摘要目的 研究单光子发射计算机体层摄影术(single photon emission computed tomography,SPECT)与计算机体层摄影术(CT)同机融合在口腔癌侵犯下颌骨中的诊断价值.方法 将34例口腔癌侵犯下颌骨行下颌骨节段性切除患者分为两组:A组28例为外周侵犯型;B组6例为中心侵犯型.对比研究CT、SPECT-CT、手术标本组织病理学检查的范围,分别对CT及SPECT的检查结果 进行定量研究.结果 A组:SPECT-CT、CT和病理学测量3种方法 确定下颌骨受侵犯范围分别为(5.7±1.2)cm、(3.3±1.2)cm、(4.7±1.1)cm.SPECT-CT显示下颌骨受侵犯的范嗣较病理检查高估1.0 am,CT显示骨侵犯范围较病理检查低估1.4 cm,CT与SPECT-CT的结果 相差2.4 cm,3种检查方法 显示的下颌骨侵犯范围比较,差异均有统计学意义(P<0.01).B组:SPECT-CT、CT和病理学测最结果 分别为(6.4±1.2)cm、(2.2±1.6)cm、(5.2±1.2)cm.SPECT-CT比病理检查高估1.2 cm,比CT显示的骨侵犯范围高估4.2 cm,cT比病理检杳低估3.0 cm,3种检查方法 显示的下颌骨受侵范围比较,差异均有统计学意义(P<0.01).结论 SPECT-CT可早期发现CT不能显示的颌骨中心型肿瘤,显示的病变范围符合手术需要切除的合理范围;CT显示的病变范围受肿瘤类型的影响较大,需视肿瘤类型确定切骨范围;在排除骨扫描假阴性的前提下,下颌骨肿瘤只需SPECT-CT或CT一种检查,即可推测病变侵犯范围.

abstractsObjective To investigate the value of single photon emission computed tomography (SPECT)-computed tomography (CT) in diagnosis of oral carcinoma invasion to mandible. Methods Thirty-four patients with oral carcinoma invasion to mandible were divided into two groups, group A (surrounding invasion) and group B (central invasion). The edge of the invasion was evaluated by SPECT-CT, CT and pathological examination. The results of CT and SPECT-CT were analyzed by quantitative methods. Results In group A,the cancer-invaded area of the mandible exhibited on SPECT-CT was 1.0 cm lager than that on pathological examination, 2. 4 cm lager than that on CT. The difference of invaded areas hown on CT was 1.4 cm smaller than that of pathological examination. There were significant difference among the three methods. In group B, the affected area on SPECT-CT was 1.2 cm lager than that of pathological examination, 4. 2 cm lager than that of CT. The invision area on CT was 3. 0 cm smaller tha nthat of pathological examination. There were significant difference among the three methods. Conclusions SPECT-CT could find the jaw central tumor earlier than CT and the range of lesion showed by SPECT-CT was the adequate range of bone incision during operation. The range of lesion showed by CT was influenced by the type of tumor and the range of bone incision was determined according to the pathological type. If the false negative result was eliminated, only SPECT-CT or CT was needed to estimate the invasion range of mandible.