- 期刊
The Significance of Tc-99m SPECT and MRI Findings in the Diagnosis of Skull Base Invasion in Nasopharyngeal Carcinoma
Tc99m SPECT檢查與核磁共振掃瞄在診斷鼻咽癌病人顱骨侵犯程度之比較
摘要
目的：評估Tc99m SPECT檢查在診斷鼻咽癌(NPC)病人顱骨侵犯上之角色，及其與核磁共振掃瞄(MRI)結果之比較。 材料和方法：我們回溯性的分析了179位於1997年8月1日至2000年12月31日間，本院新診斷治療之鼻咽癌病人。所有病人治療前均以Tc99m SPECT與核磁共振掃瞄檢查其顱骨侵犯程度。核磁共振掃瞄發現骨表缺損、異常及骨髓非對稱性強度訊號時，懷疑為顱骨侵犯。Tc99m SPECT檢查發現顱骨出現異常聚焦部位或由左至右不對稱放射活性則判斷為顱骨侵犯。病人癌症期別根據理學檢查與核磁共振掃瞄結果，依1997 AJCC鼻咽癌分期標準進行分類。原發腫瘤控制率則依Tc99m SPECT檢查與核磁共振掃瞄結果，分別進行腫瘤期別(T-stage)分類，再以Kaplan-Meier方法與對數分析。 結果：179位病人中，Tc99m SPECT檢查結果有92位(51.4%)在顱骨出現異常（陽性或懷疑為惡性），其中T1期別10位；T2期別14位；T3期別24位；T4期別44位。核磁共振掃瞄檢查結果有78位(43.6%)出現顱骨侵犯，其中T3期別30位；T4期別48位。92位Tc99m SPECT顱骨檢查陽性或懷疑為惡性之病人，其3年原發腫瘤控制率為87.1%；相較檢查正常者3年原發腫瘤控制率為98.2%，p值為0.11。23位Tc99m SPECT檢查異常，但核磁共振掃瞄無顱骨侵犯之T1-T2期別的病人，其3年原發腫瘤控制率為100%。 結論：研究分析中發現，Tc99m SPECT檢查結果顱骨為陽性或懷疑為惡性，但核磁共振掃瞄無相對應發現之病人，在原發腫瘤控制預後上，並無較高復發的風險。然而，Tc99m SPECT檢查與核磁共振掃瞄相較下，敏感度高特異性低之特性，可協助核磁共振掃瞄用於鼻咽癌治療前評估之診斷。
並列摘要
Purpose: To evaluate the role of Tc-99m SPECT in the diagnosis of skull base invasion in nasopharyngeal carcinoma (NPC) and to compare its findings to magnetic resonance imaging (MRI). Materials and Methods: We retrospectively analyzed 179 newly diagnosed NPC patients treated between August 1, 1997 and December 31, 2000 in our institute. All patients were examined with both MRI and Tc-99m SPECT of the skull base prior to treatment. Bone involvement was suspected on MRI when there was a defect in cortical intactness or an abnormality or asymmetry in the signal intensity of the marrow. Malignancy in the skull base was suspected on SPECT when there was an abnormal focal area of increased uptake or left-to-right asymmetry in the skull bone radioactivity. Patients were staged according to the 1997 AJCC classification of NPC based on physical exam and MRI findings. Primary tumor control rates for patients stratified by T stage and MRI or SPECT results were analyzed using the Kaplan-Meier method and the log rank test. Results: Out of 179 patients, a total of 92 (51.4%) had an abnormal SPECT (positive or questionable for malignancy) in the skull base (T1: 10, T2: 14, T3: 24, and T4: 44), while 78 (43.6%) demonstrated skull base malignancy on MRI (T3: 30 and T4: 48). The 3-year primary tumor control rate of the 92 patients with an abnormal SPECT was 87.1%, versus 98.2% for the patients with a normal SPECT in the skull base (p=0.11). Twenty-three patients in stages T1-T2 had an abnormal SPECT but a normal MRI in the skull base, and their 3-year primary tumor control rate was 100%. Conclusions: An abnormal SPECT in the skull base without corresponding MRI findings is not a poor prognostic factor by itself and patients are not at an increased risk for primary tumor recurrence. However, SPECT appears to be more sensitive than MRI, although specificity is low, and it can be a helpful adjunct to MRI in the pretreatment evaluation of NPC.
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