超声造影诊断鼻咽癌的动物实验与人体实验研究

Contrast-enhanced ultrasound has been proven as a practical method of detecting the features of tumor angiogenesis, which increases the accuracy of tumor diagnosis. However, contrast-enhanced ultrasound has not yet been used in the diagnosis of nasopharyngeal carcinoma until now. Whether can contrast-enhanced ultrasound be used in discriminating nasopharyngeal tumor angiogenesis imaging features and diagnosing nasopharyngeal carcinoma is still unclear. In our previous research, conventional ultrasound can only show the tumor morphological information of nasopharyngeal carcinoma, and cannot differentiate the characteristics of tumor neovascularity, especially in the cases of mucosal thickening nasopharyngeal cancer and benign mucosal thickening. In our hypothesis, due to the fact that the growing of nasopharyngeal carcinoma is always accompanied by neovascularization, and moreover, the features of tumor angiogenesis can be detected by contrast-enhanced ultrasound, so contrast-enhanced ultrasound could be helpful in diagnosing nasopharyngeal carcinoma. Therefore, this study would, based on animal and human experiments, evaluate the features and quantitative parameters of contrast-enhanced ultrasound in nasopharyngeal carcinoma, in order to explore the value of contrast-enhanced ultrasound in diagnosis and differential diagnosis of nasopharyngeal carcinoma. In addition, this study would also discuss the relationship between the features and quantitative parameters of contrast-enhanced ultrasound and local tumor invasion of nasopharyngeal carcinoma, cervical lymph node metastasis, distant metastasis, radiotherapy effect, tumor recurrence after radiotherapy, prognosis of patients and TNM staging, etc., and provide a new imaging diagnostic method for nasopharyngeal carcinoma.

超声造影已被证实可显示肿瘤血管生成的特征，从而提高对肿瘤诊断的准确性，但迄今超声造影未见用于鼻咽癌的诊断，关于超声造影在鼻咽癌肿瘤新生血管显像特征、对鼻咽癌的诊断和鉴别诊断价值等均不明确。我们前期研究显示，常规超声只能显示鼻咽癌肿瘤的形态学信息，但却无法显示其肿瘤血管特性，对于一些仅表现为黏膜增厚的鼻咽癌与良性的黏膜增厚很难鉴别。我们设想，鼻咽癌肿瘤的生长必然伴随着新生血管的生成，而其新生血管的特征又能被超声造影所揭示，那么超声造影将有助于鼻咽癌肿瘤的诊断。鉴于此，本研究拟从动物实验与人体实验两个层面，研究鼻咽癌肿瘤病灶的超声造影特征及造影定量参数，以探讨超声造影对鼻咽癌诊断和鉴别诊断的价值，同时也探讨超声造影特征及造影定量参数与鼻咽癌肿瘤局部浸润、颈部淋巴结转移、远处转移、放疗效果与放疗后复发、患者预后、TNM分期等的关系，为鼻咽癌的诊断探索出一套新的影像诊断方法。

鼻咽癌(NPC)是中国常见的头颈部恶性肿瘤之一，尤其是在中国南部。能够通过超声诊断筛查NPC对于疾病的早诊断、早治疗以及预后有着重要作用。超声造影(CEUS)能够较好地显示肿瘤新生血管，对良恶性病灶的鉴别有着重要价值。本研究从动物实验和人体实验两个方面研究了NPC的CEUS特征及其定量参数在评估NPC肿瘤生长及血管生成情况的重要意义，同时探讨了CEUS对NPC与良性病灶的鉴别以及对NPC放疗效果的评价的重要价值。. 动物实验研究发现，CEUS参数峰值强度（PI）、流入面积（AWI）及流出面积（AWO）能间接反映NPC的血管生成和肿瘤生长情况，对NPC的诊断和分期有着重要评估价值。CEUS能较好显示NPC与炎性病灶内部血供差异，尤其在PI和斜率（Slope）两个指标有着显著差异，有助于鉴别黏膜增厚型NPC与鼻咽部炎症。不同分化程度的NPC模型造影模式有所不同，为后续临床上诊断不同分化程度NPC的造影特征提供可靠的实验数据。NPC放疗后CEUS定量参数与对照组有显著差异，并且与肿瘤微血管密度（MVD）有正相关性，表明CEUS可以作为NPC放疗效果评价指标。. 人体实验研究发现，NPC病灶的造影灌注模式分为三种：团块样增强、周边增强及点、线样增强；时间-强度曲线（TIC）类型分为两种：type I（速升-缓慢下降型）及type II （速升-平台型）。NPC病灶的CEUS多呈早期、快速及明显增强，但是下降缓慢。NPC病灶造影参数中，PI与肿瘤T分期间差异具有统计学意义，而达峰时间（TP）、衰减速率与肿瘤T分期间差异无统计学意义，PI、TP、衰减率与肿瘤N、M分期间差异均无统计学意义。NPC的定量参数PI与T分期有显著性差异，则PI可作为NPC潜在的放疗预后指标。