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MRI in neck imaging

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Krishna Kiran Karanth
Krishna Kiran Karanth
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MRI in neck imaging
What is T1 ,T2,FAT SUPPRESSED SEQUENCE…? T2 FAT T1 SUPPRESSED Dark CSF , bright fat Bright CSF , bright Bright CSF , dark fat fat
Why ideally at 1.5 T MRI..? 0.2 T MRI 1.5 T advanced MRI
supraglottis
glottis
Case 1 • Recurrent pain and swelling right submandibular region , ? Submandibular sialdenitis.
MR SIALOGRAM Longitudinal projection Axial projection Dilated right submandibular duct with calculi. Normal left submandibular duct.
MR sialogram showing submandibular and parotid ducts. • MR sialogram compares favorably with digital sialography in visualization of ducts and more easier to perform.
Case 2 • Slow growing neck mass on left side.
T1 axial T2 axial A mass seen at left carotid bifurcation. Post contrast T1 axial
Angiogram showing Tumor at carotid bifurcation displacing internal and external carotid arteries Salt and pepper sign
Diagnosis- carotid body tumor • Characteristically is a hypervascular tumor located at carotid bifurcation. • It is a paraganglioma or chemodectoma.
Case 3 • 31 year old male presenting with multiple cranial nerve palsies on right side.
Nasopharyngeal tumor extending to skull base and to right cavernous sinus axial fat suppressed STIR sequence
Post contrast T1 showing entire extent of tumor.
Diagnosis- nasopharyngeal carcinoma • MRI is ideal to assess extent of tumor , in particular intracranial/ perineural extension.
Case 4 • Large swelling in left side of neck
Large left posterior triangle mass with neuroforaminal extension.
Tumor extension seen within neural foramen Normal angio and inside spinal canal.
Diagnosis -Neurogenic tumor • MRI is ideal in assessing intraspinal / neuroforaminal extension.
Case 5 • Left vocal cord palsy.
Thickening of aryepiglottic fold on left side.
Assymetric vocal cords
So , is there a mass in larynx..? • Direct laryngoscopy – no mass. • Remember that chages seen in MRI are secondary to recurrent laryngeal palsy. • They do not represent tumor. • Larynx imaging findings should always be correlated with laryngoscopy findings
CT versus MRI in neck masses • Which modality is tough decision. • In general pediatric patients , upper neck , skull base lesions are better assessed with MRI. • Lower neck masses , suspicious of bone involvement are better assessed with CT. • MRI can be done without contrast , CT will need contrast generally. • In thyroid malignancy , preoperative contrast CT is contraindicated.

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MRI in neck imaging

  • 1. MRI in neck imaging
  • 2. What is T1 ,T2,FAT SUPPRESSED SEQUENCE…? T2 FAT T1 SUPPRESSED Dark CSF , bright fat Bright CSF , bright Bright CSF , dark fat fat
  • 3. Why ideally at 1.5 T MRI..? 0.2 T MRI 1.5 T advanced MRI
  • 4.
  • 5.
  • 8.
  • 9. Case 1 • Recurrent pain and swelling right submandibular region , ? Submandibular sialdenitis.
  • 10. MR SIALOGRAM Longitudinal projection Axial projection Dilated right submandibular duct with calculi. Normal left submandibular duct.
  • 11. MR sialogram showing submandibular and parotid ducts. • MR sialogram compares favorably with digital sialography in visualization of ducts and more easier to perform.
  • 12. Case 2 • Slow growing neck mass on left side.
  • 13. T1 axial T2 axial A mass seen at left carotid bifurcation. Post contrast T1 axial
  • 14. Angiogram showing Tumor at carotid bifurcation displacing internal and external carotid arteries Salt and pepper sign
  • 15. Diagnosis- carotid body tumor • Characteristically is a hypervascular tumor located at carotid bifurcation. • It is a paraganglioma or chemodectoma.
  • 16. Case 3 • 31 year old male presenting with multiple cranial nerve palsies on right side.
  • 17.
  • 18. Nasopharyngeal tumor extending to skull base and to right cavernous sinus axial fat suppressed STIR sequence
  • 19. Post contrast T1 showing entire extent of tumor.
  • 20. Diagnosis- nasopharyngeal carcinoma • MRI is ideal to assess extent of tumor , in particular intracranial/ perineural extension.
  • 21. Case 4 • Large swelling in left side of neck
  • 22. Large left posterior triangle mass with neuroforaminal extension.
  • 23. Tumor extension seen within neural foramen Normal angio and inside spinal canal.
  • 24. Diagnosis -Neurogenic tumor • MRI is ideal in assessing intraspinal / neuroforaminal extension.
  • 25. Case 5 • Left vocal cord palsy.
  • 26. Thickening of aryepiglottic fold on left side.
  • 28. So , is there a mass in larynx..? • Direct laryngoscopy – no mass. • Remember that chages seen in MRI are secondary to recurrent laryngeal palsy. • They do not represent tumor. • Larynx imaging findings should always be correlated with laryngoscopy findings
  • 29. CT versus MRI in neck masses • Which modality is tough decision. • In general pediatric patients , upper neck , skull base lesions are better assessed with MRI. • Lower neck masses , suspicious of bone involvement are better assessed with CT. • MRI can be done without contrast , CT will need contrast generally. • In thyroid malignancy , preoperative contrast CT is contraindicated.