Eur Radiol:头颈部肿瘤合并少肌症如何评价?

2021-01-24 shaosai MedSci原创

    头颈部肿瘤是欧洲第6常见的肿瘤。少肌症和骨骼肌质量减少,是一种进展性、广泛性骨骼肌异常,其与临床不良后果具有相关性。目前临床利用颈部CT图像中第3颈椎(C3)水平颈肌的横轴位面积(CSA)指标来诊断少肌症。头颈部肿瘤患者合并少肌症较为常见,其于无力、术后并发症、化疗剂量限制性毒性、总体生存期减少及无复发生存期具有相关性。

     根据EWGSOP,骨骼肌质量(SMM)减少即可诊断为少肌症。目前,研究通常根据CT上第3颈椎水平骨骼肌质量来评价及诊断少肌症。然而,部分头颈部肿瘤患者出于某种原因未能进行颈部CT检查,而替代性做了颈部MRI检查,尤其是见于鼻咽部、鼻窦肿瘤患者以及头至舌骨水平的患者还有碘剂过敏的患者。目前,并无明确研究表明颈部CT检查中横轴位(CSA)与所有MRI序列测量指标相似,且具有相似适用性。


     近日,Eur Radiol上发表的一篇名为Skeletal muscle mass and sarcopenia can be determined with 1.5-T and 3-T neck MRI scans, in the event that no neck CT scan is performed的论文旨在论证是否可以通过颈部MRI来评价骨骼肌质量,从而进行少肌症的诊断。

     自2014年11月至2018年11月之间从前瞻性数据生物库中纳入HNC患者。 在CT(n = 125)和MRI颈部扫描(在1.5-T上为n = 92,在3-T上为n = 33)上测量了C3水平的颈部肌肉的CSAs。 将测量值转换为骨骼肌指数(SMI),并定义肌肉减少症(SMI <43.2 cm2 / m2)。评价了皮尔逊相关系数、Bland-Altman图、McNemar检验、科恩的kappa系数和类间相关系数(ICC)。

  图.受试者纳入流程图   

     研究结果发现,CT和MRI与CSA和SMI高度相关(r = 0.958-0.998,p <0.001)。 布兰德-奥特曼(Bland-Altman)图显示了平均虚差ΔSMI(-0.13-0.44 cm2 / m2)。 CT和MRI在诊断肌少症时无统计学差异(McNemar,p = 0.5-1.0)。1.5-T和3-T在肌少症诊断上一致性良好(κ= 0.956-0.978和κ= 0.870-0.933)。MRI的观察者ICC非常好。通常,T2加权图像与CT的相关性和一致性最佳。

 图.在C3水平骨骼肌测量示意图  

     研究结果表明,骨骼肌质量和肌少症可以在颈部CT和1.5-T或3-T MRI检查中得到相似效果。无论使用何种方式,都可以在治疗期间进行临床预后评估。


写在后面

  1. 骨骼肌质量变化的筛查通常依赖于颈部CT检查,因其与头颈部肿瘤不良后果具有相关性,是一项重要的临床指标
  2. 本研究发现通过CT及MRI评价的C3水平骨骼肌质量变化及少肌症就有较高一致性
  3. 当颈部CT检查数据缺失时,可利用颈部MRI数据进行评价骨骼肌质量变化

原始出处:

Aniek T Zwart,Jan-Niklas Becker,Maria J Lamers,et al. Skeletal muscle mass and sarcopenia can be determined with 1.5-T and 3-T neck MRI scans, in the event that no neck CT scan is performed.PMID:33219847DOI:10.1007/s00330-020-07440-1

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    2021-02-03 Aidy

    目前,并无明确研究表明颈部CT检查中横轴位(CSA)与所有MRI序列测量指标相似,且具有相似适用性。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=922614, encodeId=188a922614a0, content=目前,并无明确研究表明颈部CT检查中横轴位(CSA)与所有MRI序列测量指标相似,且具有相似适用性。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8585442638, createdName=Aidy, createdTime=Wed Feb 03 23:01:48 CST 2021, time=2021-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1444676, encodeId=726e14446e639, content=<a href='/topic/show?id=3d9291459d1' target=_blank style='color:#2F92EE;'>#评价#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91459, encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Tue Jan 26 03:23:35 CST 2021, time=2021-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491881, encodeId=4d63149188133, content=<a href='/topic/show?id=b4f14442346' target=_blank style='color:#2F92EE;'>#头颈部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44423, encryptionId=b4f14442346, topicName=头颈部)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0b2d8903151, createdName=wshxjq, createdTime=Tue Jan 26 03:23:35 CST 2021, time=2021-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589851, encodeId=cd601589851e6, content=<a href='/topic/show?id=124d10065220' target=_blank style='color:#2F92EE;'>#颈部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100652, encryptionId=124d10065220, topicName=颈部)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c46a17776631, createdName=木头人519, createdTime=Tue Jan 26 03:23:35 CST 2021, time=2021-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919451, encodeId=878c919451ca, content=少肌症和骨骼肌质量减少,是一种进展性、广泛性骨骼肌异常,其与临床不良后果具有相关性。, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=言西早, createdTime=Sun Jan 24 13:44:34 CST 2021, time=2021-01-24, status=1, ipAttribution=)]
    2021-01-26 huagfeg
  3. [GetPortalCommentsPageByObjectIdResponse(id=922614, encodeId=188a922614a0, content=目前,并无明确研究表明颈部CT检查中横轴位(CSA)与所有MRI序列测量指标相似,且具有相似适用性。, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c8585442638, createdName=Aidy, createdTime=Wed Feb 03 23:01:48 CST 2021, time=2021-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1444676, encodeId=726e14446e639, content=<a href='/topic/show?id=3d9291459d1' target=_blank style='color:#2F92EE;'>#评价#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91459, encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Tue Jan 26 03:23:35 CST 2021, time=2021-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1491881, encodeId=4d63149188133, content=<a href='/topic/show?id=b4f14442346' target=_blank style='color:#2F92EE;'>#头颈部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44423, encryptionId=b4f14442346, topicName=头颈部)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0b2d8903151, createdName=wshxjq, createdTime=Tue Jan 26 03:23:35 CST 2021, time=2021-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589851, encodeId=cd601589851e6, content=<a href='/topic/show?id=124d10065220' target=_blank style='color:#2F92EE;'>#颈部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100652, encryptionId=124d10065220, topicName=颈部)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c46a17776631, createdName=木头人519, createdTime=Tue Jan 26 03:23:35 CST 2021, time=2021-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919451, encodeId=878c919451ca, content=少肌症和骨骼肌质量减少,是一种进展性、广泛性骨骼肌异常,其与临床不良后果具有相关性。, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=言西早, createdTime=Sun Jan 24 13:44:34 CST 2021, time=2021-01-24, status=1, ipAttribution=)]
    2021-01-26 wshxjq
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    2021-01-24 言西早

    少肌症和骨骼肌质量减少,是一种进展性、广泛性骨骼肌异常,其与临床不良后果具有相关性。

    0

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2019年3月,美国国家综合癌症网络(NCCN)发布了头颈部肿瘤指南2019年第1版,指南主要内容涉及: 指南更新摘要 多学科团队支持服务 唇癌 口腔癌 咽部肿瘤 下咽癌 鼻咽癌 声门癌 声门上喉头癌 筛窦肿瘤 上颌窦肿瘤 晚期头颈部癌 复发性/顽固性头颈部肿瘤 原发性肿瘤 涎腺肿瘤 黏膜黑素瘤 随访建议 手术治疗原则 放射治疗 系统治疗原则 支持性治疗营养原则 口腔科评估和管理 分期

2018 CSCO临床指南:头颈部肿瘤的诊断和治疗(英文版)

头颈部肿瘤诊疗指南(2018.V1)是一部实用性强的指南,同时也是一部充分遵循循证证据的指南。指南推荐的治疗方案,特别是化疗方案,所采用的循证证据级别都较高。指南特别强调关键性的分层因素,从而更准确有效地指导临床治疗。

头颈部肿瘤放疗前景展望

对于头颈部肿瘤,外科手术很容易造成患者功能性或毁容性损伤。而放射治疗(放疗)作为一种微创的物理手段,从诞生之初至今的100多年中,一直都是头颈部肿瘤重要的治疗手段。

HNCDB——强大的头颈部肿瘤数据库平台

头颈癌(HNC)是全球第六大最常见的癌症。在过去的十年中,已经为HNC积累了大量经过批注的基因和药物数据。但是,通过查文献逐步寻找相关基因与药物费时费力。