Studies On The Diagnostic Values Of CT, MRI And TCM Syndromes Of Cranial Perineural Invasion Of Nasopharyngeal Carcinoma

Objective1.To investigate the diagnostic values of computed tomography(CT)、Magnetic resonance imaging(MRI) in cranial perineural invasion of nasopharyngeal carcinoma(NPC) by comparing the detection rate between CT and MRI.2.To analyse the constituent ratios among the different Traditional Chinese medicine(TCM) syndromes from naive patients with cranial perineural invasion of NPC,and seek the main of TCM syndrome with cranial perineural invasion of NPC.Methods1242 pathological proved naive NPC patients were scanned with MRI in Fujian Provincial Tumor Hospital,307 patients of whom were scanned simultaneously with CT.To study naive NPC patients underwent MRI and CT examinations who were diagnosed cranial perineural invasion by imaging.CT and MRI images were analyzed by two radiologists. Chi-square test was used to compare the number of infiltration in the observation index between CT and MRI.TCM syndromes of NPC naive patients with cranial perineural invasion by imaging were analyzed by two senior TCM doctors on the premise of not knowing imaging diagnosis.Chi-square test was used to compare the constituent ratios among the different TCM syndromes.Results1.In 1242 cases of NPC,358 cases were cranial perineural invasion by imaging diagnosis,the occurrence rate was 28.8 percent;116 cases of whom appeared cranial nerve palsies,the occurrence rate was 9.34 percent.307 cases were underwent MRI and CT examinations,90 cases were cranial perineural invasion by imaging diagnosis,the occurrence rate was 29.32 percent;30 cases of whom appeared cranial nerve palsies,the occurrence rate was 9.77 percent.According to cranial nerve palsies without cranial nerve invasion of the imaging features,The occurrence rate of cranial nerves involvement was 1.16 percent.This study showed that the occurrence rate of imaging diagnosis of cranial nerves involvement decreased in sequence:mangibular nerve 18 percent,cavernous sinus 17 percent, hypoglossal nerve 13 percent,trigeminal ganglion 10 percent,(glossopharyngeal nerve,vagus nerve,accessory nerve) 6 percent.2.In the cavernous sinus,Meckel cavity,trigeminal ganglion,mangibular nerve, (glossopharyngeal nerve,vagus nerve,accessory nerve),jugular foramen,hypoglossal nerve, MRI showed that the number of infiltrating 51,35,32,56,18,19,39 respectively;CT showed that the number of infiltrating 25,12,9,20,5,5,16 respectively.MRI appeared to be higher than CT in detection of these(P<0.05).In the optic nerve,(facial nerve,vestibulocochlear nerve),optic canal,foramen rotundum,foramen ovale,pterygopalatine fossa, (supraorbital,infraorbital fissure),hypoglossal canal,MRI showed that the number of infiltrating 6,1,6,19,56,31,11,41 respectively;CT showed that the number of infiltrating 6,1,6,14,46,16,7,40 respectively.These were no statistical differences between CT and MRI(P>0.05).3.In cranial perineural invasion of NPC.79 cases infiltrated cranial nerve across soft tissue around the primary tumor(87.78 percent);11 cases infiltrated across soft tissue around lymph node(12.22 percent).4.The constituent ratios were significantly statistical differences among the different TCM syndromes in cranial perineural invasion of NPC(x~2=33.111,P=0.000).Deficiency of the vital principle and poison lingering syndrome was significantly more than fire-toxin end syndrome,phlegm stasis syndrome,qi-blood eougealiug syndrome(P<0.01).These were no statistical differences among fire-toxin end syndrome,phlegm stasis syndrome,qi-blood eougealiug syndrome(P>0.05).Conclusion1.Cranial perineural invasion of NPC by imaging diagnosis is higher than clinical diagnosis in diagnostic accuracy.2.MRI appears to be higher than CT in detection of cranial perineural invasion of NPC. MRI is currently the better method of diagnosis for cranial perineural invasion of NPC.3.The main ways of cranial perineural invasion of NPC are across soft tissue around the primary tumor and lymph node.4.The constituent ratios are significantly different among the different TCM syndromes in cranial perineural invasion of NPC.Deficiency of the vital principle and poison lingering syndrome is the main TCM syndrome of cranial perineural invasion of NPC.