Ozturk M, Mavili E, Erdogan N, Cagli S, Guney E
Department of Radiology, Erciyes University Medical Faculty, 38039-Kayseri, Turkey.
AJNR Am J Neuroradiol. 2006 Jun-Jul;27(6):1300-3.
A lingual abscess is difficult to diagnose in the absence of physical signs. MR imaging may provide an excellent and invaluable adjunct to clinical examination, but the literature is incomplete in defining the various MR imaging findings of abscess. The objective of this study was to determine the MR imaging features of tongue abscesses.
Seven surgically proved tongue abscesses were evaluated with MR imaging. Four patients underwent MR imaging because of suspected tumor, and 3 patients, to show the extent and precise anatomic location of the lesion. Lesions were assessed with regard to the location, size, signal-intensity characteristics, and pattern of contrast enhancement.
Five lesions were located in the anterior tongue and 2, in the posterior tongue. The central parts of 4 anterior tongue abscesses were hypointense, surrounded by a hyperintense wall on T1-weighted precontrast images. On postcontrast images, marked wall enhancement was detected. On T2-weighted images, a markedly hyperintense central part surrounded by a hypointense rim was seen. In 2 of these patients, there was a hypointense halo surrounding the wall (target sign). In 3 patients, a perilesional hyperintense area that enhanced diffusely after contrast administration was detected on T2-weighted images. The smallest lesion located in the anterior tongue was hypointense on T1-weighted images and enhanced diffusely on postcontrast images. On T2-weighted images, a markedly hyperintense central part surrounded by a mildly hyperintense peripheral part was depicted. Posterior tongue lesions appeared as polypoid ill-defined masses and were hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images. On postcontrast images, the lesion in 1 patient showed diffuse and heterogeneous contrast enhancement, whereas the lesion in another patient enhanced peripherally. The lesions were totally excised in 4 patients and drained with surgical incisions in 3 patients. No recurrence was detected on follow-up.
An abscess typically presents as a cystic lesion surrounded by an enhancing capsule formation, but lesions may also present as solid masses that enhance diffusely or peripherally.
在缺乏体征的情况下，舌部脓肿难以诊断。磁共振成像（MR成像）可为临床检查提供出色且极有价值的辅助手段，但关于脓肿的各种MR成像表现，文献记载并不完整。本研究的目的是确定舌部脓肿的MR成像特征。
对7例经手术证实的舌部脓肿进行了MR成像评估。4例患者因怀疑肿瘤接受MR成像检查，3例患者则是为了显示病变的范围和精确解剖位置。对病变的位置、大小、信号强度特征及对比增强方式进行了评估。
5个病变位于舌前部，2个位于舌后部。4个舌前部脓肿的中央部分在T1加权预增强图像上呈低信号，周围有高信号壁环绕。在增强后图像上，可见明显的壁强化。在T2加权图像上，可见中央部分明显高信号，周围有低信号边缘。其中2例患者的壁周围有低信号晕（靶征）。3例患者在T2加权图像上检测到病变周围有高信号区，增强后呈弥漫性强化。位于舌前部的最小病变在T1加权图像上呈低信号，增强后图像上呈弥漫性强化。在T2加权图像上，可见中央部分明显高信号，周围有轻度高信号的周边部分。舌后部病变表现为息肉样边界不清的肿块，在T1加权图像上呈低信号，在T2加权图像上呈不均匀高信号。在增强后图像上，1例患者的病变呈弥漫性不均匀强化，而另1例患者的病变呈周边强化。4例患者的病变被完全切除，3例患者通过手术切口引流。随访未发现复发。
脓肿通常表现为被强化包膜包绕的囊性病变，但病变也可能表现为弥漫性或周边强化的实性肿块。
