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the staging of head and neck cancer. Plain radiographs have a very limited role and the workhorses of neck imaging are ultrasound, CT and. MRI with an. RadCases RadCases Head and Neck Imaging Edited by Series Editors Gaurang Shah, MD Jonathan Lorenz, MD Associate Professor Associate Professor of. James Chen - Head and Neck - Download as PDF File .pdf), Text File .txt) or view presentation slides online.

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chapter, guidelines for utilization are presented by region and modality. HEAD AND NECK IMAGING GUIDELINES. Plain Films and Computerized Radiography. PDF | On Apr 4, , Shalendra K. Misser and others published Head and neck imaging. Editorial. Head and Neck Imaging. This special focus edition of Clinical Radiology is devoted to head and neck radiology. The remit was to provide a range of.

The course is divided into two parts daily. The morning sessions of each day are made up of didactic lectures covering all anatomic areas of the head and neck, with special sessions on the temporal bone, skull base, squamous cell carcinoma, orbit, paranasal sinuses, and pediatric head and neck issues. Each afternoon is a mix of didactic lectures on head and neck imaging issues, protocols, and diseases with many interactive case reviews covering unknown head and neck cases correlating with the morning sessions. This time is designed to present the participant with hundreds of individual case examples of head and neck lesions. Interactive case presentations will be given with each individual case initially viewed as an unknown, maximizing the faculty-participant dynamic. Objectives At the conclusion of the conference, the participant will be able to: Understand relevant head and neck anatomy issues. Provide information on current imaging techniques and choosing the most appropriate studies for imaging the head and neck.

The book is very easy to follow and has variety of cases for a particular section. For example, the embolism section covers the characteristics of acute versus chronic pulmonary embolism signs on computed tomography with beautiful graphic illustrations and discussion of relevant ventilation and perfusion scintigraphy. There is description of pathophysiology of various etiologies of pulmonary emboli, including rare examples such as talc and silicone in easy-to-follow bullet format.

In the tumor section, however, the metabolic characterization of thrombi and tumor with fludeoxyglucose positron emission tomography could use more detail. Later sections deal with systemic lung disease such as sarcoid, hepatopulmonary syndrome, sickle cell disease, pulmonary venoocclusive disease, pulmonary hemosiderosis, and others. Cardiac disease and pulmonary hypertension are briefly covered. Overall image quality is good; however, areas of chest radiographs could have been magnified to highlight the important findings.

The book can serve as a quick reference to pulmonary vascular pathologies. Som, H. Curtin, editors. Som and Hugh D. Each chapter is well-organized with innumerable computed tomography and magnetic resonance images, multiple histology and gross pathology photos, anatomy drawings, and multiple boxes and tables to summarize the information. Compared to the fourth edition, published in , the authors have made some substantial changes that improve an already impressive reference.

Patient now presents with complaint of stringlike neck lump. The right internal jugular vein does not opacify arrow. Adjacent soft tissue iniltration is noted along with several surgical clips. This is the most obvious choice, low incidence of pulmonary emboli in comparison to as the internal jugular vein is not visualized adjacent to lower extremity thromboses.

May also present as a lump. Given sociation with adjacent inlammatory changes if infection postsurgical nature of the neck, this is a decent second is present. However, one would expect to see a low at- tenuation center with some degree of enhancement. Always check low can lead to thrombosis.

The mass is in close proximity to left thyroid carti- lage and likely iniltrates it. D The true vocal cords appear C D to be free of the mass.


Moderately enhancing soft tissue mass involving epiglot- tis and left aryepiglottic fold, likely iniltrating the left thy- roid cartilage, is seen in a man with history of smoking. A rare submucosal vocal cord. Sagittal reconstruction is helpful to evaluate mass of supraglottic larynx; it can be indistinguishable invasion of preepiglottic space. The carcinoma of aryepi- on imaging from supraglottic squamous of carcinoma.

Paraglottic extension is possible in tumors involving the false vocal cord. Enhancement of cartilage similar to the mucosal folds above the true vocal cords including the mass signiies tumor invasion.

How- spaces, and false vocal cords. There is a close association with history of alcohol and tobacco use. The goal of imaging is to evaluate have nodal disease at the time of presentation.

Knowledge of the endoscopic with low staging. In cases with involvement of true vocal indings is very helpful in imaging assessment. B—D CT angiogram of the neck was also performed and shows a focal area of luminal narrowing involving the left internal carotid artery ICA B, D, arrows , which has a normal lumen distally C, circle.

Vessel and otherwise clean appearance of the remaining neck abnormalities, such as focal narrowing, occlusion, and vasculature. Fat-saturated images through the neck can ture; unusual age range unless other comorbidities are assess for methemoglobin, and difusion-weighted brain present. Large vessel arteritis, such as Takayasu, could during the same exam. Therefore, if suspicion remains high and test neurovascular compromise to neck pain to no symptoms results are inconclusive, try another method.

Interventional therapies may be warranted if medical management fails or if there is extensive vessel damage. There is patchily enhancing mild nodularity of left true vocal cord, suggesting that spread. A bulky soft tissue invasion of surrounding structures. There is involvement of posterior commissure. Nodularity of left true vocal cord is compat- ible with direct spread of tumor. A primary soft tissue neoplasm centered in cricoid or thyroid cartilage.

A very rare tumor, it tion of cricoid cartilage is common. Involvement of can be confused with subglottic squamous cell carcinoma posterior commissure and arachnoid cartilages is also on imaging. Presence of lymph nodes is unusual at the time of diagnosis. Enhancement of cartilage indicates tumor iniltration. There is signiicant association with smoking or alcohol abuse.

National Comprehensive Cancer Network

A luid—luid level is also observed small arrows. An orbital lesion with an lesion.

Typically found in nents and are best diagnosed on MRI. Fluid—luid levels can be present and are hemangiomas; no luid—luid level. Typically, the patient is quite ill and the are not typically associated with other masses. B T2 axial image exhibits a rounded high T2 signal cystic midline mass arrow at the tongue base at the expected location of foramen cecum arrow. A midline benign cystic mass is of hyoid bone with surgical dissection of the duct up to seen at the tongue base projecting into the vallecula in a the foramen cecum.

It would display a fat or luid attenuation low-density mass on CT scan. It is rare in a thin peripheral rim enhancement. If infected, there may children. Necrotic node of delphian chain may mimic an be an irregular thick wall enhancement. The mass can be infected thyroglossal duct cyst.

Head and Neck Imaging Conference

Only thin peripheral rim sents a remnant of the thyroglossal duct. Sometimes, ectopic thyroid tissue is also gland. The lesion arrows demonstrates signiicant T2 hyperin- tensity and uniform contrast enhancement.

Less common lesion in the parapharyngeal space. However, T2 prolongation can also be seen, as in other head and neck schwannomas. More aggressive lesions can also be found in this space and could appear similarly. C Restricted difusion arrow is seen at the right petrous apex. It sion in pediatric to young adult population. No signiicant contrast enhancement is seen.

Expansile lytic petrous apex sequence. Relationship with adjacent neural structures mass with relative preservation of trabeculae is seen on like cranial nerves V and VII is better appreciated on CT.

MRI exhibits low T1 and high T2 signal. However, MRI. Diferentiation from arachnoid cyst, cholesterol there is no evidence for restricted difusion. Unilateral sensorineural hearing loss, palsy of cranial nerve VI or VII, vertigo, or trigeminal symptoms may also be present, depending on the extent of the mass.

These images demonstrate a partially cystic, rim-enhancing focus within the suprasellar cistern C D circles. Peripheral calciications are present arrow. Solid portions will enhance. Common suprasellar lesion, often tumor as well as efects on adjacent structures.

Less common lesion of the suprasellar characteristic calciications. Common suprasellar cystic lesion; does not signiicantly enhance and usually does not calcify. There is gross erosion of the anterior thyroid car- tilages arrow. There is anterior extralaryngeal spread with iniltration of bilateral strap muscles arrow. There is also sclerosis of left arytenoid car- tilage. Subglottic extension is seen to the base of cricoid cartilage arrow.

D A right-sided level 3 C D lymph node is seen lateral to right jugular vein. Marked glottic and seen on the true vocal cord. Possible iniltration of thyroid supraglottic thickening is seen. It is seen in association cartilage is better visualized on CT. It is a submucosal mass T2 signal mass with homogeneous postcontrast enhance- centered in the thyroid or cricoid cartilage. Areas of ment is seen on vocal cord.

It may be diicult to avoid typical chondroid calciication are seen. An irregular mucosal change in voice. There is a tubular luid density focus, without associated enhance- ment, along the loor of the mouth arrows within the sublingual space.

Common, painless lesion due to obstruction of gland. More often found along the lar space. Lesions tend to be multilocular and retrograde to the sublingual space. They may be purple in color. There is presence of multiple, irregular, low attenuating cystic areas arrows seen within both the lobes of the thyroid gland. Difuse enlargement of both lobes is necessary for clinically asymptomatic patients. Presence of multiple cystic intraglandular nodules is seen.

Imaging pdf head and neck

It has no clinical evidence for thyrotoxicity. Sometimes, it may be hemorrhagic. Enhancing unilateral solitary hetero- presence of multiple and nonenhancing low attenuating geneous mass is seen within the thyroid gland. Areas of peripheral rimlike or amorphous calciication are commonly seen.

On coronal imaging, the brachiocephalic response to low levels of circulating endogenous thyroid vessels are seen running along the inferior margin of hormone. Areas of hemorrhage, ibrosis, cyst formation, the mass. There is a rim-enhancing luid attenuation collection arrow between the left submandibular gland, sternocleidomas- A toid muscle, and carotid space structures. Most common branchial the sternocleidomastoid muscle.

Could have a similar appearance but such as an upper respiratory infection. Whether due to neoplastic or sinus, extending to the skin surface. Rim-enhancing wall is typically present. There is likely pericapsular iniltration with thickening of the overlying left platysma arrowheads.

The margins seen in an older man. Well-deined spread along the auriculotemporal nerve or cranial nerve homogeneously enhancing parotid space mass can mimic VII is better evaluated on MRI. Well-deined parotid mass enhances more heterogeneously. There is a luid collection along the lateral aspect of the mandible arrows.

An internal gas pocket is present white circle. The collection is in continuity with a periapical lucency along the mandible black circle. Most likely due to a enhancement can be seen as well as gas produced from gas-containing luid collection in conjunction with likely infectious organisms. Usually, they are secondary to adjacent dental disease, as in this case. An additional heterogeneously enhancing smaller solid mass is also seen arrow.

Presence of preferred treatment. Simultaneous tonsillar hyperplasia and solid component. Simultaneous presence of periauricular cervical lymph node enlargement is generally seen. It is or cervical nodal metastasis may be seen. Multiple bilateral small cystic lesions crotic, low to intermediate T1, and intermediate to high are seen with solid and cystic masses. It may be T2 signal unilateral masses with heterogeneous contrast associated with collagen vascular disorder.

If positive, further evaluation and California. Facial pain and palsy of cranial nerve VII may also from adjacent scalp or skin sites, whereas bilateral mul- be present. Presence of nodal metastatic disease of the tifocal disease signiies hematogenous metastatic spread parotid gland is a poor prognostic indicator.

Additionally, there is a focus of T2 prolongation within the left basal ganglia arrowhead. This is the most likely enlargement, enhancement, and T2 prolongation. The additional mimicking a meningioma or other extra-axial process.

Could potentially have this appearance, as lymphoma is a great mimicker of disease. There is presence of an enlarged, ovoid, left level 2 lymph node with pericapsular spread with iniltration and thickening of the overlying left platysma muscle white arrows.

A treatment. Postcontrast enhancement is moderate. Sharply erosion of underlying bony structures and widening of marginated, homogeneously enhancing, benign mass is neural foramina due to early perineural spread. It arises from the trast T1-weighted sequences. The checklist for perineural spread includes submucosal mass in the pharyngeal wall.

Late recurrence is common. B, C Pre- and postcontrast sagittal T1-weighted images through that region demonstrate a low T1 signal intensity lesion with robust contrast enhancement arrows. In a child or young adult, component.

Another top diferential. Metastatic foci from a variety of tumors can present as lytic bone lesions. Lung involvement is as well as malignant processes can have a similar occasionally seen. B T1-weighted axial imaging displays a hetero- geneous mildly high T1 signal arrow well-deined mass at the level of carotid bifurcation.

C On T2-weighted image, the mass appears hyperintense arrow with presence of serpiginous low voids apparent. Intensely enhancing, high preoperative embolization to control operative bleeding. T2 signal mass with multiple low voids and salt-and- Radiotherapy is utilized for nonsurgical candidates.

A well-deined soft tissue ance may be seen. There is lack of high velocity serpentine low chyma. The low T1 signal, curvilinear, high velocity low voids and absence of tumor blush.

An intense vascular blush and early glomus bodies or paraganglia, which are composed of draining veins are seen. There may be temporal bone. There are enhancing lesions located both within the sella turcica arrow as well as within the pineal region arrowhead. Enhancing soft tissue is also noted along the septum pellucidum circle. A good choice due to involve- may be rather homogeneously hyperintense on CT. Fat density or ment raise the possibility of metastatic disease.

Even if the initial radio- ing diabetes insipidus or hormonal abnormalities due to graphic evaluation is normal, repeat imaging at a later sellar involvement, hydrocephalus from pineal involve- date is usually warranted. A similar smaller mass is also seen on the right side.

B T2-weighted axial imaging shows previous hyperintense T2 signal of this mass black arrow. C Postcontrast T1-weighted imaging reveals homogeneous contrast enhancement black arrow. D Postcontrast fat-saturated T1-weighted imaging reveals marked intense postcontrast enhancement arrow.

The right-sided mass is now more conspicuous. There is homogeneous and intense postcontrast enhancement. In the suprahyoid neck, the postcontrast enhancement with lack of serpentine high mass displaces the parapharyngeal space anteriorly and velocity low void areas. Rounded, well-deined, infrahyoid neck, the mass displaces the thyroid cartilage hyperintense T2 signal, carotid space mass is seen with and trachea to the contralateral side. The carotid artery intense homogeneous postcontrast enhancement.

There is seen at the anteromedial surface of the mass with is presence of serpentine high velocity low void areas. Commonly seen in younger patients. Areas of central cyst formation signal and moderate postcontrast enhancement. In coronal and sagittal planes, the mass reveals a fusiform shape along the length of carotid artery. There is mineraliza- tion of the basal turn of the right cochlea arrow. The right superior semicircular canal is also mineralized and poorly seen black circle.

The left superior semicircular canal is normal in appearance arrowheads , as is the left cochlea curved arrow. Classic appearance of High-resolution T2-weighted images may show loss of cochlear and vestibular apparatus mineralization.

Can alter and cause either sclerosis or structures. Can appear similar to otospongiosis but tends to involve the pericapsular structures. There is presence of large cystic left level 3 and level 4 lymph nodes white arrow with smaller lymph nodes with ring and nodular contrast enhancement seen superiorly small white arrow. There is mass efect on the trachea with contralateral displace- ment. There is medial displacement of left internal carotid A B artery black arrow.

There may be margins, large left carotid space, and cystic level 3 and evidence for extracapsular invasion. Areas of calciication level 4 lymph nodes. Solitary, low attenu- lymph node metastasis is common.

The primary thyroid ating, unilateral thyroid gland mass without pericapsular lesion may appear similar to a benign adenoma. The spread or lymph node enlargement. A large, unilateral cystic mass is Areas of calciication and nodular enhancement are seen. No evidence for pericapsular spread or with heterogeneous postcontrast enhancement is seen. The invasive margins are irregular. The lymph nodes may exhibit high T2 signal due to necrotic changes and nodu- lar postcontrast enhancement.

It may be sporadic or radiation induced. There is opaciication and expansion of the left ethmoid and sphenoid sinuses asterisks with high attenuation material arrow. Note relative preservation of the internal ethmoid septae arrowhead. High on the diferential list due sinus results from mucin accumulation. Can appear as high attenuation within the sinuses. However, sinuses are not usually illed and expanded with such material.

Unusual, unless in the setting of trauma. B FLAIR-weighted axial imag- ing exhibits mildly high signal arrow , compatible with proteinaceous content. C T2 axial imaging ex- hibits a hyperintense T2 signal rounded mass arrow. D Postcontrast T1 axial imaging exhibits enhance- ment arrow of mucosal delection along the anterior C D surface of this mass. A rounded, benign high T1 and T2 sig- charge, constant nasal speech, sore throat, and eustachian nal posterior nasopharyngeal mass with enhancement of tube dysfunction are other less common complications.

Difuse adenoidal hyperplasia excision or marsupialization surgery is performed. However, a sinus without contrast enhancement is seen. Only edema en- tract connecting the cephalocele to cranial cavity can hancement is seen on postcontrast imaging. There is extensive replacement of the left parotid gland with T2 hyperintense, enhancing tissue arrows. Note the normal appearing right parotid gland arrowheads. Correlation with physical malformations, hemangiomas, arterial abnormalities, exam indings is key.

Although venolymphatic malformations intracranial vascular malformations. Although this lesion may may be present. Deep tissue lesions may be ings is essential. Steroid and laser treatment can also be used to facilitate regression. C—F A low T1 black arrow and high T2 signal mass white arrow with heterogeneous postcontrast enhancement is seen at the postcricoid region. On sagittal T1-weighted imaging, the extensive vertical extent of the mass along the posterior pharyngeal wall white arrow is seen.

Larger masses require laryngopharyngectomy. Presents with dysphagia mass can be seen. Depending on location, invasion of thy- and weight loss rather than sore throat. It can involve the roid or cricoid cartilage should be evaluated.

Extension to postcricoid hypopharynx, larynx, or thyroid gland but carotid space, prevertebral space, retropharyngeal space, does not extend superiorly along the posterior hypopha- glottic space, or cervical soft tissue is possible.

It consists of the piriform sinuses, the posterior pharyngeal wall, and the postcricoid region.

And pdf imaging head neck

On CT, coronal and sag- ittal reconstructions are helpful to evaluate vertical extent. The airway is deviated to the left. A large rim-enhancing ation indings without a discrete luid collection in this tonsillar luid collection in a sick child is most likely a region suggest either phlegmon or early abscess, which tonsillar abscess. If the patient developed an enlarging focus along the pharynx after a recent upper respiratory infection URI , one may consider this diagnosis. Treatment is typically performed with needle this entity.

E Bone window reveals cortical dehiscence D E arrow at the site of tooth removal. An irregular and tubular cystic mass in lar cystic mass with peripheral rim enhancement is seen. No There may be extensive edema and soft tissue stranding evidence for surrounding cellulitis or edema.

Rounded or tubular node enlargements at level 1 and 2 are common. No evidence for cellulitis or edema. It root abscess, or mandibular osteomyelitis. Presence of cellulitis and edema is seen peripheral rim enhancement is seen. High T2 signal within the bone marrow of mandible signiies osteomyelitis.

The incidence of submandibular abscess. Presence of possible submandibular formation. Restricted difusion is often noted, pearance.

Head and neck imaging

T2 shortening and restricted difusion may likely due to increased cellularity. Excellent location for this cellularity of the tumors. As in lymphoma, can occur in any region of the body; again, less likely to restrict difusion. B On T2-weighted imaging, the mass ap- pears hyperintense to muscles black arrow. However, the subcutaneous fat exhibits higher T2 signal than the mass. Serpiginous low void areas are seen adjacent to and within the mass black arrow. C On fat-saturated T1-weighted postcontrast imaging, intense postcontrast enhancement of the mass is seen.

D On T2-weighted imaging, the mass appears hyperintense to muscles arrow. Serpiginous low void areas are seen adjacent to and within the mass. There is no evidence ment and presence of prominent vessels within and for osseous erosion; however, bony remodeling is adjacent to the mass.

Fat-saturated enhancement, and presence of phleboliths. It is generally associated with postcontrast enhancement. It can involute with fatty replacement over next by the age of 9 years. It AVM. The surgical excision and emboli- zation is indicated in case of airway compromise or optic nerve compression if intraorbital.

There is an aggressive soft tissue mass in the left nasopharynx arrow with extension into the muscles of mastication. Note the loss of the normal fat plane between the medial and lateral pterygoid muscles asterisks. The left mastoid air cells are obstructively opaciied arrowhead. The lesion heterogeneously enhances rectangle.

Perineural spread may also occur. However, routine use of sue in the adenoids, this entity must also be considered. PET examinations has not been established. Careful radiographic evaluation of this region aerodigestive tract. There is mild patchy enhancement of the swollen left parotid gland black arrow.

A well- ated cystic mass in an infant or child is seen within the marginated, ovoid, nonenhancing low-density mass is parotid gland with peripheral postcontrast enhancement seen. However, when infected, a thick rim-enhancing and inlammatory changes within the parotid gland.

Well-marginated, within the parotid gland. On postcontrast tubular, cystic channels. It also involves other neck imaging, the wall enhances only in the case of an infected spaces, rarely only the parotid space and rarely single.

It is more commonly discovered in infancy or further cross-sectional imaging with contrast-enhanced childhood but can present at any age. CT scan. There is a homogeneous, mildly enhancing, well-demarcated T2 hypointense mass lesion along the expected location of the left tonsil. Lesion demonstrates increased DWI signal arrows. Tonsillar tissue is rich in lymphatics constitutional symptoms such as fever, night sweats, and and thus a possible location for lymphoma.

Lymphomas weight loss. Additional nodal sites of involvement may tend to be more homogenous than other tonsillar tumors. However, they are usually more tense on MRI, similar to normal tonsillar tissue. Most heterogeneous. Although these can be present in tend to be more homogeneous in comparison to SCCA.

NHL does not contain such cells and is more commonly noted within the extranodal head and neck regions in comparison to HD. The mass also extends laterally on the left side into the expected location A B of the left cavernous sinus. B T1-weighted coronal MRI exhibits a soft tissue mass isointense to gray matter, arising in the left side of the pituitary gland and extending inferiorly into the sphenoi- dal sinus with a breach of the loor of the sella turcica. The pituitary stalk is deviated toward the right.

C T2-weighted coro- nal MRI exhibits the mass to be isointense to gray matter arrow. The normal pituitary parenchyma displays lower signal than the mass. D Postcontrast T1-weighted coronal MRI exhibits that the left lateral mass has less contrast uptake arrowhead than normal pituitary gland, as seen on the right side of the sella turcica.

The mass envelopes the intracavernous ICA but of surrounding bone and soft tissue is seen. On contrast- does not cause narrowing of the lumen. An intensely enhancing mass, of the mass is seen.

Expansion and erosion of the loor of isointense to gray matter on both T1- and T2-weighted sella turcica is common in invasive macroadenoma. Inva- imaging that arises from the lateral wall of cavernous sinus, sion of the sphenoidal sinus and destruction of the upper extends into the sella, and displays a dural tail along the clivus can also be seen. A vasoformative neoplasm imaging, they enhance heterogeneously and absorb less arising from the lateral wall of the cavernous sinus that contrast than normal pituitary gland, which is discerned can extend into the sella.

It displays high T2 signal and better on this sequence than any other. On invasion of intense postcontrast enhancement. When itary tumors. Bone window head CT demonstrates a bony defect along the loor of the anterior cranial fossa black arrow with additional defects along the left orbital rim arrowhead and left frontal bone curved black arrow.

MRI may be more helpful in such cases. B T2-weighted axial MRI exhibits a markedly hyperintense mass arrow with a few hypointense foci within. Note the exophytic intracranial extension into the left side of the posterior fossa.

C Postcontrast T1-weighted axial MRI exhibits intense but somewhat heterogeneous postcon- trast enhancement arrow.

Distal metastasis is rare. However, total surgical resection centered at left petroclival issure invading the clivus in this region is challenging due to high morbidity and and petrous temporal bone.

Foci of low T2 signal within proximity of neurovascular structures. It is associated with hyperostosis Invasion of adjacent clivus and petrous temporal bone is and sometimes calciication within the soft tissue mass well evaluated on bone windows. However, it exhibits homogeneous postcontrast hypointense intratumoral foci of calciication is charac- enhancement with presence of dural tail and low to teristic. It arises from midline, involving clivus postcontrast enhancement is common.

A majority of these arise from the petroclival T2 signal mass with hypointense foci and heteroge- issure. There is a bony plate along the expected location of the right nasal choana arrows. Nasal unilateral or bilateral, bony or membranous. An isolated truncated ossicle in the epitympanum is likely the body of incus arrow. C High-resolution coro- nal temporal bone CT exhibits dehiscent fracture across the mastoid air cells with fracture of the tegmen tympani and parietal bone.

A prolapsed ossicle arrow is seen in mesotympanum. Extensive opaciication of mastoid facial nerve paralysis by decompressing the facial nerve. Both longitudinal and in thickness CT scans with coronal reconstructions.

There are small luid collections within the parotid glands bilaterally black arrows. The palatine tonsils are also enlarged white arrows.

HIV infection is sug- parotid glands with variable amounts of cystic and solid gested by tonsillar enlargement. Most of these lesions have at bilaterally. Tonsillar enlargement would not be present. This may be the presenting sign of HIV infection.

B Bone window of axial CT exhibits formation of new bone within the mass. D T2-weighted axial MRI exhibits a heterogeneously high T2 signal mass arrow iniltrating the masticator space. An aggressive squa- and poorly marginated masticator mass with extension mous cell carcinoma of the retromolar trigone or palatine into adjacent spaces of the neck and invasion of surround- tonsil can invade the masticator space. However, there is ing bony and neurovascular structures is seen. The bone no new bone formation.

It also displays mildly high window can exhibit abnormal calciication or ossiication T2 signal with patchy postcontrast enhancement. An aggressive, large, especially along the cranial nerve V3, is frequently seen heterogeneous, masticator space mass is seen with bone and detected early on MRI. D Cervical spine CT demonstrates the area of signal dropout to represent sclerotic fused bone black arrow.

There is an abrupt kyphosis at this level with areas of adjacent bony demineralization arrowhead and relatively intact adjacent C D vertebral endplates. Process involving many space height is usually preserved early in the disease pro- vertebrae and the presence of adjacent luid collections cess and multiple discontiguous levels may be involved. Also a possibility.

However, adjacent musculature such as the psoas muscles are adjacent involved levels would likely show more involved also a hallmark of spinal TB, particularly if calciication is endplate erosion. Earlier in the disease, similar imaging prolongation with enhancement of the involved struc- indings may be present. Subligamentous spread, however, can occur in spinal TB. Additionally, loss of vertebral height is more common, with development of kyphosis. There is mild narrowing of the intracavernous right internal carotid artery ICA with mass efect on the right side of the ventral surface of pons.

B T2-weighted axial MRI exhibits the soft tissue mass to be isointense to gray matter arrow. C Postcontrast T1-weighted axial image exhibits intense postcontrast enhancement of the right cavernous sinus mass arrow as well as the exophytic component layering on the dorsal surface of clivus. There is thickening along both sides of the lateral dural wall of the right cavernous sinus, which appears as a hypointense line. Mild narrowing of the right ICA is also seen.

D Postcontrast T1-weighted coronal image exhibits the right cavernous sinus mass enveloping the intracavernous right ICA arrow. Radiation treatment can extending away from the edge of the tumor. The mass contain the growth of the tumor and is many times the envelopes the intracavernous right ICA and may cause preferred treatment.

However, gray matter on all the sequences and exhibits intense it is diicult to determine, as the mass is indistinguish- homogeneous postcontrast enhancement. A dural tail is able from the pituitary gland.

Presence of abnormal soft frequently seen extending from the edge of the tumor tissue between the lateral wall of the cavernous sinus into the ipsilateral lealet of the tentorium cerebelli. Unlike meningiomas, pituitary adenomas sometimes be seen within the thickened and intensely generally do not cause narrowing of the ICA. They display high T1 and high intracavernous ICA unlike pituitary microadenoma or T2 signal and originate from the lateral wall of cavernous schwannoma.

They are composed of sinusoidal spaces with slow lowing or stagnant blood and exhibit late illing in after contrast. There is mild remodeling of the fossa for lacrimal gland. C Postcontrast, fat-saturated, T1-weighted coronal MR image exhibits intensely and homogeneously enhancing, ovoid mass white arrow in supratentorial extraconal compartment of the left orbital cavity.

A well-cir- rupture or incomplete expiration may lead to recurrence cumscribed, oval, solid, moderately enhancing soft tissue or malignant transformation.

It is the second most common characteristic. Presence of punctate calciication is seen lacrimal epithelial mass, commonly presenting in the in about one-third of cases. Bony erosion contrast enhancement of a well-circumscribed round or and areas of calciication are more commonly seen. Malignant lymphoma and serous or mucous collections is seen in larger masses. It appears mildly hyperdense on any ing malignancy. Painful, tender, palpably enlarged lacrimal gland.

The risk of tinguishable from pleomorphic adenoma. B T1-weighted axial MRI exhibits the expansile right nasal cavity mass to be mildly hyperintense to muscles arrow. High T2 signal right maxillary mucosal disease is seen. On MRI, the mass exhibits low T2 signal. Avid postcontrast enhancement is also seen. It more commonly arises in the destruction and remodeling is seen. The nasal septum, maxillary antrum and then extends into the nasal cavity.

Secondary extension into the tion and appears to be much more heterogeneous. It is a homoge- ing degree of melanoma deposits. Melanotic melanoma neous solid soft tissue mass that can exhibit low T2 signal exhibits high T1 and low T2 signal; however, amelanotic and mild hyperattenuation on CT scan.

A superior nasal cavity mass, it able low to high T2 signal. Areas of possible hemorrhage is seen with relation to the cribriform plate, prominently can exhibit susceptibility artifact on gradient echo arising from the olfactory mucosa. Areas of cystic T2-weighted imaging. On postcontrast imaging, there is degeneration and presence of an intracranial cyst at the intense enhancement of the mass. Lower cranial nerve schwan- nomas involving the jugular foramen.

Nontraumatic orbital conditions: Radiographics ;28 6: MRI ;28 6: J Comput Assist Tomogr ;18 1: Extrathyroidal manifestations of thyroid disease: Esthesioneuroblastoma methods of intra- thyroid ophthalmopathy.

Neuroimaging Clin N Am ;18 3: CT and MR imaging indings. Neuroradiology —, viii—ix ;51 Lesions of the petrous apex: Radiographics ;32 1: Petrous apex. Neuroimaging Clin N Am ;19 3: Imaging Hodgkin and non-Hodgkin lymphoma in Case 4 the head and neck. Radiol Clin N Am ;46 2: The role of PET in lymphoma. Endolymphatic sac tumors ;47 8: Otol Neurotol ;31 4: Tumors and pseu- Case 14 dotumors of the endolymphatic sac.

Skull Base ;17 6: Petrous apicitis in a child: Clin Imaging ;30 2: Radiographics neuropathies. Br J Radiol ;78 The eye. Head and Neck Imaging. Jugular foramen tumors: Louis, MO: Mosby, Inc. Neurosurg Focus ;17 2: Soft tissue tumors of the head and neck: Radiographics Case 16 ;31 7: Orbital venous-lymphatic malformation. Eye Lond ;23 An analysis of thirty cases of orbital lymphangioma.

Current approach to ibrous dysplasia of bone and management recommendations. Ophthalmology ;97 McCune-Albright syndrome. J Child Orthop ;1 1: Unusual tumors of the posterior fossa skull base. Skull Mukherji SK. Base ;16 2: Primary jugular foramen meningioma: Paranasal sinus mucocele.

Pdf head imaging and neck

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