Vogl Thomas J, Burck Iris, Stöver Timo, Helal Rania
Clinic for Radiology and Nuclear Medicine, Hospital of the Goethe University Frankfurt Center of Radiology, Frankfurt am Main, Germany.
Clinic for Ear, Nose and Throat Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany.
Rofo. 2025 Jun;197(6):638-647. doi: 10.1055/a-2419-9782. Epub 2024 Dec 4.
Diagnosis of lesions of the parapharyngeal space (PPS) often poses a diagnostic and therapeutic challenge due to its deep location. As a result of the topographical relationship to nearby neck spaces, a very precise differential diagnosis is possible based on imaging criteria. When in doubt, imaging-guided - usually CT-guided - biopsy and even drainage remain options.Through a precise analysis of the literature including the most recent publications, this review precisely describes the basic and most recent imaging applications for various PPS pathologies and the differential diagnostic scheme for assigning the respective lesions in addition to the possibilities of using interventional radiology.The different pathologies of PPS from congenital malformations and inflammation to tumors are discussed according to frequency. Characteristic criteria and, more recently, the use of advanced imaging procedures and the introduction of artificial intelligence (AI) allow a very precise differential diagnosis and support further diagnosis and therapy. After precise access planning, almost all pathologies of the PPS can be biopsied or, if necessary, drained using CT-assisted procedures.Radiological procedures play an important role in the diagnosis and treatment planning of PPS pathologies. · Lesions of the PPS account for about 1-2% of all pathologies of the head and neck region. The majority are benign lesions and inflammatory processes.. · If differential diagnostic questions remain unanswered, material can - if necessary - be obtained via a CT-guided biopsy. Exclusion criteria are hypervascularized processes, especially paragangliomas and angiomas.. · The use of artificial intelligence (AI) in head and neck imaging of various pathologies, such as tumor segmentation, pathological TMN classification, detection of lymph node metastases, and extranodal extension, has significantly increased in recent years.. · Vogl TJ, Burck I, Stöver T et al. Parapharyngeal Space: Diagnostic Imaging and Intervention. Rofo 2025; 197: 638-646.
由于咽旁间隙（PPS）位置较深，其病变的诊断常常带来诊断和治疗上的挑战。鉴于其与颈部附近间隙的解剖关系，基于影像学标准可以进行非常精确的鉴别诊断。存疑时，影像引导下（通常是CT引导下）的活检甚至引流仍是可行的选择。通过对包括最新出版物在内的文献进行精确分析，本综述精确描述了各种PPS病变的基本和最新影像学应用，以及除介入放射学可能性之外的对相应病变进行鉴别诊断的方案。根据发病率讨论了PPS从先天性畸形、炎症到肿瘤的不同病变。特征性标准以及最近先进影像学检查的应用和人工智能（AI）的引入使得能够进行非常精确的鉴别诊断，并支持进一步的诊断和治疗。经过精确的穿刺计划，几乎所有PPS病变都可以通过CT辅助程序进行活检，必要时还可进行引流。放射学检查在PPS病变的诊断和治疗规划中起着重要作用。·PPS病变约占头颈部所有病变的1 - 2%。大多数是良性病变和炎症过程。·如果鉴别诊断问题仍未解决，如有必要，可通过CT引导下的活检获取组织样本。排除标准为高血运病变，尤其是副神经节瘤和血管瘤。·近年来，人工智能（AI）在各种病变的头颈部成像中的应用显著增加，如肿瘤分割、病理TMN分类、淋巴结转移检测和结外扩展。·沃格尔TJ、布尔克I、施托弗T等。咽旁间隙：诊断成像与介入。《德国放射学杂志》2025年；197:638 - 646。
