Departments of Radiology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
AJNR Am J Neuroradiol. 2011 May;32(5):929-33. doi: 10.3174/ajnr.A2401. Epub 2011 Feb 24.
ENB is a rare malignant neoplasm that affects the anterior skull base. Disease stage is a significant predictor of survival, in particular the presence or absence of lymph node metastases. Multiple studies have identified the cervical lymph nodes as the most frequent site of spread; however, no studies have attempted to characterize the radiographic appearance of metastatic lymph nodes or identify the primary nodal drainage for these tumors.
We retrospectively reviewed the medical records and imaging examinations of patients with a pathologically proved diagnosis of ENB from a single tertiary care institution from 2004 to 2010. A head and neck radiologist with 9 years of experience in evaluating ENB reviewed the imaging of all patients with lymph node metastases to confirm the lymph node findings.
Spread of ENB to cervical lymph nodes was discovered in 14/48 patients (29%). Of the 14 patients, 5 (36%) were discovered to have lymph node involvement at initial staging, while 9 (64%) showed development of disease in the cervical nodes on surveillance examinations. Level II lymph nodes were the most frequently involved (13/14 cases). Levels I (57%) and III (50%) nodes and RPNs (43%) were also frequently involved. Metastatic lymph nodes were predominantly solid and demonstrated marked contrast enhancement, often approaching the degree of enhancement of nearby blood vessels. Metastatic nodes were moderately or highly FDG-avid.
ENB exhibits a predictable pattern of metastasis to cervical lymph nodes, typically spreading first to level II nodes, with frequent involvement of level I and III nodes and RPNs. Metastatic lymph nodes have characteristic imaging features that can assist radiologists in the identification of nodal disease.
嗅神经母细胞瘤（ENB）是一种罕见的恶性肿瘤，影响前颅底。疾病分期是生存的重要预测因素，特别是有无淋巴结转移。多项研究已经确定颈部淋巴结是最常见的转移部位；然而，尚无研究试图描述转移性淋巴结的影像学表现或确定这些肿瘤的主要淋巴结引流区域。
我们回顾性分析了 2004 年至 2010 年期间，一家三级医疗中心的经病理证实的 ENB 患者的病历和影像学检查。一位具有 9 年评估 ENB 经验的头颈部放射科医生，对所有有淋巴结转移的患者的影像学进行了复查，以确认淋巴结的发现。
在 48 例患者中，有 14 例（29%）发现 ENB 扩散至颈部淋巴结。在这 14 例患者中，有 5 例（36%）在初始分期时发现有淋巴结受累，而有 9 例（64%）在监测检查中发现颈部淋巴结疾病进展。Ⅱ级淋巴结最常受累（13/14 例）。Ⅰ级（57%）和Ⅲ级（50%）淋巴结和咽后淋巴结（RPNs，43%）也常受累。转移性淋巴结主要为实性，增强明显，常接近邻近血管的增强程度。转移性淋巴结中度或高度摄取 FDG。
ENB 表现出向颈部淋巴结转移的可预测模式，通常首先扩散到Ⅱ级淋巴结，Ⅰ级和Ⅲ级淋巴结以及 RPNs 常受累。转移性淋巴结具有特征性的影像学表现，可以帮助放射科医生识别淋巴结疾病。
