Carotid artery and jugular vein invasion of oral-maxillofacial and neck malignant tumors: Diagnostic value of computed tomography
Carotid artery and jugular vein invasion of oral-maxillofacial and neck malignant tumors: Diagnostic value of computed tomography
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DOI：
10.1016/s1079-2104(03)00366-4
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发表时间：
2003-09-01
影响因子：
--
通讯作者：
Luo, JC
中科院分区：
文献类型：
--
作者：
Yu, Q;Wang, PZ;Luo, JC
Objective.本研究旨在探讨计算机断层扫描（CT）图像在口腔颌面颈部恶性肿瘤侵犯颈动脉和颈静脉中的诊断价值。对43例（44个肿瘤）口腔颌面颈部恶性肿瘤术前行增强CT检查的患者进行评价。回顾性分析所有肿瘤的CT表现并与手术结果对照。手术结果显示，口腔颌面颈部肿瘤与颈总动脉（CCA）或颈内动脉（伊卡）粘连11例，与颈静脉（JV）粘连25例。44例累及颈总动脉、伊卡动脉和颈内静脉的口腔颌面颈部恶性肿瘤的CT异常表现可分为6型：I型4例，颈总动脉或颈内伊卡受压变形，28例累及颈内静脉; II型13例，颈内静脉节段性轴位CT显示闭塞。肿瘤;第三型为颈动脉或颈内动脉移位14例，颈静脉移位18例，第四型为肿瘤包绕颈动脉血管180 °以上5例，第五型为节段性缺失。其中16例肿瘤与CCA或伊卡之间存在脂肪或筋膜平面，33例肿瘤与JV之间存在脂肪或筋膜平面，7例肿瘤为VI型，CCA或伊卡壁边界不清。CT节段横断面诊断颈总动脉或伊卡受压变形的敏感性、特异性和准确性分别为36.4%、100%和84.1%，椎弓根受压变形的敏感性、特异性和准确性分别为84%、63.2%和75%，椎弓根闭塞的敏感性、特异性和准确性分别为52%、100%和72.7%;颈动脉或颈内动脉与颈内静脉移位分别为36.4%~ 52%、53.8%~ 69.7%、61.4%，肿瘤包绕颈动脉血管周径大于180 °分别为18.5%、100%、50%，肿瘤与颈动脉或颈内动脉间部分脂肪或筋膜缺失分别为90.9%、81.8%、84.1%，肿瘤与颈内动脉间部分脂肪或筋膜缺失分别为18.5%、100%、50%，肿瘤与颈内动脉间部分脂肪或筋膜缺失分别为84.1%、81.8%、84.1%。肿瘤与JV之间部分脂肪或筋膜缺失分别为92%、47.4%和72.7%，CCA或伊卡壁边界不清分别为36.4%、90.9%和77.3%。各种CT表现对口腔颌面颈部侵犯颈动脉和颈静脉的恶性肿瘤的诊断有重要价值。CCA或伊卡受压变形、JV节段性闭塞、CCA或伊卡壁不清、肿瘤与CCA或伊卡之间脂肪或筋膜平面缺失等征象对诊断伊卡和JV侵犯可能有价值，但口腔颌面颈部恶性肿瘤累及CCA或伊卡的准确诊断仍有困难。
Objective. This study aimed to disclose the diagnostic value of computed tomography (CT) images in detecting carotid artery and jugular vein invasion by oral-maxillofacial and neck malignant tumors.Study design. Forty-three patients (44 tumors) who had had enhanced CT examination before surgical treatment of oral-maxillofacial and neck malignant tumors were evaluated. The CT manifestations of all tumors were retrospectively compared with the surgical findings.Results. Surgical findings recorded that the oral-maxillofacial and neck tumors adhered to 11 of 44 common carotid arteries (CCA) or internal carotid arteries (ICA) and 25 of 44 jugular veins (JV). The abnormal CT manifestations of the 44 oral-maxillofacial and neck malignant tumors with CCA, ICA, and JV involvement consisted of 6 types: type I, compression and deformation of CCA or ICA in 4 tumors and JV in 28 tumors; type II, obliteration of IJV on segmental axial CT views in 13. tumors; type III, displacement of CCA or ICA in 14 tumors and JV in 18 tumors; type IV, tumor encasement of greater than 180 degrees of the circumference of the carotid vessels in 5 tumors; type V, the segmental deletion. of fat or fascial planes between tumor and CCA or ICA in 16 tumors and JV in 33 tumors; and type VI, ill-defined CCA or ICA wall in 7 tumors. The respective sensitivity, specificity, and accuracy were 36.4%, 100%, and 84.1% for compression and deformation of CCA or ICA; 84%, 63.2%, and 75% for compression and deformation of JV; 52%, 100%, and 72.7% for obliteration of JV in segmental axial CT views; 36.4% to 52%, 53.8% to 69.7%, and 61.4% for displacement of CCA or ICA and JV; 18.5%, 100%, and 50% for tumor encasement of greater than 180 degrees of the circumference of the carotid vessels; 90.9%, 81.8%, and 84.1% for partial fat or fascia deletion between tumor and CCA or ICA; 92%, 47.4%, and 72.7% for partial fat or fascia deletion between tumor and JV; and 36.4%, 90.9%, and 77.3% for ill-defined CCA or ICA wall.Conclusions. Various CT findings are of value in the diagnosis of oral-maxillofacial and neck malignant tumors that affect the carotid arteries and jugular veins. Comparatively, the signs of compression and deformation of the CCA or ICA, segmental obliteration of the JV, undefined CCA or ICA wall, and fat or fascial plane deletion between a tumor and the CCA or ICA may be valuable in diagnosing ICA and JV invasion, although accurate diagnosis of CCA or ICA involvement by the oral-maxillofacial and neck malignant tumors remains difficult.