Quillin S P, Balfe D M, Glick S N
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
AJR Am J Roentgenol. 1993 Dec;161(6):1205-8. doi: 10.2214/ajr.161.6.8249726.
In patients previously irradiated for head and neck carcinomas, persistent soft-tissue thickening in the larynx and pharynx makes it difficult to distinguish between postirradiation edema and recurrent epidermoid carcinoma. The goal of this work was to characterize the standard double-contrast pharyngographic appearance after irradiation and to differentiate this appearance from that of recurrent or residual neoplasms.
The posttreatment pharynogograms in 43 patients treated with radiotherapy for malignant tumors of the head and neck were retrospectively reviewed. The pharynx had been included in the radiation field in each case. We characterized the posttherapy appearance and identified radiographic signs that could be used to distinguish normal postirradiation edema from recurrent tumor.
Soft-tissue thickening of normal laryngeal and pharyngeal structures and laryngotracheal aspiration were common nonspecific findings on posttherapy pharyngograms, each occurring in 39 of 43 patients. Epiglottic enlargement and laryngotracheal aspiration did not correlate with the presence of residual or recurrent neoplasm. Asymmetric swelling was more common ipsilateral to the original neoplasm and did not necessarily indicate a malignant tumor. Mucosal irregularity, ulceration, and a demonstrable focal mass were the only significant predictors of recurrent or residual tumor; at least one of the three findings was present in 17 of 19 patients with neoplasm correctly identified by pharyngography.
Double-contrast pharyngography is a useful means of diagnosing pharyngeal tumors in patients who have had radiation therapy. Radiographic signs of neoplasm (ulcer, mucosal irregularity, and a focal mass) can be used to distinguish recurrent tumor from nonmalignant changes after irradiation.
在先前接受过头颈部癌放疗的患者中，喉和咽持续存在的软组织增厚使得难以区分放疗后水肿和复发性表皮样癌。本研究的目的是描述放疗后标准双对比咽造影的表现，并将其与复发性或残留肿瘤的表现区分开来。
回顾性分析43例接受头颈部恶性肿瘤放疗患者的治疗后咽造影。所有病例的咽部均包含在放疗野内。我们描述了治疗后的表现，并确定了可用于区分放疗后正常水肿与复发性肿瘤的影像学征象。
喉和咽正常结构的软组织增厚以及喉气管误吸是治疗后咽造影常见的非特异性表现，43例患者中有39例出现。会厌肿大和喉气管误吸与残留或复发性肿瘤的存在无关。不对称肿胀在原肿瘤同侧更常见，不一定表明存在恶性肿瘤。黏膜不规则、溃疡和可证实的局灶性肿块是复发性或残留肿瘤的唯一重要预测指标；在19例经咽造影正确诊断为肿瘤的患者中，17例至少出现了这三种表现中的一种。
双对比咽造影是诊断接受过放射治疗患者咽部肿瘤的有用方法。肿瘤的影像学征象（溃疡、黏膜不规则和局灶性肿块）可用于区分放疗后复发性肿瘤与非恶性改变。
