Importance of nasopharyngeal mucosa typing in diffusion weighted imaging for the diagnosis of nasopharyngeal malignant lesions
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摘要:
目的 探讨鼻咽黏膜DWI分型对于诊断鼻咽恶性病变的价值。 方法 根据鼻咽黏膜显示的对称性、黏膜最高信号与脊髓信号的比较，91例鼻咽黏膜DWI图像分为4型，Ⅰ型（低信号对称型）15例、Ⅱ型（低信号不对称型）5例、Ⅲ型（高信号对称型）32例、Ⅳ型（高信号不对称型）39例。将分型结果与定性结果进行比较，探讨各型表现与鼻咽恶性病变发生的关系。 结果 Ⅰ型中未发现恶性病变，Ⅱ型发现1例恶性病变，Ⅰ型与Ⅱ型之间无显著性差异，合并为“Ⅰ型+Ⅱ型”。Ⅲ型发现恶性病变21例、Ⅳ型发现37例。整体上各型之间有显著性差异（χ2=46.848，P < 0.001）。“Ⅰ型+Ⅱ型”与Ⅲ型、“Ⅰ型+Ⅱ型”与Ⅳ型、Ⅲ型与Ⅳ型之间均存在显著性差异（χ2=18.533，P < 0.001；χ2=46.579，P < 0.001；χ2=10.052，P=0.002）。 结论 当DWI图像上鼻咽黏膜表现为Ⅲ型或Ⅳ型时，临床应高度怀疑恶性病变的可能；若表现为Ⅰ型或Ⅱ型时，临床上不应盲目诊断为恶性，需充分结合其他辅助资料分析。 Abstract:Objective This study aims to investigate the importance of nasopharyngeal mucosa typing in the diffusion weighted imaging (DWI) for the diagnosis of nasopharyngeal malignant lesions. Methods Based on the symmetry of nasopharyngeal mucosa and on the comparison between the highest mucosa signal and the spinal cord signal, 91 cases of nasopharyngeal mucosa DWI images were divided into four types, namely, type Ⅰ (low signal and symmetry, 15 cases), type Ⅱ(low signal and asymmetry, five cases), type Ⅲ (high signal and symmetry, 32 cases), and type Ⅳ (high signal and asymmetry, 39 cases). The typing and qualitative results were compared to investigate the relationship between the typing and nasopharyngeal malignant lesions. Results Malignant lesions were not found in type Ⅰ, and only one case of malignant lesions was found in type Ⅱ. No significant differences were observed between types Ⅰand Ⅱ; therefore, these types were merged into "type Ⅰ+Ⅱ." A total of 21 and 37 cases with malignant lesions were found in types I Ⅱ and Ⅳ, respectively. Significant differences were generally found among these types (χ2=46.848, P=0.000), that is, between "type Ⅰ+Ⅱ" and type Ⅲ, "type Ⅰ+Ⅱ" and type Ⅳ, as well as between types Ⅲ and Ⅳ (χ2= 18.533, 46.579, 10.052, P=0.000, 0.000, and 0.002, respectively). Conclusion The DWI images of the nasopharyngeal mucosa showed that suspected malignant lesions should be found in type Ⅲ or Ⅳ. If found to be type Ⅰ or Ⅱ, such lesions should not be clinically considered malignant. Other auxiliary data are needed for diagnosis. -
Key words:
- diffusion weighted imaging /
- nasopharyngeal neoplasm /
- diagnostic imaging
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图 1 Ⅰ型，Ⅰa亚型。DWI：鼻咽黏膜显示欠清，尤其是鼻咽后壁黏膜呈明显低信号
Figure 1. Type I, Ia subtype. DWI:nasopharyngeal mucosa was unclear, an obvious low signal is observed in the posterior wall of the nasopharyngeal mucosa
图 2 Ⅰ型，Ⅰb亚型。DWI：鼻咽黏膜不厚，双侧咽隐窝处局部信号对称性增高，接近于脊髓信号
Figure 2. Type I, Ib subtype. DWI:nasopharyngeal mucosa is not thick, bilateral pharyngeal recess at the local symmetry of the signals is increased close to the spinal cord signal
图 3 Ⅱ型。DWI：双侧鼻咽黏膜不对称，以咽隐窝处信号最高，接近于脊髓信号
Figure 3. Type Ⅱ。DWI:asymmetric bilateral nasopharyngeal mucosa, the pharyngeal recess is at the highest signal, close to the spinal cord signal
图 4 Ⅲ型，Ⅲa亚型。DWI：鼻咽黏膜双侧对称显影，未见明显增厚，以咽隐窝处信号最高，高于脊髓信号
Figure 4. Type Ⅲ, Ⅲa subtype. DWI: nasopharyngeal mucosa bilaterally symmetrical development; no obvious thickening; pharyngeal recess at the highest signal, higher than that of spinal cord signal
图 5 Ⅲ型，Ⅲb亚型。DWI：鼻咽黏膜对称性增厚，双侧咽隐窝处信号最高，高于脊髓信号
Figure 5. Type Ⅲ, Ⅲb subtype. DWI: nasopharyngeal mucosa thickening of bilateral symmetry; pharyngeal recess at the highest signal; signal is higher than that of the spinal cord
图 6 Ⅳ型，Ⅳa亚型。DWI：鼻咽左侧咽隐窝处黏膜结节状增厚，信号高于脊髓信号，左侧咽后淋巴结转移
Figure 6. Type Ⅳ, Ⅳa subtype. DWI: left side pharyngeal recess; nasopharyngeal mucosal nodular thickening; signal is higher than the spinal cord signal. Metastasis of left retro-pharyngeal lymph node is observed
图 7 Ⅳ型，Ⅳb亚型。DWI：鼻咽左侧壁、顶后壁黏膜明显增厚形成肿块灶，信号不均匀，最高信号高于脊髓信号
Figure 7. Type Ⅳ, Ⅳb subtype. DWI: left side wall; thickening observed in the top wall of the nasopharyngeal mucosa mass range with signal heterogeneity. The highest signal is higher than that of the spinal cord
表 1 DWI鼻咽黏膜分型与定性结果比较
Table 1. Comparison of DWI nasopharyngeal mucosa typing and qualitative results
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