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Integrated multi-model imaging in study of acute myocardial ischemia in Chinese mini-swine model

Xiang TANG ; Bin Lü ; Wei FANG ; Minjie LU ; Jinguo LU ; Xiongbiao CHEN ; Zhihui HOU ; Shihua ZHAO ; Zuoxiang HE ; Yue TANG ; Fengying Lü ; Shiliang JIANG

Chinese Journal of Radiology.2010;44(10):1094-1099. doi:10.3760/cma.j.issn.1005-1201.2010.10.020

Objective To evaluate the value of MSCT, MRI and SPECT in detecting acute myocardial ischemia in Chinese mini-swine model. Methods A total of six male mini-pigs were recruited with a mean body weight of (21.6 ± 1.2) kg. All pigs were scanned on MSCT before the ligation of distal segment of Left anterior descending artery. Then, MSCT was rescanned every 2 h from ligation till 8 h latter.MRI, SPECT and the last MSCT scan were performed within 24 h one by one. Finally pathological examination was carried out right after the pig killed. Results One pig died during operation, the other 5 finished all the examinations. The pathological staining showed the same areas of myocardial infarction in the left ventricular anterior wall with the all the imaging findings, including low perfusion region of MSCT arterial phase at 2-24 h, low perfusion region of SPECT at 24 h and low perfusion region of MRI first pass phase at 24 h. Three of 5 pigs showed enhanced edge of low perfusion region on MSCT delayed scan at 4-8 h. The mean CT values in the region with reduced first-pass perfusion were 75.9,36.4, 35. 2,37. 8,37.4,33.3 HU on MDCT image at baseline, 2-8 h after operation and within 24 h after operation, respectively,and there were statistically significant difference of CT values ( F = 12. 341, P ＜0. 01 ) between preoperative and all postoperative MSCT scan. There were no statistically significant difference (F = 2. 278, P = 0. 792)among all postoperative MSCT scan. At baseline, 2-8 h after operation and within 24 h, the average volumes of stroke volume(SV)were 21.7,11.9,10.3,11.4,12. 3,12.6 ml, respectively, while the average volume of end-systolic volume( ESV)were 15.2,23.4,25.0,24. 4,25.3,22. 8 ml,respectively. The average volume of end-diastolic volume ( EDV ) at these time point were 37. 0,35.4,35.0,35.7,37. 6,37.5 ml,respectively and the average percentage of ejection fraction (EF) were 58.9% ,33.8% ,29. 0%, 31.9%,32.6% ,33.5% ,respectively. SV(F =22. 349, P＜0.01) ,ESV (F=8. 810, P＜0.01) ,EF(F =27. 240,P ＜ 0. 01 ) were all significantly different among all postoperative MSCT scan except EDV ( F = 2. 339, P =0. 079). Infarct size, which was defined as the proportion of the area of infarction to that of the entire heart,were (39.4 ±12.6)% for MSCT,(37.2 ± 10.0)% for MRI, (35.9 ±9.6)% for TTC, respectively.There were no significant differences of infarct size between TTC and MSCT (t =0. 612, P =0. 574), TTC and MRI (t=0.820, P=0.458), MSCTand MR (t=0. 425 ,P =0. 692 ). Conclusions MSCT,MRI and SPECT were all able to be used to detect the myocardial infarction in acute myocardial ischemia model The infarct size defined on MSCT, MRI and pathology were consistent. The density of ischemic myocardium and cardiac function did not change over the time within 24 h right after infarction.

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Diagnostic value of macrophage activity MRI in rat model of multiple sclerosis

Haiqin ZHANG ; Kuncheng LI ; Chunshui YU ; Jia MA ; Wen QIN

Chinese Journal of Radiology.2010;44(10):1089-1093. doi:10.3760/cma.j.issn.1005-1201.2010.10.019

Objective To investigate the value of macrophage activity imaging (MAI) in the diagnosis of brain and spinal cord lesions in rat model of multiple sclerosis(MS). Methods Twenty LEW rats were divided into 15 model rats and 5 control rats. MS animal model, experimental autoimmune encephalomyelitis (EAE) was induced by the injection of peptide 35-55 of myelin oligodendrocyte glycoprotein ( MOG35-55 ). MRI was performed on the third day of the acute stage of disease. The brain and spinal cord of rats were scanned by 3.0 T MR scanner( Siemens Trio Tim) with quadrature wrist joint coil.The T2W and T1 W images, Gadolinium enhanced T1 W images in 3D volume were obtained respectively. The MAI were obtained at 24 hours after intravenous injection of ultra small superparamagnetic iron oxide (USPIO) as contrast medium on T2WI. The workstation with special software was used for the reconstruction images of brain and spinal cord of rat in multiple orientations. Results Fifteen MOG35-55-EAE rats model of MS were successfully induced. The great majority lesions of central nervous system in acute stage were located in the brain( 58/63 ) and less in the spinal cord (5/63). The main manifestation of EAE lesions presented was hyperintensity on T2 WI and hypointensity on T1 WI, and some lesions had enhancement after Gd-DTPA injection. The EAE lesions presented as hypointensity on MAI images, but some of them were found to be isointensity on T2 WI. The enhancement pattern was discrepant between USPIO and Gd-DTPA.The sensitivity of depicting lesions of MOG35-55-EAE rat at acute stage were higher on T2WI ( 14/15 ) and MAI ( 13/15 ), and the detection rate was 100% ( 15/15 ) if they were combined. Gd-DTPA enhanced T1 WI had a lower sensitivity (7/15). All the MAI findings were negative in the control rats. Conclusions MAI can complement the drawback of conventional MRI techniques by continuously monitoring the inflammatory activity of EAE lesions, and it could raise the detection rate of EAE lesions by combining with T2WI. Gd-DTPA enhanced T1 WI monitors the breakdown of the blood brain barrier. MAI and Gd-DTPA enhanced MR imaging are complementary in the diagnosis and monitoring of EAE lesions.

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An in vitro experimental study and clinical applications of MR angiography with low-dose contrast agent of lower limb arteries at 3.0 T

Lei ZHANG ; Jian CHANG ; Dongchun SHI ; Hongbin GU ; Ke LI ; Lei ZHU ; Zijian HU ; Zhen JIN ; Zhangrong XU

Chinese Journal of Radiology.2010;44(10):1078-1083. doi:10.3760/cma.j.issn.1005-1201.2010.10.017

Objective To evaluate the feasibility and diagnostic accuracy of CE-MRA with low dose contrast agent by comparison with DSA in diabetic patients with peripheral arterial diseases. Methods ( 1 )Study in vitro: test tubes containing Gd-DTPA of different concentrations were scanned, and the relationship between signal intensities and concentrations of GD-DTPA was analyzed. DSA and CE-MRA with selected concentrations of Gd-DTPA were performed on stenotic vascular models to estimate the proper low dose of GD-DTPA for clinical applications. (2) Clinical applications: 78 diabetic patients with peripheral arterial diseases were scanned from the abdomen and pelvis station to the calf-foot station in a 3 T MR system with standard bolus chase 3D CE-MRA sequence after injection of 13 ml GD-DTPA . The image quality,diagnostic rate of stenosis of arteries in calf and degree of venous contamination were evaluated with Fisher's exact test. DSA images of 220 vascular segments in 22 patients ( 10 segments per patient) were acquired as the gold standard and compared with CE-MRA by using Kappa test. Results The MR signal intensities were proportional to the concentrations of contrast agent in present study, and all stenotic segments of vascular model were displayed by CE-MRA with GD-DTPA at lower concentration of 1.5 mmol/L. As for MRA images of 78 diabetic patients with low dose Gd-DTPA, about 97.4% (76/78) showed diagnostic image quality for pelvic and thigh stations. But the MRA images of lower extremities were interfered by the venous contamination significantly (P ＜ 0.01 ). Compared with DSA for 22 patients, the diagnostic sensitivity, specificity and agreement coefficient (Kappa value) of MRA were 96. 0% ( 168/175), 73.3%(33/45), and 0.72 (P＜0.01), respectively. Conclusion Using 3.0 T MR scanner, high quality CE-MRA of lower limb arteries can be obtained for clinical applications with contrast agent dose as low as 13 ml,which has comparable diagnostic sensitivity and specificity with DSA. But the limitation of venous contamination in MRA image should be resolved in further studies.

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Initial study of stability and repeatability of measuring R2 ' and oxygen extraction fraction values in the healthy brain with gradient-echo sampling of spin-echo sequence

Lihong HUI ; Xiaodong ZHANG ; Chao HE ; Sheng XIE ; Jiangxi XIAO ; Jue ZHANG ; Xiaoying WANG ; Xuexiang JIANG

Chinese Journal of Radiology.2010;44(10):1073-1077. doi:10.3760/cma.j.issn.1005-1201.2010.10.015

Objective To evaluate the stability and repeatability of gradient-echo sampling of spinecho (GESSE) sequence in measuring the R2'value in volunteers, by comparison with traditional GRE sequence (T2* map and T2 map). Methods Eight normal healthy volunteers were enrolled in this study and written informed consents were obtained from all subjects. MR scanning including sequences of GESSE,T2 map and T2 * map were performed in these subjects at resting status. The same protocol was repeated one day later. Raw data from GESSE sequence were transferred to PC to conduct postprocessing with the software built in house. R2'map and OEF map were got consequently. To obtain quantitative R2'and OEF values in the brain parenchyma, six ROIs were equally placed in the anterior, middle and posterior part of bilateral hemispheres. Both mean and standard deviation of R2 'and OEF were recorded. All images from T2 * map and T2 map were transferred to the Workstation for postprocessing. The ROIs were put at the same areas as those for GESSE sequence. R2'is defined as R2' = R2 * -R2,R2* = 1/T2*. The R2'value of GESSE sequence were compared with that of GRE sequence. Results The mean R2 'values of GESSE at the first and second scan and those of the GRE were (4.21 ±0.92),(4.45 ±0. 94) Hz and (7.37 ±1.47), (6. 42 ±2. 33) Hz 0. 035 respectively. The R2'value and OEF value obtained from GESSE were not significantly different between the first and second scan ( t = - 0. 83, - 1.48, P ＞ 0. 05 ). The R2' value of first GRE imaging had significantly statistical difference from that of second GRE inaging ( t = 1.80, P ＜ 0. 05 ). The R2' value of GESSE sequence was less than that of GRE sequence, and there was significantly statistical difference between them(t = 1.71 ,P＜0. 05). Conclusion The GESSE sequence has good stability and repeatability with promising clinical practicability.

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The research of optimizing exposure factors in digital chest radiography

Jianzhong SUN ; Zhikang WANG ; Weimin ZHANG ; Jinsong CAI

Chinese Journal of Radiology.2010;44(10):1069-1072. doi:10.3760/cma.j.issn.1005-1201.2010.10.014

Objective To explore the optimum exposure factors in digital chest radiography.Methods Chest phantom was exposed under auto exposure control model with 73, 90, 125kV and S200,400,800 plus or minor 4 micro-adjust for each sensitivity grade. Meanwhile dose area product (DAP) was recorded and the value of IQFinv was analyzed automatically by Artinis CDRAD Analyzer 1.1. Ten volunteers were exposed with 73 kV, S800 - 2; 90 kV, S800 + 2 and 125 kV, S400 + 2. Two radiologists evaluated and scored image quality. Statistical analysis was performed using one way ANOVA test by SPSS 12. 0. Results ( 1 ) The quality scores of volunteers' images obtained with three combinations of exposure factors were 2. 7 ± 0. 5 for 73 kV group, 2. 9 ± 0. 3 for 90 kV group and 2. 8 ± 0. 4 for 125 kV group. The difference among them was not statistically significant ( F = 0. 587, P ＞ 0. 05 ). Whereas the DAP values were (29. 1 ± 7.9) mGy · cm2 for 73 kV group, ( 30. 5 ± 4. 5 ) mGy ·cm2 for 90 kV group and (40. 4 ±7.6) mGy · cm2 for 125 kV group, with statistically significant difference among them ( F = 9. 803, P ＜0. 01 ). (2) In all three kV conditions, DAP value of phantom declined when sensitivity increased. There was a difference of DAP value by 11％ between two successive sensitivity grades. Under the condition of same sensitivity, DAP value changed with kV in the following order: 73 kV ＞90 kV ＞ 125 kV. (3) The value of IQFinv decreased when sensitivity increased. Under the condition of same sensitivity, IQFinv changed with kV as follow: 73 kV ＞90 kV ＞ 125 kV. Conclusion The combination of exposure factors of 90 kV and S800 + 2-S800 +4 is optimum for digital chest radiography.

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Differentiation of benign from malignant lesions of heart and pericardium: the feasibility of Fluorine-18 fluorodeoxyglucose positron emission tomography CT

Dan SHAO ; Shuxia WANG ; Changhong LIANG ; Siyun WANG ; Weiping XU

Chinese Journal of Radiology.2010;44(10):1061-1065. doi:10.3760/cma.j.issn.1005-1201.2010.10.012

Objective To assess the feasibility of integrated 18F-FDG PET-CT for the differentiation of malignancy from benign lesions of heart and pericardium. Methods A total of 23 cases (malignancy∶benign= 13∶10) with cardiac and pericardial lesions confirmed by pathology or clinic were analyzed in the present study. All lesions were evaluated semi-quantitatively using maximum standard uptake values (SUVmax) and SUVmax lesion/blood, and the density of the heart and pericardium lesions and the relationship with surrounding tissues were evaluated. The differences of SUVmax and SUVmax lesion/blood between benign and malignant lesions were analyzed using Mann-Whitney test. Subsequently, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CT and PET-CT respectively. Results The maximum SUV showed significant difference between malignancy(6. 5 ) and benign ( 1.5 ) ( Z = - 3. 601, P ＜ 0. 01 ), the SUVmax Lesion/Blood of malignancy and benign were 3.4 and 0. 9 respectively, also with significant difference(Z = -3. 600, P ＜0. 01 ). The optimal cut-off value of SUVmax is 3.5-4. 0 and SUVmax Lesion/Blood is 1.3-2. 0. The sensitivity, specificity, accuracy, PPV and NPV of CT and PET-CT were 76. 9％ ( 10/13 ), 100. 0％ ( 10/10) ,87.0％ (20/23), 100. 0％ ( 10/10 ), 76. 9％ ( 10/13 ) and 100. 0％ ( 13/13 ), 90. 0％ (9/10), 95.7％(22/23),92.9％ (13/14),100.0％ (9/9) respectively. Conclusion 18F-FDG PET-CT can correctly differentiate benignity and malignancy of cardiac and pericardial lesions.

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Cerebral metabolic changes in cirrhotic patients before and after liver transplantation: a MR spectroscopy study

Bin JIANG ; Wen SHEN ; Longjiang ZHANG ; Jianzhong YIN ; Hong ZHENG ; Ji QI

Chinese Journal of Radiology.2010;44(10):1054-1060. doi:10.3760/cma.j.issn.1005-1201.2010.10.010

Objective To quantitatively evaluate the metabolic changes in posterior cingulated cortex and left basal ganglia in patients with liver cirrhosis before and after liver Transplantation (LT).Methods A total of 22 controls and 37 cirrhotic patients listed for LT were enrolled in the study. Brain MRS (PRESS sequence) and neuropsychological (NP) tests were performed in all subjects. Eighteen patients were followed up at 1 month and 3 month after LT. The NP parameters including number connection test-A ( NCT-A), digital symbol test (DST) and symbol digital test (SDT) were measured. MRS metabolic contents were measured automatically at posterior cingulate cortex (PCC) and left basal ganglia (LBG).Independent t-test was used to compare the parameters of NP test and MRS metabolites between the 2 groups. The changes of the parameters before and after LT were compared using analysis of variance.Pearson correlation test was also used to analysis the relationship between NP test parameters and MRS metabolites. Results ( 1 ) Before LT, significant difference of metabolites was found in the PCC between the two groups [ NAA/Cr(1.96 ±0.21, 1.73 ±0. 12), Cho/Cr(0. 65 ±0. 12,0. 83 ±0.09), mI/Cr (0.41 ±0.14,0.72±0.11), Glx/Cr(2. 37 ±0. 38,1. 92 ±0. 32) (t= -5.42,5.96,8.62,-4.72,P＜0.01)].And statistical significance also were found in LBG between the 2 groups [ Cho/Cr (0. 63 ± 0. 16,0. 77 ±0. 10), mI/Cr(0.38 ±0. 17,0.53 ±0.21), GIx/Cr(1.70 ±0.36,1.29 ±0.30), (t =3.64,3.07,-4.58 ,P ＜ 0. 01 )]. (2)Compared with controls, the patients before LT had longer NCT-A reaction time [ (58. 17 ±19. 12) s,(37.68 ±8.02) s,t =4. 14,P＜0.01], lower scores of DST (36.67 ±9.91,55.36 ±9.27,t = 4.60,P＜0.01) and SDT (31.67 ±9.49,50.73 ±8.34,t = 4.652,P＜0.01) before LT. All the scores of NP tests changed significantly at 1 and 3 month after LT compared with those before LT[ NCT-A (53.06±12.71) s,(35.72 ±5.20) s,F =33.554,P ＜0.01 ], DST(41.89 ±8. 17,54.39 ±5.69,F =85.772,P＜0.01),SDT(37.44±7.68,49.39±5.65,F=83.061,P＜0.01)]. (3) In the 18 patients who were followed, Cho/Cr [ PCC (0. 90 ± 0. 14,0. 92 ± 0. 08, F = 38. 178, P ＜ 0. 01 ); LBG (0. 81 ± 0. 08,0. 80 ±0.09,F =9.447,P ＜0.01)] and Glx/Cr [ PCC(1.86 ±0.32,1.75 ±0.25,F = 19.420, P ＜0. 01 ); LBG( 1.30 ±0. 20,1.23 ±0. 25 ,F = 17. 952,P ＜0. 01 ) ] recovered at 1 month after LT, while the mI/Cr [PCC (0.39±0.15,0.71 ±0. 10,F =75. 186,P＜0.01) ;LBG (0.47 ±0.25,0.61 ±0.27,F =8. 027, P ＜ 0. 01 ) ] recovered at 3 month after LT. (4)mI/Cr of cingulate cortex correlated significantly with NCT-A, DST and SDT (r= -0.743, 0.597, 0.615, P＜0.01 ) before LT. Conclusion Cerebral metabolic changes in patients with liver cirrhosis is reversible and MRS of the posterior cingulate cortex is a helpful method in following up the changes after LT. mI/Cr is a useful indicator to predict the brain changes of cirrhotic patients before and after LT.

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CT features of small thyroid carcinoma

Yanping YU ; Pingding KUANG ; Liang ZHANG ; Fangxiao LU ; Jiaping ZHENG

Chinese Journal of Radiology.2010;44(10):1049-1053. doi:10.3760/cma.j.issn.1005-1201.2010.10.009

Objective To study the CT findings of small thyroid carcinoma. Methods The CT findings of 40 patients with histology-proven small thyroid carcinoma (diameter, 1.0 to 2. 0 cm) were retrospectively reviewed. Results (1)The single lesion was detected in 38 cases and two lesions in bilateral thyroid in 2 cases. Two cases were combined with contralateral nodular goiter and I case with contralateral thyroid adenoma. ( 2 ) Eight lesions showed smooth edge and complete envelope. Thirty-four lesions demonstrated foggy edge and incomplete envelope,but they didn't invade the surrounding soft tissues and important organs. ( 3 ) The density of all lesions were homogeneous or comparatively homogeneous without obvious hemorrhage or necrosis area on non-enhanced CT. Thirty lesions showed varied shape calcifications,with granular calcifications in 20 lesions being the most common. Irregular nodular,eggshell-like or mulberrylike calcifications were also detected. (4)Forty-one lesions showed marked enhancement on post-contrast CT and the amplitude of enhanced CT value was greater than 40 HU(range,90 to 140 HU). Thirty-eight lesions exhibited homogeneous enhancement, and other 3 lesions showed marked enhancement center with a ring-like low density edge and manifested as a characteristic damascene-like appearance. (5)Enlarged cervical lymph nodes were found in 24 cases ( 60. 0% ), which displayed solid, cystic-solid or cystic appearances on nonenhanced CT. They showed markedly homogeneous,irregular ring or wall-node enhancement on post-contrast CT. In 8 cases there were granular, nodular or eggshell-like calcifications within the enlarged lymph nodes.Conclusion A solid thyroid nodule with granular calcification, incomplete envelope and marked enhancement, companied with enlarged lymph nodes with calcification, cystic degeneration and obviously enhanced solid part are the relatively characteristic CT features of small thyroid carcinoma.

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Utility of diffusion-weighted imaging with background signal suppression in metastatic cervical lymph nodes

Yun ZHANG ; Biling LIANG ; Chuanmiao XIE ; Jinglian ZHONG ; Ruixin YE

Chinese Journal of Radiology.2010;44(10):1041-1044. doi:10.3760/cma.j.issn.1005-1201.2010.10.007

Objective To prospectively evaluate the value of diffusion-weighted imaging with background signal suppression (DWIBS) in the detection and diagnoses of metastatic cervical lymph nodes. Methods Twenty patients with head and neck squamous cell carcinomas underwent conventional MRI and DWIBS. The ADC values were measured and compared between metastatic and benign lymph nodes. The abilities of DWIBS and conventional MRI in the evaluation of metastatic cervical lymph nodes were compared. Results Conventional MRI demonstrated 101 lymph nodes, in which 58 were diagnosed as metastatic nodes. When MRI criteria were used for discrimination between metastatic and benign nodes, the obtained sensitivity, specificity, accuracy, positive and negative predictive value were 78% (47/60), 81%(44/54), 80% (91/114), 82% (47/57) and 77% (44/57), respectively. The mean ADC values of metastatic nodes (n =60) and benign nodes (n =54) were (0.945 ±0.122) × 10-3 mm2/s and (1. 210 ±0. 151 ) × 10-3 mm2/s ( t = - 10. 354 ,P ＜0. 01 ). When an ADC value of 1. 090 × 10 -3 mm2/s was used as the threshold for discrimination between metastatic and benign nodes, the obtained sensitivity, specificity,accuracy, positive and negative predictive value were 88% (53/60), 80% (43/54), 84% (96/114), 83%(53/64) and 86% (43/50), respectively. Conclusion DWIBS is helpful in diagnosing metastatic cervical lymph nodes of head and neck squamous cell carcinoma, and is superior to conventional MRI in their detection.

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Comparison analysis of Chinese 2008, 1992 and 2002 UICC staging system for nasopharyngeal carcinoma

Qihua YANG ; Biling LIANG ; Zehong YANG

Chinese Journal of Radiology.2010;44(10):1030-1035. doi:10.3760/cma.j.issn.1005-1201.2010.10.005

Objective To compare the Chinese 2008, 1992 and 2002 UICC (International Union Against Cancer) staging System for nasopharyngeal carcinoma and find out the reasons for the changes in the new Chinese 2008 staging system. Methods From Apr. 2007 to Dec. 2008, 285 naive patients with pathologically proved NPC, but without metastasis, received standard enhanced MRI scans of the nasopharynx and neck. Based on MRI imaging data and clinical information, clinical stage was classified according to the Chinese 2008, Chinese 1992 staging system and 2002 6th UICC staging system,respectively. Comparisons were made between Chinese 2008 and 1992 staging system, and between Chinese 2008 and 2002 UICC staging system by χ2 test. Results As a result of deleting some details of the old staging system, Chinese 2008 staging system is easier to grasp. With Chinese 2008 staging system, the number of cases in stage T1 to T4 are 66, 84, 72,63, respectively; those in stage N0 to N3 are 12,48,169,56; the number of cases in clinical stage Ⅰ -Ⅳ are 5,30,141 and 109. With 2002 6th UICC staging system, the number of cases in stage T1 to T4 are 66, 83, 55,81; those in stage N0 to N3 are 26,50,201,8;the number of cases in clinical stage Ⅰ -Ⅳ are 6,40,153 and 86. With Chinese 1992 staging system, the number of cases in stage T1 to T4 are 62,91,71,61; those in stage No to N3 are 26,189,61,9; the number of cases in clinical stage Ⅰ -Ⅳ are 6, 110, 98 and 71. Comparing with the staging results of Chinese 1992 staging system, many cases showed different stage based on Chinese 2008 system including 12 cases (4.21%) inT stage (3 up-staging and 9 down-staging), 217 cases (76.14%) in N stage (216 up-staging, most rise I stage, and 1 down-staging), 123 cases (43. 16% ) in clinical stage ( 121 up-staging and 2 down-staging). Comparing with the staging results of 2002 UICC staging system, 35 cases ( 12. 28% )changes in T stage (8 up-staging and 27 down-staging), 77 cases (27. 02% ) changes in N stage (all upstaging, most rise 1 stage), 74 cases (25. 95% ) changes in clinical stage (54 up-staging and 20 downstaging) based on Chinese 2008. Comparing the constituent ratio of T, N and clinical staging results separately, statistical differences were found between Chinese 2008 and Chinese 1992 staging system in N0,N1, N2, N3, clinical stage Ⅱ , Ⅲ, Ⅳ. Statistical difference was also found in N0, N2, N3, clinical stage Ⅳ between Chinese 2008 and 2002 UICC staging system. χ2 test results show that there is N0 significant difference of T stage constituent ratio among the 3 staging system ( χ2 = 6. 916, P = 0. 329 ), but the difference of N stage and clinical stage constituent ratio are significant( χ2 = 275. 169 and 84. 515, P ＜0. 0125). Conclusion Chinese 2008 Staging System for nasopharyngeal carcinoma is based on MRI, with clear definition to some anatomical location, after deleting some details in the old stage system, it's easier to use. The most obvious change for Chinese 2008 Staging System is the up-staging in N staging,which leads to the changes in clinical stage and constituent ratio of stage result.

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