Department of Radiology, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan.
Radiographics. 2012 Sep-Oct;32(5):1261-82; discussion 1282-4. doi: 10.1148/rg.325115160.
In patients with head and neck cancer, posttreatment imaging can be complicated and difficult to interpret because of the complexity of the surgical procedures performed and the postirradiation changes, but such imaging is critical for the evaluation of (a) the response to therapy and (b) tumor control. Posttreatment changes are affected by the type of surgery performed, reconstruction, neck dissection, and radiation therapy. Three types of flaps are used for reconstruction in the head and neck region: (a) the local flap, with geometric repositioning of adjacent tissue; (b) the pedicle flap, with rotation of donor tissue and preservation of the original vascular system; and (c) the free flap, with transfer of tissue that is revascularized by using microvascular surgical techniques. The posttreatment imaging findings in patients with head and neck cancer can be divided into four groups: altered anatomy secondary to surgical reconstruction, tumor recurrence, potential postsurgical complications, and possible postirradiation changes. Potential postsurgical complications are wound infection, abscess, fistula, flap necrosis, hematoma, chylous fistula, and serous retention. Possible postirradiation changes include mucosal necrosis, osteoradionecrosis, radiation-induced vasculopathy, radiation pneumonitis, radiation lung fibrosis, radiation-induced brain necrosis, and radiation-induced secondary malignancies. A familiarity with the imaging characteristics of posttreatment changes and of the potential complications caused by surgery and irradiation and an ability to differentiate these findings from tumor recurrence are essential for posttreatment surveillance and follow-up management of patients with head and neck cancer.
在头颈部癌症患者中，治疗后的影像学检查可能会变得复杂且难以解读，这是因为手术过程的复杂性以及放射治疗后的变化，但这种影像学检查对于评估（a）治疗反应和（b）肿瘤控制至关重要。治疗后的变化受到所进行的手术类型、重建、颈部清扫和放射治疗的影响。在头颈部区域，有三种类型的皮瓣用于重建：（a）局部皮瓣，通过对相邻组织进行几何重定位；（b）带蒂皮瓣，通过旋转供体组织并保留原始血管系统；以及（c）游离皮瓣，通过使用微血管外科技术使组织再血管化。头颈部癌症患者的治疗后影像学表现可分为四组：手术重建引起的解剖结构改变、肿瘤复发、潜在的术后并发症和可能的放射后变化。潜在的术后并发症包括伤口感染、脓肿、瘘管、皮瓣坏死、血肿、乳糜瘘和浆液性潴留。可能的放射后变化包括黏膜坏死、放射性骨坏死、放射性血管病、放射性肺炎、放射性肺纤维化、放射性脑坏死和放射性继发恶性肿瘤。熟悉治疗后变化的影像学特征以及手术和放射引起的潜在并发症，并能够将这些发现与肿瘤复发区分开来，对头颈部癌症患者的治疗后监测和随访管理至关重要。
