Mar Martha V, Miller Scott A, Kim E Edmund, Macapinlac Homer A
Department of Nuclear Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Nucl Med Technol. 2007 Mar;35(1):10-6; quiz 17-20.
In patients with head and neck tumors, preoperative lymphoscintigraphy can be used to map lymphatic drainage patterns and identify sentinel lymph nodes. However, it is very difficult to determine the exact locations of head and neck sentinel nodes on preoperative lymphoscintigraphy without the use of anatomic landmarks. Lymph nodes in the head and neck are grouped into 7 regions, or levels, on the basis of anatomic landmarks. In patients undergoing standard lymphoscintigraphy, obtaining lateral marker images that show important anatomic landmarks can help with the localization of sentinel nodes. However, technical problems often render marker images of little or no use. Hybrid SPECT/CT lymphoscintigraphic imaging facilitates the localization of sentinel nodes by reliably showing the relationships between sentinel nodes and important anatomic structures. After reading this article, the reader should understand the lymph node level classification system for head and neck melanomas, be able to describe the technique used for the imaging of sentinel nodes in the head and neck region, and be able to demonstrate how SPECT/CT lymphoscintigraphic imaging can enable precise sentinel node localization and thus help to ensure minimal dissection.
对于头颈部肿瘤患者，术前淋巴闪烁显像可用于描绘淋巴引流模式并识别前哨淋巴结。然而，在不使用解剖标志的情况下，很难在术前淋巴闪烁显像上确定头颈部前哨淋巴结的确切位置。基于解剖标志，头颈部淋巴结被分为7个区域或水平组。在接受标准淋巴闪烁显像的患者中，获取显示重要解剖标志的侧位标记图像有助于前哨淋巴结的定位。然而，技术问题常常使标记图像用处不大或毫无用处。SPECT/CT淋巴闪烁显像融合成像通过可靠地显示前哨淋巴结与重要解剖结构之间的关系，有助于前哨淋巴结的定位。阅读本文后，读者应了解头颈部黑色素瘤的淋巴结水平分类系统，能够描述头颈部区域前哨淋巴结成像所采用的技术，并能够说明SPECT/CT淋巴闪烁显像如何实现精确的前哨淋巴结定位，从而有助于确保进行最小范围的清扫。
