Neoplastic fixation to the prevertebral compartment by squamous cell carcinoma of the head and neck

AJR Am J Roentgenol. 1998 May;170(5):1389-94. doi: 10.2214/ajr.170.5.9574622.

Abstract

Objective: The purpose of this study was to determine the accuracy of MR imaging in determining fixation of squamous cell carcinomas to the prevertebral space.

Materials and methods: MR images of 15 patients with large pharyngeal carcinoma (n = 13) or laryngeal carcinomas with pharyngeal extension (n = 2) were retrospectively reviewed independently by two head and neck radiologists who were unaware of the surgical findings. MR images were evaluated for four criteria in the prevertebral longus muscle complex: muscle concavity, irregular tumor-muscle interface, T2 hyperintensity, and enhancement. All patients underwent panendoscopy where fixation or mobility of the tumor relative to the prevertebral fascia was assessed by manual manipulation. Tumors in six patients were fixed to the prevertebral space and inoperable. In nine patients whose tumors were not fixed, open neck explorations were performed and tumors were resected in seven patients. MR findings were compared with panendoscopy in all patients and with intraoperative assessment in nine patients.

Results: Eleven of 15 patients had at least two of the MR imaging criteria present. None of the MR findings were both sensitive and specific for tumor fixation. Although muscle concavity and enhancement each had a sensitivity of 88%, both criteria suffered from low specificity (14% and 29%, respectively). An irregular tumor-muscle interface and muscle T2 hyperintensity were criteria that suffered from both low sensitivity and specificity. Accuracy of the imaging criteria independently ranged from 53% to 60%.

Conclusion: Although abnormal muscle contour, T2 hyperintensity, and enhancement are frequently present in neck carcinomas that are fixed to the prevertebral space, these findings may also be present in patients in whom the tumor is mobile and resectable. MR imaging may not be able to differentiate between neoplastic fixation and nonneoplastic changes in the prevertebral space.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue / pathology
  • Adipose Tissue / surgery
  • Aged
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / surgery
  • Cervical Vertebrae / pathology
  • Cervical Vertebrae / surgery
  • Contrast Media
  • Diagnostic Techniques, Surgical
  • Endoscopy
  • Fascia / pathology
  • Fasciotomy
  • Female
  • Gadolinium DTPA
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / surgery
  • Humans
  • Image Enhancement
  • Laryngeal Neoplasms / pathology*
  • Laryngeal Neoplasms / surgery
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Neck / pathology*
  • Neck / surgery
  • Neck Muscles / pathology
  • Neck Muscles / surgery
  • Neoplasm Invasiveness
  • Pharyngeal Neoplasms / pathology*
  • Pharyngeal Neoplasms / surgery
  • Predictive Value of Tests
  • Retrospective Studies
  • Sensitivity and Specificity

Substances

  • Contrast Media
  • Gadolinium DTPA