T1, T2, and fat suppressed sequences provide different contrasts in MRI neck imaging. Ideally MRI is performed at 1.5T for advanced imaging. MR sialograms compare favorably to digital sialography for visualizing salivary ducts. Carotid body tumors are hypervascular and located at the carotid bifurcation, displaying a "salt and pepper" sign. Nasopharyngeal carcinoma extends into the skull base and cavernous sinus. Neurogenic tumors can extend intraspinally. MRI is better than CT for assessing upper neck, skull base, and pediatric lesions while CT is better for lower neck and bone involvement.

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

6. supraglottis

7. glottis

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.

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.

27. Assymetric vocal cords

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.