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The value of CT and MRI in the diagnosis of oral carcinoma
【Abstract】
Objective To analyze the CT and MRI manifestations of oral carcinoma，and to evaluate the value of imaging technologies in the diagnosis of oral carcinoma，thus to explore the most reasonable imaging method.
Methods 46 cases with oral carcinoma，proved by surgery and pathology （2 lip tumors，8 carcinomas of the gingival ridge，5 carcinomas of the buccal mucosa，24 tongue carcinomas，5 carcinomas of the floor of the mouth，2 tumors of the hard palate），were analysed retrospectively.32 cases were examined with CT and 14 cases with MRI.Imaging presentations were compared with surgery and pathology.
Results Of the 46 cases with oral carcinoma，22 were ulcerative lesion of infiltrative growth，24 were masslike lesion of extruded trowth.Of the 32 cases examined with CT scan，27 were detected，5 were missed，the 4 missed cases were confirmed to be superficial ulcers by surgery and pathology.Of the 10 cases with bone destruction examined with CT scan，8 were manifested，2 were missed.And of the 14 cases with MRI scan，all 14 were detected.
Conclusion CT and MRI scan are valuable for diagnosis of oral carcinomas.They can manifest the morphology and size of primary tumor，contiguous structures，bone invasion and cervical lymph node metastasis.MRI is the optimal imaging method for superficial ulcerative lesion of infiltratibe growth.
【Key words】 oral carcinoma；computed tomography；magnetic resonance imaging
口腔癌是头颈部常见的恶性肿瘤，易侵犯周围结构，区域淋巴结转移率高，对放、化疗敏感性差，目前主张采取个体化综合治疗方案［1～6］。口腔病变位置表浅，临床检查及活检常可明确诊断，但明确原发肿瘤情况、肿瘤与周围结构的关系以及有无颈部淋巴结转移均需要影像学检查。
1 资料与方法
1.1 一般资料 回顾性分析1999～2004年经手术及病理证实、有完整临床及影像资料的口腔癌46例，男34例，女12例，年龄32～82岁，中位年龄53岁。32例行CT扫描，14例行MRI扫描，所有病例术前未接受任何抗肿瘤治疗，影像检查距手术时间为1～22天，中位时间8天。将影像资料与手术及病理结果进行对照分析。
1.2 方法
1.2.1 CT扫描 分别使用GE 9800型、PQ 6000型及GE Lightspeed Ultra 8层螺旋CT扫描机，扫描范围自颅底至锁骨上，显示层厚5mm，间距5mm，扫描条件为120kV，180mA。17例患者行直接增强扫描，以高压注射器由肘前静脉注入300mgI/ml碘对比剂100ml，注射流率3.0ml/s，延迟30s扫描，15例患者仅做平扫。
1.2.2 磁共振扫描 采用0.5T超导型MRI机（PHILIPS，Gyroscan T5－Ⅱ），同时平扫及增强扫描，应用头部线圈，扫描范围自额窦至C3水平。增强前扫描序列应用自旋回波序列，T1加权像（TR 400～500ms、TE 10～20ms），轴位加做快速自旋回波（TSE），T2加权脂肪抑制像（TR 2000～2500ms、TE 100ms）。肘静脉推注钆喷酸葡胺（Gd－DTPA，剂量为0.2ml/kg）后立即扫描，增强后做T1加权脂肪抑制像（TR 400～500ms、TE 10～20ms）。
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