局部晚期鼻咽癌颅底骨质破坏与骨转移的相关性

目的 探讨局部晚期鼻咽癌颅底骨质破坏与骨转移的关系。方法 2008年1月1日至2010年3月31日共518例初治的局部晚期鼻咽癌患者（UICC2002版分期标准分为Ⅲ期、ⅣA期、ⅣB期）入组。按治疗前是否有颅底骨质破坏分为A、B两组：A组（无颅底骨质破坏）243例,B组（有颅底骨质破坏）275例。比较两组患者首次治疗后的骨转移发生率及骨转移时间。结果 518例骨转移发生率为11.8%（61/518）,其中A组16例（6.6%）,B组45例（16.4%）（P<0.05）。在61例发生骨转移患者中,B组单一骨转移发生率明显高于A组（73.3% vs. 43.8%,P<0.05）;A、B两组出现首次骨转移事件的中位时间分别为14.0月,19.1月,组间比较差异无统计学意义（P>0.05）。单因素及多因素分析均显示颅底骨质破坏是影响局部晚期鼻咽癌骨转移发生的不良预后因素。结论 伴有颅底骨质破坏的局部晚期鼻咽癌患者易发生骨转移、单一骨转移发生率高,颅底骨质破坏是引起骨转移发生的不良预后因素。     

18F-FDG SPECT/CT与99mTc-MDP骨显像在检测肺癌骨转移中的对比研究

目的对比研究双探头符合线路SPECT/CT仪18F-脱氧葡萄糖(FDG)显像和99mTc-亚甲基二膦酸盐(MDP)显像对肺癌骨转移病灶的诊断效能。方法肺癌患者56例,分别行18F-FDGSPECT/CT胸腹部显像和99mTc-MDP全身骨显像,间隔时间不超过2周。结果56例患者中24例有骨转移,共发现92个转移灶;18F-FDGSPECT/CT检查发现68个转移灶,探测骨转移灶的灵敏度73.9%,特异性94.1%,准确率为81.1%;99mTc-MDP全身骨显像发现82个转移灶,探测骨转移灶灵敏度89.1%(P<0.01),特异性为72.5%(P<0.05),准确率为83.2%(P>0.05)。当把骨骼转移性病变以成骨性与溶骨性方式分类时,99mTc-MDP骨显像可判定94.3%的成骨性转移灶和82.1%的溶骨性转移灶,而18F-FDGSPECT/CT可判定58.5%的成骨性转移灶和94.9%的溶骨性转移灶。结论探测肺癌骨转移,18F-FDGSPECT/CT显像具有较高的特异性,99mTc-MDP骨显像具有较高的灵敏度,两者诊断的准确性无明显差异。99mTc-MDP骨显像联合18F—FDGSPECT/CT显像检测肺癌骨转移,可起到信息互补、明确诊断的作用。     

增强CT冠状扫描在诊断鼻咽癌颅底侵犯中的意义

目的：探讨鼻咽部增强CT冠状位扫描对诊断鼻咽癌侵犯颅底的价值。方法：将经病理学检验证实的193例鼻咽癌的CT增强轴位扫描与冠状位扫描颅底情况进行回顾性对照分析。结果：193例鼻咽癌中，120例(占62．2％)经两种扫描均未见颅底侵犯；10例(5．2％)轴位扫描未见颅底异常而经冠状扫描发现其受侵犯；15例(7．8％)轴位可疑颅底受侵犯而经冠状扫描肯定侵犯11例．排除4例；轴位扫描显示海绵受窦侵有26例。增强CT冠状扫描则为3例。结论：增强CT冠状扫描对确定鼻咽癌有无颅底骨质侵犯及其侵犯部位、范围与程度均有重要价值，在显示海绵窦受侵犯，肿瘤组织沿脑池或／和脑沟等蛛网膜下腔生长，侵犯周围组织的征像方面，明显优于轴位扫描。     

核素全身骨显象对鼻咽癌骨移转的探讨

对本科将近１０年间所做全身骨显象２３３３例中的３４例鼻咽癌患者的全身骨象结果进行了分析，并结合复习文献，在鼻咽癌骨转移的发生率，分布特点及与颈部淋巴结转移和颅底骨破坏的关系等方面进行了讨论。其中１５例骨显象为异常，结合临床及Ｘ线检查确诊为骨转移，其发生产达检病人的４４．１％。骨转移患者全部为多发骨转移，平均每例病灶数８．７个，骨转移的部位以脊柱和胸部为最多，其次为骨盆，肢体，颅骨，肢体转移中以下肢     

鼻咽癌扩散途径的研究

本文对47例鼻咽癌尸解资料临床病理分析,研究其扩散途径。结果表明:鼻咽癌是一种局部侵袭力强、远处较移广泛的恶性肿瘤。局部扩张可以向头颅器官、副鼻窦腔、咽旁软组织间隙、颅底骨质、颅腔内广泛侵犯。远处转移率高达77.5％(31/40)。本研究发现,鼻咽癌好发淋巴结转移,占远处转移的55％,居第一位,其次为骨、肝、脊髓等。鼻咽癌如此广泛的局部侵犯和远处转移,单纯放疗难以取得理想的效果,故提出鼻咽癌的治疗应采取综合治疗手段,并对如何提高疗效,提出一些意见和建议。     

Mode of spread in nasopharyngeal carcinoma as seen on CT scan

From April 1984 to April 1986, 993 NPC patients were scanned with an 8800 CT scanner in our hospital. 200 consecutive cases who had CT scan before treatment were selected for analysis. CT features of local invasion, incidence of involvement of the parapharyngeal spaces and the adjacent structures, and bone destruction of the base of the skull were analysed. The results showed that the mode of local spread of nasopharyngeal carcinoma is direct infiltration. It tends to spread posterolaterally. According to the relation of the carotid sheath area and lymph nodes in the neck, it is most likely that metastasis in the cervical lymph nodes is the result of direct spread of the disease via the carotid sheath area. CT could detect more bone destruction of the skull base than the conventional submental view. The relationship of neck lymph node metastasis and bone destruction is discussed.     

女性双侧乳癌SPECT全身骨扫描显像的临床意义

目的:通过对女性双侧乳腺癌病人的SPECT全身骨扫描分析,了解骨转移病灶分布特点.方法: 病人注射99mTc-MDP显像剂,2-3小时后,行全身SPECT骨扫描.结果: 女性双侧乳腺癌病人大部分发生多发性骨转移.结论: 女性双侧乳腺癌病人,易发生多发性骨转移,常规行SPECT全身骨扫描是必要的.     

局部骨融合断层显像在乳腺癌患者肋骨病变中的诊断价值

目的:探讨局部骨融合断层显像在乳腺癌患者肋骨病变中的诊断价值。方法:选取21例进行全身骨扫描的乳腺癌患者,对肋骨放射性浓聚灶进行局部骨融合断层显像。结果:局部骨融合断层显像结果如下:21例患者共检出病灶39例次,结果依次为肿瘤骨转移:21例次;骨折:12例次;肋骨良性骨病:3例次;术后改变:2例次;胸膜所致反应性改变:1例次。结论:局部骨融合断层显像可敏感的发现病变,并可准确的对病变进行定性,对患者进一步治疗方案的制定有很高的临床价值。     

Lace‐like enhancement pattern of osteosarcoma of rib and liver metastasis in CT scans

The rib is an uncommon site of osteosarcoma. With the use of adjuvant chemotherapy and aggressive surgical resection of the metastatic pulmonary lesions, extrapulmonary metastases are becoming more clinically evident. Primary rib osteosarcoma with extrapulmonary metastasis is exceedingly rare. A case is reported, showing that the pattern of metastasis of rib osteosarcoma is similar to that of primary bone osteosarcoma. The liver metastasis occurred after resection of the metastatic pulmonary lesions. A CT scan of the primary rib lesion and liver metastasis both showed a lace‐like enhancement pattern, its histological appearance corresponding with neoplastic osteoid. With the increasing use of CT abdomen for localization of extrapulmonary metastases, lace‐like enhancement may be seen more readily in the future.     

MRI联合CT诊断鼻咽癌颅底转移

目的:探讨MRI联合CT诊断鼻咽癌颅底转移的价值。方法:选取2006年8月至2013年8月经病理证实为鼻咽癌的患者50例,全部患者治疗前均行CT及MRI检查,分析鼻咽癌颅底转移的CT及MRI影像学表现,评价联合应用CT/MRI对鼻咽癌颅底转移诊断的价值。结果:CT示颅底骨质侵犯30例,MRI扫描示颅底侵犯39例,其中5例MRI扫描发现斜坡、蝶骨翼和蝶骨体早期骨髓浸润,而CT检查表现正常。另外1例MRI见肿瘤沿三叉神经向颅内侵犯,而CT未见明确的卵圆孔破坏。两种影像学方法的检出率存在显著性差异（P<0.05）。结论:CT与MRI均可显示鼻咽癌颅底转移,MRI对颅底组织侵犯更加敏感,二者联合有助于提高诊断的准确性。     

基于MRI的3100例鼻咽癌淋巴结转移规律分析

目的 应用MRI研究鼻咽癌淋巴结转移规律,为IMRT提供颈部照射范围依据。方法 前瞻分析2010—2013年间具有MRI检查的 3100例初治鼻咽癌患者资料。由鼻咽癌多学科综合治疗组阅片,分析淋巴结转移。淋巴结位置按RTOG分区2003版评判。结果 全组淋巴结转移占86.42%(2679/3100),其中分布在咽后外侧组 2012例 (64.90%,其中 6例 同时位于中央组), Ⅱ341例 (75.52%,其中 492例 淋巴结上界至C1一半水平、115例 到达颅底水平), Ⅱ798例 (58.00%),Ⅲ区 1184例 (38.19%),Ⅳ区 350例 (11.29%,其中 28例 下界超出RTOG规定的范围),Ⅴ区 995例 (32.10%,其中 91例 超出规定范围),Ⅰb 区 115例 (3.71%),腮腺区域 40例 (1.29%,均伴随同侧广泛淋巴结转移,且淋巴结总数≥6个)。只 6例 发生跳跃性转移(0.19%)。结论 ①鼻咽癌中央组咽后淋巴结转移较为罕见;②Ⅱ区淋巴结上界为颅底水平更合适;③鼻咽癌淋巴结转移从上至下规律性发展;④Ⅳ、Ⅴ区有转移时淋巴结可能超出RTOG规定范围;⑤同侧淋巴结广泛转移时可能出现腮腺区累及。     

鼻咽癌调强放疗后感音神经性听力下降的临床分析

目的 分析鼻咽癌患者调强放疗后感音神经性听力下降(SNHL)的影响因素。方法 比较2012— 2013年间接受单纯放疗和同期放化疗的 29例鼻咽癌患者声导抗测听、纯音听阈测定及耳蜗放射剂量,所有患者均接受调强放疗。采用前瞻性分析方法分析耳蜗放射剂量对鼻咽癌患者SNHL的影响,同时了解放疗后时间、化疗、T分期、年龄等因素对结果的影响。结果 58只耳中6只(10%)发生了低频SNHL,17只(29%)发生高频SNHL。放疗后发生感音神经性耳聋患者和未发生听力下降患者耳蜗剂量不同(左耳46、1 Gy∶35、5 Gy,P=0、006;右耳45、0 Gy∶35、8 Gy,P= 0、009)。当耳蜗平均剂量限制到44 Gy以下时只有15%(6/38)耳发生SNHL。颅底骨质破坏对听力有影响(P=0、047)。结论耳蜗的平均剂量和颅底骨质的侵犯是鼻咽癌患者放疗后SNHL的重要影响因素。建议耳蜗的平均剂量限制在44 Gy是合理的。     

Prognostic factors of nasopharynx tumors investigated by MR imaging and the value of MR imaging in the newly published TNM staging

PURPOSE: To examine the usefulness of MR imaging for predicting local control of nasopharyngeal carcinoma (NPC) and the value of MR imaging in the newly published fifth edition of the TNM classification. METHODS AND MATERIALS: We studied 29 patients with NPC with MR imaging and CT before and after treatment. Staging was done according to the fourth and newly published fifth editions of the International Union Against Cancer (UICC) staging system. The radiotherapy protocol was designed to deliver 66 to 68 Gy to the primary tumor and clinically involved nodes. RESULTS: MR proved better than CT at identifying obliteration of the pharyngobasilar fascia, invasion of the sinus of Morgagni, through which the cartilaginous portion of the eustachian tube and the levator veli palatini muscle pass, invasion of the skull base, and metastases to lymph nodes in the carotid and retropharyngeal spaces. All seven patients without invasion of the pharyngobasilar fascia had local control. The local control rates of patients with invasion of the skull base were not good (60 to 73%). There was no apparent relationship between tumor volume determined by T1-weighted MR images and local control when the tumor volume was more than 20 cc. The newly published N staging system appears to successfully identify the high-risk group for distant metastasis as N3. In our series, four of five patients with N3 disease developed distant metastases. CONCLUSION: Deep infiltration of the tumor is a more important prognostic factor in NPC than tumor volume. Since the newly published T staging system requires a search for tumor invasion into soft tissue such as parapharyngeal space and bony structures, MR imaging may be indispensable for the newly published NPC staging system.     

False negative bone scintigraphy in a patient with primary breast cancer: a possible transient phenomenon of bisphosphonate (alendronate) treatment

Breast cancer is the most common cancer and the second leading cause of cancer deaths among women in developed countries. Bone is a frequent site of metastatic disease with a stage-dependent incidence. Most women with breast cancer are at risk of osteoporosis due to their age or their breast cancer treatment. Scintigraphy enables imaging of the entire skeleton with high sensitivity but limited specificity. The false positive rate varies from 1.6% to as high as 22%, while the false negative rate varies from 0.96% to 13%. We observed a 70-year-old woman with a diagnosis of breast cancer and a false negative bone scan despite extensive bone metastases. She was under alendronate treatment for osteoporosis at the time. The false negative finding might be due to a transient phenomenon of alendronate, a bisphosphonate cleared from the plasma by uptake into bone and by renal excretion. 99mTc-MDP is eliminated via the same pathways, and therefore competition may occur between the two substances. Another possible explanation for the false negative bone scan could be that bone metastases, indicating hematogenous tumor spread, are detected earlier by CT scan or MRI than by bone scan. Breast cancer patients under bisphosphonate treatment for osteoporosis must be carefully evaluated for bone metastasis during radionuclide studies with 99mTc-MDP.     

恶性黑色素瘤SPECT全身骨扫描显像的临床分析

目的：通过对恶性黑色素瘤病人的SPECT全身骨扫描分析,了解骨转移病灶分布特点。方法：给病人注射99mTc-MDP显像剂,2-3小时后,行全身SPECT骨扫描。结果：恶性黑色素瘤病人大部分发生多发性骨转移。结论：恶性黑色素瘤病人,易发生多发性骨转移,常规行SPECT全身骨扫描是必要的。     

Bone metastasis after a resection of stage I and II primary lung cancer

In the present study, we reviewed the patients who developed bone metastases after a surgical resection of primary lung cancer and evaluated their clinicopathological features. From 1992 to 1995, 177 patients with stage I and II primary lung cancer underwent a surgical resection at the Kitakyushu Municipal Medical Center. Bone metastases were detected in 14 patients (7.9%) by follow-up examinations including bone scintigraphy (scan). Bone metastasis was one of the most frequent extra-thoracic recurrent forms. Patients with adenocarcinoma tended to develop bone metastases more frequently than those with squamous cell carcinoma. In the preoperative bone scans, an abnormal uptake was observed in 76 patients (42.9%), and 10 (13.1%) of them were found to develop bone metastases in the follow-up studies. A microscopic examination of the primary tumor demonstrated close correlation between intratumoral and peritumoral lymphatic vessel invasion and postoperative development of bone metastases. A bone scan is a very useful and indispensable procedure for diagnosing bone metastases. However, this scan may also show false positive finding in a number of benign conditions. Therefore, a surgical resection should be considered as the first-line treatment for patients with positive findings in the bone scan when the diagnosis of bone metastasis can not be confirmed based on both their symptoms and other clinical examinations.     

MRI对78例鼻咽癌患者临床分期的影响

背景与目的：目前国内鼻咽癌按92’福州分期进行临床分期,其主要依据是临床检查和CT检查。随着MRI在临床上普及应用,其对显示鼻咽癌侵犯范围更加敏感、精细,势将影响鼻咽癌的临床分期。本文通过对78例鼻咽癌患者的CT与MRI图像的比较,探讨MRI相对于以CT为基础,对鼻咽癌92’福州分期造成的影响。方法：回顾分析我院2005年8月至2006年8月收治的78例鼻咽癌患者放射治疗前的CT和MRI图像,所有病例均经病理证实。采用χ2检验分别以CT和MRI图像为依据的鼻咽癌92’福州分期的差异。结果：MRI和CT对鼻咽癌病变检出率分别为：茎突前间隙82.0%,65.4%;口咽34.6%,20.5%;咽后淋巴结74.4%,55.1%;颅底骨质51.3%,30.8%;海绵窦/颅内19.2%,5.1%;副鼻窦33.3%,19.2%;翼腭窝16.7%,6.4%等,差异均有显著性（P〈0.05）。鼻腔28.2%,21.8%;茎突后间隙侵犯65.4%,67.9%;喉咽2.6%,1.3%;以及对颈部淋巴结各区检出率等,差异无显著性。对T、N分期的影响：按照92’福州分期标准,MRI使42.3%的T分期发生改变;25.6%（20/78）的N分期发生改变。对临床分期的影响：按照92’福州分期标准,MRI使28.2%的临床分期发生改变。结论：以MRI作为鼻咽癌的检测手段,诊断更准确,尤其对颅底颅内病变和咽后淋巴结;临床分期改变幅度大,将影响对临床预后的评估;应考虑将MRI图像作为鼻咽癌的临床分期标准。     

Using CT or MRI to assess locoregional spread to determine the radiotherapy target of hypopharyngeal carcinoma

Aim: To identify the locoregional extension of hypopharyngeal carcinoma (HPC), particularly the invasion of the nasopharynx and skull base, and metastasis of level VI and retropharyngeal lymph node (RPLN) by investigating computed tomography (CT) and magnetic resonance (MR) images; together with the radiotherapy target of HPC. Methods: CT and MR images of 186 patients with pathologically confirmed HPC between Aug 2000 and Dec 2010 were analyzed retrospectively. We used the χ² test and logistic regression to analyze local invasion and regional spread and to determine their relationships. Results: Of the 186 patients, there was only one case of invasion of the nasopharynx without skull base involvement. The rate of regional node metastasis was 79%. There was no significant relationship between T stage and lymph node metastasis (P = 0.1). Level IV metastasis (P = 0.001), RPLN metastasis (P = 0.041) and esophageal invasion (P = 0.003) were significantly correlated with level VI metastasis. Primary tumor subsite (P = 0.024), bilateral cervical node metastasis (P < 0.001) and size of cervical nodes (P = 0.01) significantly contributed to the occurrence of RPLN metastasis. Conclusion: The locoregional spread of HPC occurs via certain routes. It is potentially unnecessary to routinely and prophylactically irradiate the nasopharynx and skull base. Patients with early stage HPC should receive bilateral cervical prophylactic irradiation. The decision regarding the administration of prophylactic irradiation to the level VI and RPLN areas should be according to the relative risk factors.     

鼻咽癌颅底侵犯的临床及影像学分析

目的分析鼻咽癌(NPC)颅底侵犯的临床特征和影像学诊断价值。方法对病理确诊的67例NPC病例资料进行回顾性分析,所有资料均有CT、MRI平扫和增强扫描。CT常规采用横断面扫描,MRI采用横断面、矢状面、冠状面扫描,扫描层面自口咽到鞍上池水平。结果① MRI扫描显示52例有颅底侵犯,CT显示35例。CT和MRI对颅底结构侵犯显示例数如下:翼板8 例,14例;斜坡22例,25例;岩尖25例,28例;蝶骨体或蝶窦19例,25例;蝶骨翼9例,12例;海绵窦14例,17例。两者的显示差异有显著意义(x2=9．47,P=0．02)。②颅底侵犯的CT表现主要为孔道的骨质破坏和吸收,而MRI除骨质改变外,还能清楚显示通过孔道的肿瘤。③头痛、颅神经受累及两症状均出现的发生率分别为82．7％(43／52)、67．3％(35／52)和57．7％(30／52)。结论头痛和颅神经损害症状是NPC颅底侵犯的主要特征;MRI诊断颅底和脑组织受侵优于CT。     

Serum CCL2 and serum TNF-α--two new biomarkers predict bone invasion, post-treatment distant metastasis and poor overall survival in nasopharyngeal carcinoma

Purpose

To evaluate the prognostic potential of serum CCL2 (sCCL2) and serum TNF-α (sTNF-α) in nasopharyngeal carcinoma (NPC) before treatment by analysing the expression of these two markers.

Experimental design

Both sCCL2 and sTNF-α were prospectively detected in 297 NPC patients with enzyme-linked immunosorbent assay (ELISA) before treatment. The correlations between sCCL2 level or sTNF-α level and patient’s survival were evaluated.

Results

For sCCL2, the 5-year overall survival (OS) and 5-year distant metastasis-free survival (DMFS) of high expression group and low expression group were 64% versus 81% and 67% versus 84% (P < 0.05), respectively. For sTNF-α, the 5-year OS and 5-year DMFS of high expression group and low expression group were 62% versus 79% and 66% versus 82% (P < 0.05), respectively. The 5-year OS and 5-year DMFS for both positive patients, one marker positive patient and both negative patients were 53% versus 77% versus 85% and 58% versus 80% versus 86% (P < 0.05), respectively. Concentrations of sCCL2 and sTNF-α in patients with large skull base invasion were higher than those without or with small skull invasion (P < 0.05). Patients who developed bone metastasis alone after radical treatment had higher pre-treatment concentrations of sCCL2 and sTNF-α than those without metastasis (P < 0.001). Multifactorial Cox regression analyses demonstrated that T/N/M classification, chemotherapy, sCCL2 level and sTNF-α level were independent predictors of OS and DMFS of NPC patients.

Conclusion

High expression levels of sCCL2 and sTNF-α predict bone invasion, post-treatment distant metastasis and poor overall survival in NPC patients.