鼻咽癌磁共振分期及其影像.ppt

咽后间隙 为充满脂肪的从颅底到第三胸椎的中线后间隙，分为舌骨上、下。 咽后淋巴结仅仅分布于舌骨以上 咽后淋巴结： 外侧组：Rouviere 内侧组：极少见 鼻咽部分较窄：潜在性 下部分对病原播散的抵御力较弱，在第三胸椎以下，危险间隙直接位于其后面，是脓肿等感染灶从咽后间隙蔓延到纵隔的通道。 Neck node metastases from NPC: MR of patterns of disease Purpose: to use MR to document the patterns of nodal involvement in the upper neck in NPC. Methods : The MR of 150 patients with newly diagnosed NPC were reviewed retrospectively. Nodes were considered abnormal on MR criteria of size, necrosis, and extracapsular spread . Results : Retropharyngeal nodes (RN) were more frequently involved than nonretropharyngeal nodes (NRNs) (94% vs 76%). NRN involvement without RN was seen in only 7 of 115 patients (6%). Involvement of RN at the level of the oropharynx (82%) was as common as at the nasopharynx (83%) level. Internal jugular nodes were the most frequently involved NRN nodes (72%). Spinal accessory nodal involvement was also common (57%) but seldom in isolation (8%). , Ann D. King, Head Neck 22: 275-281, 2000 The Chinese University of HK,  Submandibular (3%) and parotid (2%) nodal metastases were uncommon and were always associated with advanced nodal metastases in the ipsilateral RN, internal jugular, and spinal accessory regions. RN are the first echelons of nodal metastases. Direct lymphatic spread to the neck without involvement of the RN nodes is uncommon. Conclusion RN metastases at the level of the oropharynx are more common than previously suspected, and this should influence radiotherapy planning. NRN outside the internal jugular and spinal accessory chains are rare and only occur when the usual routes of lymphatic spread have already been blocked by tumor 腮腺间隙 腮腺淋巴结转移 PD +C STIR 界定解剖界线 鼻腔：肿瘤向前侵犯超过双侧上颌窦后缘连线。 咽旁间隙：肿瘤向侧方侵犯超过咽颅底筋膜咽。 口咽：肿瘤向下超过第2颈椎下缘。 咽旁间隙：肿瘤向侧方侵犯超过咽颅底筋膜。 下咽：侵犯向下超过第3颈椎下缘。 咀嚼肌间隙 （颞下窝）： 侵犯翼内肌T3。 侵犯翼外肌T4。 鼻咽鼻腔分界：上颌窦后壁连线 鼻腔：肿瘤向前侵犯超过双侧上颌窦后缘连线。 肿瘤向侧方侵犯超过咽颅底筋膜咽。 鼻咽与咽旁间隙分界 鼻咽与口咽 肿瘤向下超过第2颈下缘平面 。 口咽与喉咽 肿瘤向下超过第3颈 下缘平面 。 鼻咽癌与颅神经 鼻咽癌沿颅神经内膜或神经周围蔓延，是肿瘤传播到非相邻区域的一种途径 。 2002年AJCC/UICC分期、