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目的探讨MR I在鼻咽癌的诊断、分期、放疗计算设计上的独特价值。方法经病理确诊为鼻咽癌无远处转移的首程3D-CRT前均行增强CT和MR I扫描,分别根据增强CT及CT/MR I配准勾画靶区,比较由此形成的两套治疗计划的相关参数。结果59例患者中经CT/MR I配准检查后TNM分期升高者16例,其中8例由Ⅰ、Ⅱ期升级为Ⅲ、Ⅳ期。CT/MR I配准后得到的VG′TV=(45.6±33.5)cm3,单纯CT增强扫描得到的VGTV=(39.1±30.8)cm3,两组VGTV之间的差异有统计学意义。结论MR I在检出超腔侵犯咽后淋巴结转移,早期的颅底骨质破坏方面有明显优势。鼻咽癌患者基于MR I的临床分期更为准确,CT/MR I配准有助于准确勾画靶区,较好的避免“漏靶”的可能。建议临床中应尽可能采用MR I对原发灶进行评价,以便指导合理的治疗。
Objective To explore the unique value of MR I in the diagnosis, staging and radiotherapy of nasopharyngeal carcinoma. Methods Pathologically confirmed nasopharyngeal carcinoma without distant metastasis before the first trip to 3D-CRT were performed enhanced CT and MR I scan, respectively, according to enhanced CT and CT / MR I outlined the target area, compared to the resulting two sets Treatment plan related parameters. Results Among the 59 cases, 16 cases were found to have TNM staging after CT / MR I registration examination. Among them, 8 cases were upgraded from stage Ⅰ and Ⅱ to stage Ⅲ and Ⅳ. VGTV = (45.6 ± 33.5) cm3 after CT / MR I registration and VGTV = (39.1 ± 30.8) cm3 after CT scan enhancement respectively. The difference between the two groups was statistically significant. Conclusions MR I has obvious advantages in detecting supraclavicular lymph node metastasis and early skull base bone destruction. The clinical staging based on MR I of NPC patients is more accurate. The registration of CT / MR I can help to accurately design the target area and avoid the possibility of “missed target”. It is recommended that clinical use of MR I should be used to evaluate the primary tumor in order to guide the rational treatment.