v1.0可编辑可修改1循证医学实践教学案例分析2014年2月18日修訂科別:口腔颌面外科住院号:38871入院日期:报告者姓名:职务:□住院医师□基地医师实习医师完成时间:病例摘要患者,女,31岁。因“右上腭肿块2年余,伴胀痛3个月”之主诉于2014年3月16日收住我科。查体:患者一般情况良好,右眶下隆起,鼻道无异常分泌物,开口度:3.0cm,牙列完整无叩痛,右上腭部明显隆起,内界接近中线,后界达软腭前部,黏膜光滑无溃疡,触之中等硬度,无明显压痛,上颌瓦氏位片示,右上颌窦内有一半球形软组织阴影。MRI与CT扫描见右上颌窦内有一半球形软组织阴影,上颌窦底骨质无规则破坏。肿块穿刺液涂片发现异形细胞,血尿常规、生化检验无异常。初步诊断右上颌骨恶性肿瘤,侵犯上颌窦。于2014年3月13日在经鼻气管插管全麻下。行右上颌骨次全切除术。手术进行顺利,术后恢复良好。术后病理报告:腺样囊性癌。由修复科行上颌赝复体修复,恢复上颌形态及咀嚼功能,于2014年4月7日出院。提出可回答的临床问題(Asking)P:唾液腺腺样囊性癌患者I:CT或者MRI诊断C:病理诊断O:诊断正确率的评价检索最有用的证据(Acquire)关键词(Keyword):oraladenoidcysticcarcinoma,CTorMRI数据库来源(Database):PubMedClinicalQueries主要內容:Perineuralspreadofadenoidcysticcarcinomaintheoralandmaxillofacialregions:evaluationv1.0可编辑可修改2withcontrast-enhancedCTandMRIObjectives:Theobjectiveofthisstudywastocomparetheaccuracyofcontrast-enhancedCT(CECT)andcontrast-enhancedMRI(CEMRI)inthedetectionofperineuralspread(PNS)ofadenoidcysticcarcinoma(ACC)intheoralandmaxillofacialregions.Methods:Thisstudyconsistedof13ACCsfrom13patients,allofwhichwerehistopathologicallydiagnosed.BothCECTandCEMRIwereperformedinallpatientsbeforethetreatment.TheimagesofeachpatientwereretrospectivelyevaluatedforthedetectionofPNS.ThedefinitionsofPNSincludedabnormaldensity/signalintensity,contrastenhancementorwideningofthepterygopalatinefossa,palatineforamen,incisivecanal,mandibularforamenandmandibularcanal,andenlargementorexcessivecontrastenhancementofanerve.Results:11outof13caseswereproventoexhibitPNShistopathologically.8ofthe11casesforwhichPNSwashistopathologicallyprovenexhibitedPNSonMRimages.SixoftheeightcasesforwhichPNSwasexhibitedonMRimagesalsoexhibitedPNSonCTimages.Thesensitivity,specificityandaccuracyforthedetectionofPNSwere55%,100%and62%onCTimagesand73%,100%and77%onMRimages,respectively.AlthoughtheaccuracyofPNSonMRimageswasslightlysuperiortothatonCTimages,therewerenostatisticallysignificantdifferencesbetweenthedetectionofPNSonCTimagesandonMRimages.Conclusions:CTandMRimagesareequallyusefulforthedetectionofPNSofACCintheoralandmaxillofacialregions.证据评价(Appraisal)证据等級:DWorksheet:一、标准诊断方法的确定:v1.0可编辑可修改3组织病理学检查的神经侵犯(thepresenceofPNSbythehistopathologicaldiagnosis)二、诊断对象的选择:ThestudysamplewasderivedfromthepopulationofpatientswhopresentedtoOsakaUniversityDentalHospital,andwerehistopathologicallydiagnosedwithACCbetweenJune2000andDecember2007.此研究中病例组指的是患有腺样囊性癌有神经侵犯的病例。病例组和对照组的确定是根据标准诊断方法,即组织病理学检查的神经侵犯(thepresenceofPNSbythehistopathologicaldiagnosis)的阴阳性来决定的。阳性为病例组,阴性为非病例组。1.病例组包括该病的各种类型:神经侵犯(PNS)有一个标准(thebasisofGinsberg’scriteriaofPNS),包括不正常牙的密度,翼腭窝的增强,腭孔、切牙管上颌管和孔神经侵犯性(abnormaldensity/signalintensity,contrastenhancementorwideningofthepterygopalatinefossa,palatineforamen,incisivecanal,mandibularforamenandmandibularcanal,andenlargementorexces...