头颈部不同原发肿瘤颈部淋巴结转移的CT表现

CT Manifestations of Cervical Lymph Node Metastasis of Head and Neck Neoplasms

目的 评价头颈部不同原发肿瘤颈部淋巴结转移的CT特点。 资料与方法 回顾性分析261例经手术、病理证实的头颈部不同原发肿瘤颈部淋巴结转移的CT表现,并进行统计学处理。 结果 头颈部不同原发肿瘤转移淋巴结在Ⅱ、Ⅳ、Ⅴ、Ⅵ区,咽后组及腮腺区的分布存在极显著性差异(P<0.01);100例鼻咽癌中,转移至咽后组淋巴结68例,Ⅴ区48例。100例甲状腺癌中,转移至Ⅵ区40例,Ⅶ区21例。不同原发肿瘤颈部转移淋巴结的形态及边缘表现之间存在极显著性差异(P<0.01)。不同原发肿瘤的颈部转移淋巴结的强化程度及内部密度存在极显著性差异(P<0.01)。152例鳞癌转移淋巴结中92例(61%)表现为不规则环形强化伴中央低密度区,100例甲状腺癌中,出现囊性变、囊壁内结节及细颗粒状钙化分别为 36 例、23 例及 18 例。 结论 头颈部不同原发肿瘤有不同的颈淋巴结转移好发部位及密度改变。熟悉颈部转移淋巴结的部位、形态及边缘,强化程度及密度特点,对头颈部肿瘤的诊断与鉴别诊断有明显价值。

Objective To evaluate the CT manifestations of cervical lymph nodes metastasis of head and neck neoplasms. Materials and Methods CT appearances of 261 patients with metastatic cervical lymph nodes of head and neck neoplasms proved by surgery and pathology were reviewed retrospectively, and which were statistically analyzed.Results There were significant difference in distribution of the metastatic lymph nodes in various head and neck neoplasms at level Ⅱ,Ⅳ,Ⅴ,Ⅵ, retropharyngeal group, parotid group (P<0.01). Of 100 nasopharyngeal carcinoma, retropharyngeal group and level Ⅴ lymph node metastases were found in 68 and 48 cases respectively. Of 100 thyroid carcinoma, level Ⅵ and Ⅶ lymph node metastases were found in 40 and 21 cases respectively. There were significant difference in the shape and edge of the metastatic lymph nodes among various kinds of head and neck neoplasms (P<0.01). There were significant difference in the extent of enhancement and the inner density of the lymph nodes (P<0.01). Of 152 squamous carcinoma, 92 cases were (61%) shown as irregular enhancing rim and central low-density areas in the lymph nodes, of 100 thyroid neoplasms, with cystic formations (n=36), intracystic nodules (n=23), and fine granular calcifications (n=18).Conclusion There were different locations and attenuations in metastatic lymph nodes of various head and neck neoplasms. It have very important value for diagnosis and differential diagnosis to know well about the CT manifestations of cervical metastatic lymph nodes in various of head and neck primary tumors.