摘要 目的 分析口腔癌的CT及MRI表现，评价影像检查在口腔癌诊断中的应用价值，探索公道的影像学检查方法。方法 回顾性分析经手术及病理证实的口腔癌46例（唇癌2例，牙龈癌8例，颊黏膜癌5例，舌癌24例，口底癌5例，硬腭癌2例），其中32例行CT扫描，14例行MRI扫描，将影像表现和手术所见及病理结果进行对照分析。结果 46例口腔癌中，呈浸润性生长的溃疡型病变22例，外生性生长的肿物型病变24例。CT扫描32例，明确显示病变27例，遗漏病变5例，其中4例为表浅溃疡型病变。CT扫描病例中，10例有骨质侵犯，CT扫描正确评价8例，遗漏2例。MRI扫描14例，均正确评价肿瘤及其和四周结构的关系。结论 CT、MRI对口腔癌原发肿瘤的形态、大小、四周结构侵犯、颈部淋巴结转移的评价有重要价值。对于较小及呈浸润性生长的表浅溃疡型肿瘤，CT扫描尤其是CT平扫难以正确显示，应首选MRI。
【 口腔肿瘤；计算机断层摄影术；磁共振成像
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，易侵犯四周结构，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、肿瘤和四周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 资料和方法
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。将影像资料和手术及病理结果进行对照分析。