Lääveri Meira, Heikkinen Jaakko, Happonen Tatu, Sirén Aapo, Nurminen Janne, Vierula Jari-Pekka, Velhonoja Jarno, Irjala Heikki, Soukka Tero, Mattila Kimmo, Gunell Marianne, Snäll Johanna, Hirvonen Jussi
Department of Oral and Maxillofacial Surgery, University of Turku and Turku University Hospital, Turku, Finland.
Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2025 May;139(5):594-599. doi: 10.1016/j.oooo.2024.12.017. Epub 2024 Dec 20.
Streptococcus anginosus group (SAG) bacteria have been associated with severe illness in patients with odontogenic neck abscesses. Magnetic resonance imaging (MRI) offers excellent diagnostic accuracy in neck abscesses. We sought to explore whether MRI findings could predict SAG-positivity.
We included patients who had received emergency MRI for an acute odontogenic neck abscess and subsequent surgery with pus sampling. From the MR images, we measured abscesses and determined patterns of retropharyngeal, mediastinal, submandibular space, sublingual space, and visceral space edema. SAG-positive and -negative patients were compared regarding MRI findings along with demographic, clinical, laboratory, and surgical parameters. Data were analyzed using univariate models and a multivariate binary logistic regression model.
Of 93 total patients, 46 patients (49%) were SAG-positive and 47 (51%) SAG-negative. The SAG-positive patients had larger maximal abscess diameters (36.2 vs 31.7 mm, P = .036) and a higher prevalence of mediastinal edema (ME) (43% vs 15%, P = .003). In the multivariate model, ME was the only statistically significant predictor of SAG positivity (OR = 7.455, P = .004). Regarding surgical outcomes, SAG-positive patients required transcervical incisions more often than SAG-negative patients (61% vs 36%, P = .004).
ME detected on emergency MRI is highly suggestive of the involvement of SAG in odontogenic neck abscesses. These findings highlight the clinical utility of emergency MRI in patients with acute neck infections.
咽峡炎链球菌群（SAG）细菌与牙源性颈部脓肿患者的严重疾病有关。磁共振成像（MRI）对颈部脓肿具有出色的诊断准确性。我们试图探讨MRI表现是否能预测SAG阳性。
我们纳入了因急性牙源性颈部脓肿接受急诊MRI检查并随后进行手术及脓液采样的患者。从MR图像中，我们测量了脓肿大小，并确定了咽后、纵隔、下颌下间隙、舌下间隙和内脏间隙水肿的模式。比较了SAG阳性和阴性患者的MRI表现以及人口统计学、临床、实验室和手术参数。使用单变量模型和多变量二元逻辑回归模型分析数据。
93例患者中，46例（49%）为SAG阳性，47例（51%）为SAG阴性。SAG阳性患者的最大脓肿直径更大（36.2对31.7mm，P = 0.036），纵隔水肿（ME）的患病率更高（43%对15%，P = 0.003）。在多变量模型中，ME是SAG阳性的唯一具有统计学意义的预测因素（OR = 7.455，P = 0.004）。关于手术结果，SAG阳性患者比SAG阴性患者更常需要经颈切开（61%对36%，P = 0.004）。
急诊MRI检测到的ME高度提示SAG参与牙源性颈部脓肿。这些发现突出了急诊MRI在急性颈部感染患者中的临床应用价值。
