Alberico Ronald A, Husain Syed Hamed S, Sirotkin Igor
State University of Buffalo School of Medicine and Biomedical Sciences, Buffalo VA Medical Center 3495 Bailey Avenue, Buffalo, NY 14215, USA.
Surg Oncol Clin N Am. 2004 Jan;13(1):13-35. doi: 10.1016/S1055-3207(03)00124-8.
Evaluation of head and neck cancer with imaging is a topic that is far more extensive than can be covered in this article. The main reason for head and neck imaging is to evaluate the true extent of disease to best determine surgical and therapeutic options. This process includes evaluation of the size, location, and extent of tumor infiltration into surrounding vascular and visceral structures. Important anatomic variants must be pointed out so the surgeon can avoid potential intraoperative complications. These variant scan be evaluated with the appropriate multiplanar and three-dimensional images to provide as much information as possible to the surgeon preoperatively. Second, nodal staging should be assessed in an effort to increase the number of abnormal nodes detected by physical examination and, more important, to precisely define their location by a standard classification system that can be understood and consistently applied by the radiologist, surgeon, radiation oncologist, and pathologist. Although secondary to the previously described tasks, imaging frequently enables a limitation of the diagnostic and histologic possibilities based on lesion location and signal-attenuation characteristics, which may lead the clinical investigation along a different path. saving the patient unnecessary risk and shortening the time to diagnosis and ultimate treatment. This article has attempted to detail the current state of the controversy between CT, MRI, and other modalities, and has emphasized the constant evolution of this controversy because of the evolving imaging technology. Although CT and MRI are both well suited to evaluation of the deep spaces and submucosal spaces of the head and neck, each has some limitations.MRI has the advantages of higher soft tissue contrast resolution, the lack of iodine-based contrast agents, and high sensitivity for perineural and intracranial disease. The disadvantages of MRI include lower patient tolerance, contraindications in pacemakers and certain other implanted metallic devices, and artifacts related to multiple causes, not the least of which is motion. CT is fast, well tolerated, and readily available but has lower contrast resolution and requires iodinated contrast and ionizing radiation. The current authors' practice is heavily centered on CT for initial evaluation, preoperative planning, biopsy targeting, and postoperative follow-up. They reserve MRI for tumors that are suspicious for perineural,cartilaginous, or bony invasion on CT, or for tumors such as adenoid cystic carcinoma that are highly likely to spread by way of these routes. For patients who have head and neck cancer, a radiologist who is educated in the treatment options, patterns of tumor growth, and important surgical landmarks, and who has a well-established pattern of communication with the head and neck clinical services, including surgery, radiation oncology,and pathology, is key in providing accurate and useful image interpretation.
利用影像学评估头颈部癌是一个远比本文所能涵盖的内容更为广泛的主题。头颈部影像学的主要目的是评估疾病的真实范围，以便最佳地确定手术和治疗方案。这个过程包括评估肿瘤的大小、位置以及向周围血管和内脏结构浸润的程度。必须指出重要的解剖变异，以便外科医生能够避免潜在的术中并发症。可以通过适当的多平面和三维图像来评估这些变异，从而在术前为外科医生提供尽可能多的信息。其次，应进行淋巴结分期，以增加体格检查发现异常淋巴结的数量，更重要的是，通过一种放射科医生、外科医生、放疗科医生和病理科医生都能理解并一致应用的标准分类系统来精确确定其位置。尽管排在上述任务之后，但影像学检查常常能根据病变位置和信号衰减特征限制诊断和组织学检查的可能性，这可能会使临床研究走上不同的路径，为患者省去不必要的风险，并缩短诊断和最终治疗的时间。本文试图详细阐述CT、MRI及其他检查方式之间争议的当前状况，并强调由于成像技术的不断发展，这种争议也在持续演变。虽然CT和MRI都非常适合评估头颈部的深部间隙和黏膜下间隙，但每种方法都有一些局限性。MRI的优点是软组织对比分辨率更高、无需碘造影剂以及对神经周围和颅内疾病的敏感性高。MRI的缺点包括患者耐受性较低、起搏器及某些其他植入金属装置的患者存在禁忌证以及由多种原因导致的伪影，其中最主要的是运动伪影。CT检查速度快、耐受性好且易于获得，但对比分辨率较低，需要碘造影剂且有电离辐射。目前作者的做法主要是以CT进行初始评估、术前规划、活检定位和术后随访。对于CT上怀疑有神经周围、软骨或骨质侵犯的肿瘤，或者对于腺样囊性癌等极有可能通过这些途径扩散的肿瘤，他们会选择MRI检查。对于患有头颈部癌的患者，一位熟悉治疗方案、肿瘤生长模式和重要手术标志，并且与包括外科、放疗科和病理科在内的头颈部临床科室建立了良好沟通模式的放射科医生，对于提供准确且有用的影像解读至关重要。
