Carotid artery and jugular vein invasion of oral-maxillofacial and neck malignant tumors: diagnostic value of computed tomography

Abstract

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.