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鼻咽癌咀嚼肌间隙侵犯的MR特点分析

作者:万 玲1,2 梁碧玲1 吴 卓1 谢明伟1 王东烨1

所属单位:1.中山大学孙逸仙纪念医院 (广东 广州 510120) 2.广州市干部疗养院/广州市第十 一人民医院 (广东 广州510000)

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摘要

目的探讨鼻咽癌咀嚼肌间隙侵 犯的MR特点。方法 回顾性分析经病理确 诊的442例初诊无远处转移鼻咽癌患者的 临床及影像资料,根据中国鼻咽癌临床分 期工作委员会制定鼻咽癌2008年分期方 案标准,将其中101例咀嚼肌间隙侵犯的 鼻咽癌患者资料纳入本研究。结果 442 例鼻咽癌患者中,咀嚼肌间隙侵犯101例 (22.8%),咀嚼肌间隙侵犯途径及各部分 受侵情况呈由内向外侵犯,按侵犯部位分 布,其中翼内肌侵犯87例(19.6%),翼外 肌及以外间隙侵犯48例(10.8%),侵犯颞 肌3例(0.7%),咬肌1例(0.2%)。咀嚼肌间 隙中单独侵犯翼内肌病例53例,7例为单 纯侵犯翼外肌病例。结论 MRI能清晰显示 鼻咽癌侵犯咀嚼肌间隙的范围,有助于准 确分期、精确勾画靶区。充分认识咀嚼肌 间隙结构特点及其MR表现,对指导鼻咽癌 的临床治疗意义重大。

Objective To investigate the MR features of masticator space involvement in NPC. Methods From July 2009 to December 2012, all the biopsy—proven newly diagnosed non-metastatic NPC 442 patients were collected, The clinical and imaging data of all cases were analyzed, and according to The Chinese 2008 staging system for NPC, The 101 cases with masticator space involvemen of NPC patients included in this study. Results In 442 cases of NPC patients , 101 cases (22.8%) were invasion of masticator space. Research showed that masticator space was violated from the inside to the outside. 87 cases (19.6%)were the medial pterygoid muscle involvement, 48 cases (10.8%)with the lateral pterygoid muscle and outside involveent, 3 cases (0.7%)with temporal muscle involvement , 1 cases (0.2%) of masseter muscle involvement. 53 cases were Singly the medial pterygoid muscle involvement,7 cases of simple violations of the lateral pterygoid muscle. Conclusion MRI can clearly show the range of nasopharyngeal carcinoma with masticator space involvement,and help us accurate staging and precise outline target. Fully understanding the masticator space structure characteristics and performance of MR is great significance for the clinical treatment in nasopharyngeal carcinoma.

【关键词】鼻咽癌;咀嚼肌间隙;磁共振成像

【中图分类号】R739.6

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.07.001

前言

鼻咽癌(nasopharyngeal carcinoma, NPC)为我国常见的恶性肿瘤 之一,尤其在广东地区高发。由于鼻咽部解剖结构复杂,NPC易浸润性 生长,而鼻咽镜仅能显示鼻咽部表浅肿瘤,难以探及深层病灶,因此 影像学检查显得尤为重要。及时、准确而全面的影像诊断, 尤其是正 确判断鼻咽癌侵犯的范围和程度对该病的治疗及预后至关重要。咀嚼 肌间隙(masticator space,MS)位置深在,结构复杂,又临近鼻咽, 是NPC容易侵犯的解剖结构,中国鼻咽癌2008分期以咀嚼肌间隙取代原 分期中的颞下窝,并明确指出分期中的咀嚼肌间隙特指其固有部分, 并首次提出肿瘤侵犯翼内肌为T3期,翼外肌及以外的结构为T4期[1], 因此正确认识咀嚼肌间隙解剖结构特点及侵犯的各种MRI表现,对于 NPC分期及指导临床治疗意义重大。为此,笔者对101例咀嚼肌间隙侵 犯的MR图像进行分析,探讨NPC咀嚼肌间隙侵犯的MRI特点。