Institute of Radiology and Nuclear Medicine, Alb Fils Kliniken, Klinik am Eichert, Göppingen, Department of Otolaryngology (ENT)/ Head & Neck Surgery, Bonn University Hospital, Institute of Clinical Radiology, Städtische Kliniken Neuss-Lukaskrankenhaus-GmbH, Neuss, Department of Craniomaxillofacial Surgery-Plastic Surgery-Universität Witten/Herdecke, Klinikum Dortmund gGmbH, Klinikzentrum Nord, Department of Neurosurgery, University Hospital Tübingen, Department of Diagnostic Radiology, Martin Luther University Halle-Wittenberg.
Dtsch Arztebl Int. 2014 Jun 9;111(23-24):417-23. doi: 10.3238/arztebl.2014.0417.
Because of the complex anatomy of the head and neck region, conventional projection radiography alone is unreliable and carries a high risk of misdiagnosis. The poor risk-benefit ratio of conventional radiography has led to their replacement by tomographic imaging for nearly all studies in this region.
This review is based on pertinent articles retrieved by a selective search in the PubMed database (January 1980 to May 2013) as well as on the relevant guidelines from Germany and abroad.
The indication for diagnostic imaging in the anatomically complex head and neck region should be established for a specific type of imaging study on the basis of a thorough clinical examination. Conventional films, though easy to obtain, often cannot answer the diagnostic question and may yield confusing information leading to misdiagnosis. Computed tomography (CT) has the best risk-benefit profile and a high diagnostic value, but low-dose protocols have not yet been put into use in all centers. Magnetic resonance imaging (MRI) is best for bone and soft-tissue diagnosis, but consumes more resources. Digital volume tomography (DVT) is another type of three-dimensional, sectional imaging with high local resolution; the associated radiation exposure and image quality are generally both low, but may vary depending on the apparatus used. DVT cannot be used to evaluate the soft tissues. Ultrasonography can be used to evaluate superficial structures in the head and neck region; nuclear imaging can be used to evaluate thyroid disease and cancer.
Inflammatory, traumatic, and neoplastic diseases of the head and neck are best evaluated with cross-sectional imaging (CT, MRI) in accordance with current guidelines. Conventional x-rays should, in general, only be used for dental evaluation, with rare exceptions.
由于头颈部区域的解剖结构复杂，仅靠传统的投影射线照相术不可靠，且误诊风险很高。传统射线照相术的风险效益比不佳，导致其在该区域几乎所有研究中都被断层成像取代。
本综述基于在 PubMed 数据库中进行的选择性搜索（1980 年 1 月至 2013 年 5 月）中检索到的相关文章，以及国内外的相关指南。
在解剖结构复杂的头颈部区域，应根据彻底的临床检查为特定类型的影像学研究建立诊断影像学的适应证。常规胶片虽然易于获得，但通常无法回答诊断问题，并且可能会产生导致误诊的混淆信息。计算机断层扫描（CT）具有最佳的风险效益比和较高的诊断价值，但尚未在所有中心使用低剂量方案。磁共振成像（MRI）最适合用于骨和软组织诊断，但消耗更多资源。数字容积断层摄影术（DVT）是另一种具有高局部分辨率的三维断层成像技术；相关的辐射暴露和图像质量通常都较低，但可能因使用的仪器而异。DVT 不能用于评估软组织。超声检查可用于评估头颈部的浅表结构；核成像可用于评估甲状腺疾病和癌症。
根据当前指南，头颈部的炎性、创伤性和肿瘤性疾病最好通过横断面成像（CT、MRI）进行评估。通常，除了极少数例外，常规 X 射线仅用于牙科评估。
