The Diagnostic Accuracy of Computed Tomography in Neoplastic Invasion of the Laryngeal Cartilage
The Diagnostic Accuracy of Computed Tomography in Neoplastic Invasion of the Laryngeal Cartilage
复制标题
计算机断层扫描对喉软骨肿瘤侵袭的诊断准确性
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
H. Sharifian
中科院分区：
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作者：
S. S. Kashani;M. Malek;H. Mazaher;H. Sharifian
背景/目的：喉和下咽肿瘤的治疗方案中，侵犯软骨是很重要的。本研究旨在探讨电脑断层扫描（CT）对喉软骨肿瘤性侵犯的诊断准确性。患者和方法：37例经证实的喉或下咽肿瘤患者均适合全喉切除术。对所有患者进行标准对比增强喉部CT检查。两个影像学表现被认为是肿瘤浸润的喉软骨密度增加和软骨溶解。在甲状腺、环状软骨和杓状软骨中评价了这些发现。然后，所有患者均接受全喉切除术，并将软骨送去进行组织病理学评价。评价CT表现诊断肿瘤性软骨侵犯的敏感性、特异性、阳性预测值、阴性预测值及阳性和阴性似然比。结果：患者的平均（±SD）年龄为61.4±8.8（范围：39-76）岁。34例患者为男性; 25例为喉肿瘤，12例为下咽肿瘤。共评价了139个软骨（37个甲状腺软骨、37个环状软骨和65个杓状软骨）。其中49个软骨（16个甲状腺软骨，11个环状软骨和22个杓状软骨）有肿瘤浸润。在甲状软骨中，密度增加的敏感性为0.81，软骨溶解的特异性为0.91;两种结果的特异性为0.95。环状软骨密度增高的敏感性为0.73，特异性为0.73，软骨溶解的特异性为0.96，两者的特异性均为1。在杓状软骨中，密度增加的特异性为0.67;软骨溶解的特异性为0.98;两种结果的特异性为1。综合考虑所有139个软骨，密度增加的敏感性为0.69，软骨溶解的特异性为0.96。将所有软骨设置为一组并考虑这两种CT表现，灵敏度为0.89，特异性为0.76。结论：软骨溶解是一个特定的和密度增加是一个相对敏感的诊断喉软骨肿瘤浸润的CT表现，考虑到这两个发现一起作出了一个非常具体的影像学表现的诊断。
Background/Objective: Cartilage invasion is important in the management plan of laryngeal and hypopharyngeal neoplasms. This study was conducted to determine the diagnostic accuracy of computed tomography (CT) to detect the neoplastic invasion of the laryngeal cartilages. Patients and Methods: 37 patients with proved laryngeal or hypopharyngeal neoplasm that were candidates for total laryngectomy were included in this study. For all patients, standard contrast-enhanced laryngeal CT was performed. Two imaging findings were considered as neoplastic invasion of the laryngeal cartilage—increased density and chondrolysis. These findings were evaluated in thyroid, cricoid and arytenoid cartilages. Then, all patients underwent total laryngectomy and the cartilages were sent for histopathologic evaluation. The sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios of CT findings were evaluated for the diagnosis of neoplastic invasion of these cartilages. Results: The mean (±SD) age of patients was 61.4±8.8 (range: 39–76) years. Thirty-four patients were male; 25 had laryngeal tumor and 12 had hypopharyngeal tumor. Totally, 139 cartilages were evaluated (37 thyroid, 37 cricoid and 65 arytenoid cartilages). Among these cartilages, 49 (16 thyroid, 11 cricoid and 22 arytenoid cartilages) had neoplastic invasion. In thyroid cartilage, the sensitivity of increased density was 0.81 and the specificity of chondrolysis was 0.91; the specificity of both findings together was 0.95. In cricoid cartilage, the sensitivity of increased density was 0.73; the specificity was 0.73; the specificity of chondrolysis was 0.96 and specificity of both findings was 1. In arytenoid cartilage, the specificity of increased density was 0.67; the specificity of chondrolysis was 0.98; and the specificity of both findings together was 1. Considering all 139 cartilages together, the sensitivity of increased density was 0.69 and the specificity of chondrolysis was 0.96. Setting all cartilages in a single group and considering both of these CT findings, the sensitivity was 0.89 and the specificity was 0.76. Conclusion: Chondrolysis is a specific and increased density is a relatively sensitive CT finding for the diagnosis of laryngeal cartilage neoplastic invasion; considering both findings together makes a very specific imaging finding for the diagnosis.