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Comparative Analysis Of Spiral CT And MRI In Diagnosis And Postoperative Evaluation Of Hypopharyngeal Carcinoma

Posted on:2020-10-31Degree:MasterType:Thesis
Country:ChinaCandidate:K XiangFull Text:PDF
GTID:2404330590484771Subject:Human Anatomy and Embryology
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Objectives To analyze the accuracy of CT and MRI in the diagnosis of hypopharyngeal cancer,the infiltration to adjacent tissue and lymph node metastasis,and to compare and evaluate the value of CT and MRI in the preoperative diagnosis of hypopharyngeal cancer and in the diagnosis of recurrence of hypopharyngeal cancer after comprehensive treatment.Methods From January 2013 to December 2017,90 patients with hypopharyngeal carcinoma were enrolled.Both CT and MRI examination were performed in the patients.All patients were pathologically diagnosed as squamous epithelial cell carcinoma.Among the 90 patients,65 cases were confirmed tumor recurrence by laryngoscope and / or secondary surgery.The results of pathological examination were used as the gold standard.The accuracy,sensitivity and specificity of CT and MRI examination in diagnosis of hypopharyngeal cancer,display of tumor invasion to adjacent tissue and lymph node metastasis,and in preoperative staging and postoperative recurrence were compared.Using SPPS 19.0 statistical software to analyze the data.Results 1 In the display of hypopharyngeal carcinoma invasion to adjacent structures,the CT findings of the infiltration to posterior region of cricoid cartilage and laryngeal cartilages were lower than that of pathological diagnosis(P<0.01).MRI findings of paralaryngeal space,anterior epiglottic space,posterior fat layer of cricoid cartilage,laryngeal cartilages,thyroid and upper esophageal invasion were similar to those of pathological diagnosis,with no statistical significance(P>0.05).Comparing the CT and MRI images of the location,morphology and extent of invasion of hypopharyngeal carcinoma,the results of MRI examination of the infiltration to posterior region of cricoid cartilage and laryngeal cartilages were higher than those of CT examination(P<0.05),suggesting that MRI is superior to CT in the diagnosis of hypopharyngeal carcinoma invasion to posterior region of cricoid cartilage and laryngeal cartilages.2 CT findings showed that the size,ratio of short to long diameter and the number of lymph nodes in patients with cervical metastasis were significantly higher than those in patients without metastasis,and the difference was statistically significant(P<0.05).The results of MRI imaging showed that there was significant difference between hypopharyngeal cancer patients with cervical lymph node metastasis and those without lymph node metastasis in the sharpness of the borderline between tumors and surrounding tissues,marginal smoothness of tumors,and degree of display with contrast-enhanced MRI(P<0.05).In the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of cervical lymph node metastasis in hypopharyngeal cancer,CT was 85.5%,88.0%,70.0%,90.4% and 75.7% respectively.However,MRI was 95.0%,95.3%,94.3%,97.3% and90.4% respectively.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of MRI were higher than those of CT,the difference wassignificant.In the diagnosis of the cervical lymph node metastasis,the Kappa value(the consistency coefficient)of CT was 0.670,suggesting general agreement with pathological findings.Howerver,the Kappa value of MRI was 0.886(P<0.01),which was better agreement with the pathological results.3 Comparing the tumors staging of hypopharyngeal carcinoma with CT,MRI imaging and the pathological stage,75 cases were diagnosed by CT,with the accuracy rate was 83.3%.Howerver,86 cases were diagnosed by MRI,with the accuracy rate was 95.6%,the difference was statistically significant(P=0.007).4 In 65 cases of patients with postoperative follow-up,26 cases were confirmed to have recurrence by pathological examination.The CT diagnosis of recurrence was 15 cases,with the diagnostic accuracy 57.7%.The Kappa value(consistency coefficient)CT was 0.298.Howerver,the MRI diagnosis of recurrence was 21 cases,with the diagnostic accuracy was 80.7%.The Kappa value of MR was 0.710(P<0.05).The accuracy(86.2%),sensitivity(80.8%)and negative predictive value(87.5%)of MRI were higher than those of CT,and the difference was statistically significant(P<0.05).Conclusion 1 In the demonstration of hypopharyngeal carcinoma invasion to adjacent structures,CT and MRI were similar in the demonstration the infiltration to paralaryngeal space and anterior epiglottic space,and there was no significant difference between CT,MRI and pathological diagnosis.The diagnostic accuracy of MRI was higher than that of CT in the demonstration the infiltration to posterior fat layer of cricoid cartilage and the laryngeal cartilages.In preoperative staging diagnosis,the diagnostic value of MRI is also higher than that of CT.2 In the aspect of lymph node metastasis of hypopharyngeal cancer,the diagnostic effect of MRI is obviously higher than that of CT.3 MRI was higher than CT in the detection rate and diagnostic efficiency of recurrence of hypopharyngeal cancer.Figure7;Table10;Reference 113...
Keywords/Search Tags:CT, MRI, hypopharyngeal carcinoma, lymph node metastasis, postoperative recurrence, diagnosis
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