Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei 100, Taiwan, ROC.
Radiology. 2012 Jul;264(1):136-45. doi: 10.1148/radiol.12111714. Epub 2012 Apr 10.
To compare the magnetic resonance (MR) imaging features of upper cervical spine osteoradionecrosis (ORN) with those of recurrent or metastatic disease after the treatment of head and neck malignancies.
This retrospective study was approved by the hospital institutional review board, and the requirement to obtain informed consent was waived. From January 2005 to December 2010, 35 patients who had undergone irradiation of head and neck cancer and who had subsequent C1 or C2 lesions at MR imaging were enrolled. Pathology reports, clinical records, and follow-up MR images were reviewed to classify patients into one of two groups-those with ORN or those with recurrence. The MR imaging characteristics in these patients were evaluated. Statistical significance of intergroup differences was assessed by means of the Pearson χ2 or Fisher exact test for categorical variables and the two-sample t test for continuous variables.
ORN was diagnosed in 20 of the 35 patients (57%), and recurrent or metastatic disease was diagnosed in 15 (43%). Ten of the 35 patients (29%) had undergone biopsy of the cervical spine or paraspinal soft tissue. The MR images in the ORN group showed significantly more contiguous involvement of the atlantoaxial or atlanto-occipital bones with intervening joint change (P<.001), more cases of vertebral body collapse (P<.01), more bilateral symmetric involvement of the vertebral body (P<.01), and continuation of vertebral body changes with posterior pharyngeal wall ulceration (P<.01). Posterior arch or other cervical level involvement, paraspinal solid mass, epidural involvement, lateral border cortical destruction, and cervical lymphadenopathy were noted more frequently in the recurrence group than in the ORN group (P=.03, P<.001, P=.02, P<.001, and P<.01, respectively).
Various MR imaging characteristics can be used to help differentiate between cervical ORN and recurrent disease.
比较头颈部恶性肿瘤治疗后上颈椎放射性骨坏死（ORN）与复发或转移性疾病的磁共振（MR）成像特征。
本回顾性研究经医院机构审查委员会批准，豁免了获得知情同意的要求。2005 年 1 月至 2010 年 12 月，对 35 例因头颈部癌症接受放疗且随后在 MR 成像中出现 C1 或 C2 病变的患者进行了研究。对病理报告、临床记录和随访 MR 图像进行了回顾，将患者分为 ORN 或复发组。评估了这些患者的 MR 成像特征。通过卡方检验或 Fisher 确切概率法评估分类变量的组间差异的统计学意义，通过两样本 t 检验评估连续变量的组间差异的统计学意义。
35 例患者中，20 例（57%）诊断为 ORN，15 例（43%）诊断为复发或转移性疾病。10 例患者（29%）接受了颈椎或椎旁软组织活检。ORN 组的 MR 图像显示，寰枢或寰枕骨连续受累伴关节间隙改变的比例明显更高（P<.001），椎体塌陷的比例更高（P<.01），双侧对称累及椎体的比例更高（P<.01），且椎体改变与咽后壁溃疡相连（P<.01）。复发组比 ORN 组更常出现后弓或其他颈椎水平受累、椎旁实性肿块、硬膜外受累、侧缘皮质破坏和颈淋巴结病（P=.03、P<.001、P=.02、P<.001 和 P<.01）。
各种 MR 成像特征可用于帮助区分颈椎 ORN 和复发性疾病。
