Maroldi R, Battaglia G, Farina D, Maculotti P, Chiesa A
Department of Radiology, University of Brescia, Italy.
JBR-BTR. 1999 Dec;82(6):294-300.
Clinical examination of the oral cavity and oropharynx provides essential information in the assessment of neoplastic lesions. A precise evaluation of their deep spread along the most common growth pathways can be achieved by imaging, ranging from the basic, but nowadays incomplete, information of conventional X-ray, to the sophisticated details obtained by MR. Three oncological questions must be faced: the three dimensional evaluation of primary tumour spread; the assessment of nodal involvement; the post-treatment survey with the early detection of local recurrences, during the follow up. Either CT or MR accurately assesses the deep extension of neoplasms, nevertheless, the most cost-effective protocol is provided by a combination of CT and ultrasound (staging respectively T and N). MR is the technique of first choice when an infiltration of the base of the tongue or perineural spread is suspected, because of its superior ability to detect muscular invasion and segmental abnormalities of cranial nerves. Bone involvement can be adequately showed by MR not only because focal erosions of the cortical rim are well demonstrated, but also by means of the early demonstration of bone marrow abnormalities. Moreover, MR plays an essential role during the follow up, as it is the only morphological imaging technique permitting to differentiate recurrent tumour and necrosis from scar tissue.
口腔和口咽的临床检查在肿瘤性病变评估中提供重要信息。通过成像可实现对其沿最常见生长途径的深度扩散进行精确评估，成像范围从传统X射线的基本但如今不完整的信息，到磁共振成像（MR）获得的精细细节。必须面对三个肿瘤学问题：原发肿瘤扩散的三维评估；淋巴结受累情况的评估；随访期间对局部复发进行早期检测的治疗后检查。计算机断层扫描（CT）和MR都能准确评估肿瘤的深度扩展，然而，最具成本效益的方案是CT和超声联合使用（分别对T和N进行分期）。当怀疑有舌根浸润或神经周围扩散时，MR是首选技术，因为它在检测肌肉侵犯和颅神经节段性异常方面具有卓越能力。MR不仅能很好地显示皮质边缘的局灶性侵蚀，还能通过早期显示骨髓异常来充分显示骨受累情况。此外，MR在随访中起着至关重要的作用，因为它是唯一能够区分复发性肿瘤、坏死与瘢痕组织的形态学成像技术。
