上颈部淋巴结恶性肿瘤影响颈鞘的CT评价

CT evaluation of malignant tumors of upper cervical lymph nodes invading the carotid sheath

目的:评价上颈部淋巴结恶性肿瘤影响颈鞘的CT表现。方法:收集经手术和活检病理证实的上颈部淋巴结恶性肿瘤病例77例(83侧病变),并对其在CT上显示的影响颈鞘及其内部血管的形式进行分类和评价。结果:CT上,病变对颈鞘及其内部血管影响的表现主要有:①颈鞘内血管受压变形者52侧病变(颈内动脉1侧;颈内静脉51侧);②颈鞘内血管受压“消失”者13侧病变(均为颈内静脉);③颈鞘内血管受压移位者67侧(颈内动脉22侧,颈内静脉50侧);④淋巴结恶性肿瘤围绕颈鞘血管者15侧。结论:上颈部淋巴结恶性肿瘤对颈鞘内部血管的影响主要表现为推移和受压变形。判断病变是否侵犯颈鞘及其内部血管,应综合考虑其CT影像表现。

PURPOSE: The aim of this article is to evaluate the CT findings of malignant tumors of upper cervical lymph nodes invading the carotid sheath. METHODS: Seventy-seven patients (83 lesions) with malignant tumors in the upper cervical lymph nodes shown on CT scans were collected. All lesions were certificated with pathological examination by operation or biopsy. RESULTS: The CT manifestations of malignant tumors of upper cervical lymph nodes invading the carotid sheath included :①compression and deformation of vessels in the carotid sheath in 52 lesions (ICA, one lesions; ICV, 51 lesions); ②disappearance of vessels in the carotid sheath (ICV, 13 lesions); ③displacement of vessels of the carotid sheath in 67 lesions (ICA, 22 lesions; ICV, 50 lesions); and ④malignant tumors encompassing the carotid sheath in 15 lesions. CONCLUSIONS: On CT images, the most common form of malignant lymph node lesions invading the carotid sheath is displacement of ICA and ICV. It is concluded that all forms of affecting carotid sheath demonstrating on the CT images are important in diagnosing the malignant invasion of the ICA and ICV.