These pathological and clinical features affecting the tumour spread should be considered in the management of gingival SCC in the molar region.     

保持下颌骨连续性的改良型边缘性下颌骨切除在舌癌联合根治术中的应用评价

目的:探讨保持下颌骨连续性的改良型边缘性下颌骨切除在舌癌联合根治术中的应用,评价其的手术方法、操作要点、适应症和临床效果。方法:对2007年1月~2012年12月,应用保持下颌骨连续性的改良型边缘性下颌骨切除的舌癌137例。改良型即是增加了往复锯和磨头对下颌下缘内侧和口底黏膜连接处的骨组织进行片切和选磨。选择性/根治性颈淋巴清扫术,拉拢缝合/带蒂/游离皮瓣移植行舌、口底重建再造。术后30个月以上的随访观察。结果:术后随访均达到30个月以上,中位随访时间42个月。3 、5 年生存率分别为74.45 %(101/137)和70.80 %(97/137)。术后的咀嚼、吞咽、语言和外形的丧失程度有较大的改善,无一例发生病理性骨折,疗效比较满意。结论:保持下颌骨连续性的改良型边缘性下颌骨切除、舌癌联合根治术对中期舌癌是一种可行的根治性手术,既能完成根治性,又能对患者的外形和功能保留有积极的作用。手术的关键是掌握好适应症,同时要求术者具备相当的经验和手术技巧。