| Objective: The purpose of this study was to analyze the conventional MR images between tonsillar carcinoma and tonsillar lymphoma,indentifying the imaging features that distinguish tonsillar carcinoma from tonsillar lymphoma.And analysis the MR imaging factors of tonsillar carcinoma affecting their prognosis.Materials and methods: The authors analyzed the features on MR imaging of 39 patients diagnosed with tonsillar carcinoma and 20 patients diagnosed with tonsillar lymphoma histopathologically.The tumor distribution,size,morphology,homogeneity on T2-weighted and contrast enhancement images,parapharyngeal space invasion,and cervical lymphadenopathy were evaluated and compared between tonsillar carcinoma and tonsillar lymphoma.and the 36 patients with tonsils were followed up after treatment to observe the recurrence and metastasis after treatment.The categorical variables was analyzed by two-sample t-text.The enumeration data was analyzed by univariate analysis with Chi-square test or Fisher's exact test firstly,and The statistically significant variables(P<0.05)were then used to fit a multivariate logistic regression model,which was employed to identify the most important MR imaging features to distinguish tonsillar lymphoma from tonsillar carcinoma,and calculated Sensitivity,Specificity and Diagnostic efficiency value of these meaningful signs for the differential diagnosis.The identification of the two images was firstly analyzed by univariate analysis,and then the logistic regression analysis was used to screen out the image features with independent diagnostic significance,and the diagnostic performance of the model was judged by ROC curve.36 patients with tonsillar carcinoma were divided into two groups according to the presence or absence of recurrence and metastasis,including the disease stabilization group and the disease progression group,26 patients in the stable group,and 10 patients in the progression group.The differences between the two groups were compared by clinical and imaging data.The factors that influence the single factor identification were included in the logistic regression analysis to determine the independent imaging factors affecting metastasis and recurrence after treatment of tonsillar carcinoma.Results: 39 patients with tonsillar carcinoma found 42 lesions(3 bilateral lesions)with an average diameter of 30.8±13.6 mm;38 lesions were irregular in shape and shallow lobulated;31 lesions were unclear and invaded the parapharyngeal space.A total of 25lesions(5 bilateral lesions)were found in 20 cases of lymphoma,with an average diameter of 30.4±13.9 mm.The lesions of 10 tonsillar lymphomas were irregular and shallowly lobulated;the edges of 3 lesions were unclear and the adjacent parapharyngeal space was invaded.The MR images of the two groups of tumors showed equal signals in T1 WI and slightly higher signals in T2 WI.T2WI signals were not uniform in 33 tonsil cancer lesions,and 38 lesions were unevenly enhanced.The T2 WI signals of 7 tonsil lymphoma lesions were not uniform,and the 3 lesions wereenhanced by uneven enhancement.34 cases of tonsillar carcinoma complicated with cervical lymph node involvement,26 cases were unilateral and were ipsilateral involvement,8 cases were bilaterally involved;11 cases of tonsillar lymphoma were involved in cervical lymph node involvement,and 10 cases were unilaterally affected and were ipsilateral.1 case of bilateral involvement.Univariate analysis showed that tonsil cancer was more irregular(P<0.001),T2 WI signal(P<0.001)and enhanced scan signal(P<0.001),and more infiltrated near the parapharyngeal space.<0.001)and cervical lymph node involvement(P = 0.006).Multivariate analysis of lesion enhancement uniformity(OR = 46.197,P < 0.001),adjacent parapharyngeal infiltration(OR = 9.259,P = 0.023)as an independent predictor of tonsillar carcinoma and tonsillar lymphoma,area under the ROC curve was 0.964(P<0.001).Of the 36 patients with tonsillar carcinoma who underwent concurrent chemoradiotherapy,the follow-up period was 2-153 months,the median follow-up time was 50.6 months,and the follow-up rate was 100%.Among them,there were 26 cases(72.2%)in the stable disease group.After treatment,the lesions were significantly reduced or disappeared,and stabilized.In the disease progression group,10 patients(27.8%)had recurrence or metastasis after treatment,including simple local recurrence.4 cases,local recurrence with cervical lymph node metastasis in 1 case,cervical lymph node metastasis with adjacent skin involvement in 1 case,lung metastasis in 2 cases,multiple bone metastases in 2 cases.Univariate analysis showed statistically significant differences in age(P<0.001),lesion size(P<0.001),and clinical stage(P=0.008).Logistic regression analysis showed large lesions(P<0.001,OR=24.295).Clinical stage(P<0.001,OR=0.127)was an independentinfluencing factor affecting recurrence and metastasis after treatment of tonsillar carcinoma.Conclusion:1.Conventional MRI is of great value in the identification of tonsillar carcinoma and lymphoma.If the image shows uneven enhancement of the tonsil area,unclear boundary between the edge and surrounding tissues,and soft tissue mass infiltrating the parapharyngeal space,it is more likely to diagnose tonsil cancer rather than tonsil lymphoma;2.The size and clinical stage of tonsil cancer is an independent imaging factor affecting prognosis.The larger the lesion of tonsil carcinoma,the later the clinical stage,the more likely to relapse and metastasis. |
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