喉癌颈部淋巴结转移的MRI诊断.pdf

临床耳鼻咽喉科杂志2000年10月第14卷第10期·449·
喉癌颈部淋巴结转移的MRI诊断

袁玉刚1韩德民2范尔钟2李颖2燕飞2鲜军肪2

摘要目的:探讨MRI在喉癌颈部淋巴结转移术前诊断中的作用。方法:对19例(24侧)喉癌患
者的颈部术前触诊、MRI扫描及颈清扫标本病理检查结果进行了对比研究。结果:喉癌颈部转移
淋巴结在MRI影像上基本呈圆形或类圆形,个别可表现为数个淋巴结的融合;MRI和临床触诊
诊断颈部淋巴结转移的敏感率、特异率和准确率分别为85.7%、90.0%、87.5%和64.3%、70.
0%、66.7%,MRI诊断的准确率明显高于临床触诊;同时颈部转移淋巴结除了在形态、大小方面

发生改变外,转移淋巴结内部的MRI信号及其周围邻近的软组织结构也有明显改变,其在T1加

权像上表现为略低信号和等信号的混合,T2加权像表现为高信号,转移淋巴结轮廓清晰,周围可

出现不完全环状脂肪增生带。使用脂肪抑制和Gd-DTPA增强扫描的T1加权像能较好地显示较
小的转移淋巴结。结论:MRI较为客观、直接,有助于颈部淋巴结转移的早期发现,提高诊断的准
确率。

关键词磁共振成像喉肿瘤颈部淋巴结淋巴转移

Theevaluationofcervicallymphnodemetastasisoflaryngeal
cancerusingmagneticresonanceimaging(MRI)
YUANYu-gang1HANDe-min2FANEr-zhong2LIYing2YANFei2XIANJun-fang2
(1DepartmentofOtolaryngology,FirstCentralHospitalof
TianjinMedicalUniversity,Tianjin300192;
2BeijingTongrenHospital)
AbstractObjective:ToassessthepotentialorlimitationofMRIfordemontratingthepathologicalcervical
lymphnodes.Method:Aprospectivediagnosticstudyoncervicallymphnodemetastasisfromlaryngealcarcinoma
wasperformedfor19casesundergoneneckdissection(5casesundergonebilateralneckdissection,24specimens
ofneckdissectionwerecollectedintotal).Withpathologicalfindingsasthecriterion,sensitivityandspecificity
andaccuracywerecalculatedforpalpationandMRIexaminationofallpatients.Result:MRIhadobviouslyhigher
sensitivityspecificityandaccuracythanpalpation.Besidesthechangesinsizeandshapeofthemetastaticlymphn-

odes,theintensityofMRIinsidethemetasticlymphnodeswasshowedasmixedhypo-isointensityinT1WIand

hyperintensityinT2WI.Conclusion:MRIexaminationwasaccurateindetectingcervicallymphnodemetastasis
andcouldimageoccultlymphnodeswhichareinaccessibleonpalpation.Thus,MRIwillprobablyplayanimpor-
tantroleintheevaluationofmalignantlymphnodemetastasis.

KeywordsMagneticresonanceimagingLaryngealneoplasmsCervicallymphnodeLymphaticmetasta-
sis

喉癌常转移至颈部淋巴结,治疗前正确判断是1资料与方法
否有颈部转移,对肿瘤分期、治疗方案选择及预后1.1临床资料
评估均有很大影响。但由于颈部结构复杂,使得颈19例喉癌患者均经病理证实为鳞癌,男12例,
部转移的临床诊断颇为困难。目前临床主要依靠触女7例;年龄42～66岁。其中12例行单侧根治性颈
诊对淋巴结有无转移进行判断,然而即使有丰富临清扫术(RND),2例行单侧肩胛舌骨肌上颈清扫