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目的:探讨SPECT和CT对鼻咽癌颅底骨侵犯的检测能力及临床价值。方法:对50例初治鼻咽癌患者放疗前同期进行前瞻性SPECT和CT检测,比较两者的检出率及与临床症状、体征、T、N分期的相关性。结果:SPECT和CT对鼻咽癌颅底骨侵犯的阳性检出率在全部患者中分别为60%和36%;在头痛、颅神经损害及两者并存患者中分别为83.3%、25%;100%、0;94.4%、77.8%。在T1+T2及T3+T4的患者中分别为18.2%、0;92.9%、64.3%。在N0+N1及N2+N3的患者中分别为67.7%、45.5%;41.2%、17.6%。在Ⅰ+Ⅱ及Ⅲ+Ⅳ期的患者中分别为20%、0;70%、45%。SPECT的阳性检出率明显高于CT,差异有统计学意义,P<0.05。Binarry Logistic回归分析显示,头痛及T分期是SPECT阳性检出的危险因素(OR头痛=11.92,ORT分期=15.43);颅神经损伤是CT阳性检出的危险因素(OR颅神经损伤=7.50)。结论:结合患者头痛、颅神经损害症状、T、N分期,综合SPECT和CT检测结果,提高鼻咽癌患者早期颅底骨受侵犯的检出率和诊断的准确性是可行且有实际意义的。
Objective: To investigate the detection and clinical value of SPECT and CT in detecting the invasion of skull base of nasopharyngeal carcinoma. Methods: Fifty patients with newly diagnosed nasopharyngeal carcinoma were prospectively detected by SPECT and CT before radiotherapy. The detection rates of the two methods were compared with clinical symptoms, signs, T, N stages. Results: The positive rates of SPECT and CT in detecting skull base bone in nasopharyngeal carcinoma were 60% and 36% in all patients, 83.3% and 25% in patients with headache, cranial nerve injury and their coexistence respectively. 100%, 0; 94.4%, 77.8%. It was 18.2%, 0; 92.9%, 64.3% in T1 + T2 and T3 + T4 respectively. Patients in N0 + N1 and N2 + N3 were 67.7%, 45.5%, 41.2% and 17.6% respectively. It was 20%, 0%, 70%, 45% in patients with stage I + II and stage III + IV, respectively. The positive rate of SPECT was significantly higher than CT, the difference was statistically significant, P <0.05. Binarry Logistic regression analysis showed that headache and T stage were the risk factors of SPECT positive detection (OR headache = 11.92, ORT stage = 15.43); cranial nerve injury was the risk factor for CT positive detection (OR cranial nerve injury = 7.50). Conclusion: It is feasible and practical to improve the detection rate of early skull base bone invasion and the accuracy of diagnosis in combination with the symptoms of headache, cranial nerve damage, T, N staging and SPECT and CT. .