动态容积CT在青年型鼻咽血管纤维瘤术前评估中的价值

摘要

Purpose To explore the value of 320 row dynamic volume CT angiography in the preoperative assessment of juvenile nasopharyngeal angiofibroma (JNA) and in determining feeding arteries.Materials and Methods The imaging data of 18 cases with JNA proved by surgery and pathology and examined by 320 row dynamic volume CT were analyzed retrospectively.The imaging staging and feeding artery of tumors were determined.Results Most tumors (17/18) showed heterogeneous enhancement in the early stage of enhancement.With the extension of time,the enhancement scope of lesions expended.The time-density curve (TDC) of 11 cases demonstrated rapid ascending and rapid descending after injecting contrast,while 7 cases showed continuous increasing.The blood supply of all tumors included the external carotid artery system of the affected side and showed a close relationship with tumor staging.With the increase of tumor stage,the number of feeding arteries increased (r=0.858,P＜0.05).The feeding arteries of stage Ⅱc and stage Ⅲ tumors included ipsilateral maxillary artery and ascending pharyngeal artery.Besides,the effective radiation dose of 320 row CT angiography for searching arteries [(3.30±0.08) mSv]was less than that of DSA [(7.62±2.39) mSv] (t=-7.98,P＜0.05).Conclusion The 320 row dynamic volume CT imaging of JNA has certain characteristics,which can display the blood supply artery and accurate staging of tumors,thus it has important value in preoperative evaluation of JNA.%目的 探讨320排动态容积CT在青年型鼻咽血管纤维瘤(JNA)术前评估病灶及明确供血动脉中的价值.资料与方法 回顾性分析18例经320排动态容积CT检查并经手术病理证实的.JNA患者的影像学资料,进行肿瘤的影像学分期,确定肿瘤的供血动脉.结果 增强早期肿瘤呈不均匀明显强化(17/18),随时间延长病灶强化范围扩大,其中11例时间-密度曲线(TDC)呈速升速降型,7例呈持续上升型.肿瘤的供血均包含患侧颈外动脉系的分支,并与影像学分期密切相关,随着肿瘤分期增高,供血动脉的数目增多,差异有统计学意义(r=0.858,P＜0.05),Ⅱc期以上的病灶由患侧上颌及咽升动脉同时供血.320排动态容积CT扫描检查的有效剂量为(3.30±0.08) mSv,低于DSA寻找血供时产生的辐射剂量(7.62±2.39) mSv,差异有统计学意义(t=-7.98,P＜0.05).结论 320排动态容积CT影像具有一定的特征性,能够较好地显示供血动脉,进行精准影像学分期,在肿瘤的术前评估中具有重要的临床价值.