颌面颈部恶性肿瘤侵犯颈动脉的CT诊断  

Computed tomography diagnosis of maxillofacial and neck malignant tumors invading carotid artery

作　　者：王平仲[1] 余强[1] 石慧敏[1] 罗济程[1] 

机构地区：[1]上海第二医科大学口腔医学院放射科,200011

出　　处：《中华口腔医学杂志》2003年第5期348-350,I003,共4页Chinese Journal of Stomatology

摘　　要：目的　研究颌面颈部恶性肿瘤侵犯颈动脉的CT诊断价值。方法　共收集记录完整、经手术切除治疗的颌面颈部恶性肿瘤 5 3例 (5 5侧病变 )。所有病例均在术前行横断面增强CT检查 ,并与其手术结果对照。结果　CT检查显示颈动脉的异常表现形式有 5种类型 :Ⅰ型 :动脉受压变形(6侧病变 ) ;Ⅱ型 :动脉移位 (15侧病变 ) ;Ⅲ型 :肿瘤围绕颈部血管超过 180°(8侧病变 ) ;Ⅳ型 :位于肿瘤和颈动脉之间的脂肪带或筋膜部分或完全消失 (2 5侧病变 ) ;Ⅴ型 :动脉壁缘模糊 (12侧病变 )。手术记录显示 :2 0侧颌面颈部恶性肿瘤与颈动脉粘连 ,其中 14侧病变的CT异常表现呈多样性 (70 % )。对照手术记录 ,上述CT异常表现的敏感性、特异性和准确率分别为 :30 0 % ,10 0 0 %和 74 .5 % (Ⅰ型 ) ;2 0 .0 % ,6 8.6 %和 5 0 .9% (Ⅱ型 ) ;2 2 .2 % ,10 0 .0 %和 4 9.1% (Ⅲ型 ) ;90 0 % ,80 0 %和 83.6 % (Ⅳ型 ) ;4 5 0 % ,88.6 %和 72 .7% (Ⅴ型 )。结论　颌面颈部恶性肿瘤侵犯颈动脉的CT表现以多样性表现为主。尽管存在不足 ,但部分CT征象 (Ⅰ型、Ⅲ型和Ⅳ型 )Objective To evaluate the diagnostic value of the carotid artery invasion by the oral-maxillofacial and neck malignant tumors with computed tomography (CT). Methods Fifty-three patients (55 tumors) of oral-maxillofacial and neck malignant tumors were examined with enhanced axial CT examination in pre-operation. The CT manifestations of all tumors were retrospectively corresponded with the surgical findings. Results Oral-maxillofacial and neck malignant tumors with abnormal common carotid artery (CCA)or internal carotid artery(ICA)manifestations were shown on CT as five types: type I, compression and deformation of CCA or ICA in six tumors; type II, displacement of CCA or ICA in 15 tumors; type III, the tumors encompass the carotid vessels more than 180 degrees in 8 tumors; type IV, the segmental deletion of fat or fascia planes between tumor and CCA/ICA in 25 tumors; and type V, ill-defined CCA/ICA wall in 12 tumors. Surgical findings recorded that 20 CCAs or ICAs were adhered by the oral-maxillofacial and neck malignant tumors. Of these 20 lesions, 14 malignant tumors (70%) with more than two abnormal changes of CCA or ICA were shown on CT images. The respective sensitivity, specificity and accuracy were 30.0%, 100.0% and 74.5% for type I, 20.0%, 68.6%, 50.9% for type II, 22.2%, 100.0%, 49.1% for type III, 90.0%, 80.0% and 83.6% for type IV, and 45.0%, 88.6% and 72.7% for type V. Conclusions The main CT findings of maxillofacial and neck malignant tumors affecting the carotid artery are different. Comparatively, the signs of type I, type III and type IV may be valuable in evaluating CCA or ICA invasion, although the accurate diagnosis of the CCA or ICA involvement by the maxillofacial and neck malignant tumors remains difficult.

关 键 词：颌面颈部 恶性肿瘤 颈动脉 CT诊断 X线计算机 体层摄影术 

分 类 号：R739.91[医药卫生—肿瘤]