Head and neck radiology

1. Head and Neck

2. Convoluted cerebriform pattern
Antrochoanal polyp

3. Double ring cochlea / Halo sign
Retrofenestral
Otosclerosis

4. Target sign
Plexiform neurofibroma
• Characteristic of NF1.
• T2: hyperintense signal with
hypointense central focus.

5. Sac of marble sign
Dermoid cyst

6. Soft tissue vascular lesions
• Vascular tumor / Haemangioma. (sizable parenchymal
component).
• Vascular malformations. (No sizable parenchyma)
• Arterial.
• Capillary. Venous.
• Lymphatic.
• Mixed.

7. HAEMANGIOMA
(Solid lesion with vascular channels and sizable parenchymal component)
• The most common.
• Not present in birth.
• 3 phases: proliferative, quiescent and
involutional.
Infantile
• At birth
• RICH…rapidly involuting congenital
haemangioma.
• NICH…. Non involuting congenital
haemangioma.
congenital

8. Infantile Haemangioma
Right parotid gland infantile haemangioma.
Lobulated well-defined hypointense mass with intense enhancement on
post-contrast fat-sat image.

9. ARTERIAL MALFORMATION
*AVM *AVF
A tangle of flow voids in and around the left body of the mandible with no
sizable parenchymal component … high flow vascular malformation.

10. VENOUS MALFORMATIONS (The most common)
• Focal VMs :-
• Reside within one layer of tissue: muscle, skin or mucosa.
• Treated with sclerotherapy.
• Diffuse VMs:-
• Involve multiple tissue layers and usually include muscle, subcutaneous
fat and skin.
• Require multiple sclerotherapy sessions and are more likely to recur.

11. Diffuse venous malformation
PXR: phleboli.
STIR:-multilobulated hyperintense soft-tissue lesions (skin, subcutaneous, intermuscular regions).
Fat sat pc:- Significant enhancement.

12. Focal venous malformation
Hyperintense laryngeal venous malformation (
Significant contrast enhancement on postcontrast fat-saturated T1-image.

13. Capillary malformation
• Typically isolated findings, they can be linked with more serious disease.
• Sturge–Weber syndrome is the most well-known associated disease and
presents with ipsilateral angioma formation and arteriovenous malformation
(AVM).
• CMs are diagnosed clinically, flat, pink, blanching lesion.
• However, further work-up with MRI is required when CM occurs on the face,
as this increases the risk of having Sturge–Weber syndrome

14. LYMPHATIC MALFORMATIONS
Occurs before the age of 2 years in 90% of cases.
Classifications:-
• Macrocystic (cyst >1 cm). present at birth.
• Microcystic (cyst < 1 cm). present later and more common.

15. Macrocystic lymphatic malformation.
Rim and septal enhancement (arrowheads) with no enhancement of the
lymph-filled spaces. Arrow = fluid-fluid level

16. Microcystic lymphatic malformation
No significant enhancement
of the mass

17. Treatment
• Macrocystic LMs: sclerotherapy.
• Microcystic LMs:- conservative.

18. MIXED malformation
Venolymphatic.
Capillary lymphatic.
• Acquiring criteria of different entities.

19. Venolymphatic malformation
The venous component shows significant enhancement. (Yellow arrows)
The lymphatic component shows septated enhancement on postcontrast
fat-saturated T1 image.

20. Soft tissue vascular lesions.
High flow
No enhancing tissue….
AVM, AVF
Low flow
Enhancing tissue …. vascular tumor/haemangioma
Heterogenous enhancement…..venous malformation
Marginal / septal enhancement….macrocystic lymphatic
Minimal or no enhancement…… microcystic lymphatic
Mixed patterns of enhancement…..combined
malformations.

21. Management.
• In terms of treatment decisions, recognizing whether the lesion is
a low-flow vascular malformation is more important than
determining exactly whether the lesion is predominantly venous,
lymphatic, or capillary.
• Diagnosis of low-flow malformation is based on the absence of
flow voids on SE images.

22. Venous malformations
• Have often termed ‘’cavernous haemangioma’’ but
unlike haemangioma they don’t involute and may
involve bone.
• From imaging stand point , venous malformation and
deep haemangioma share many MR features making
their differentiation difficult.

23. Intraocular medulloepithelioma
• A congenital tumor of the ciliary epithelium.
• Tumor of the childhood (6m- 5y).
• Rare. But remains the second most common primary intraocular
neoplasm.
• Good prognosis as long as tumor does not spread beyond the eye.
D.D:-
• Retinoblastoma.
• Sarcoma.
• Ciliary epithelial adenoma, adenocarcinoma.

24. MRI features
Heterogeneous, solid and cystic
mass.
T2:- hypointense to vitreous and
T1:- isointense to vitreous.
Post contrast:- intense
enhancement of the solid
component of the mass.
Retinal detachment (red
arrow)
Subretinal exudate. (Yellow
arrow)

25. MRI features
Subretinal
hemorrhage
Mass located at the
ciliary body showing
intratumoral cysts.

26. Malignant teratoid variant (“teratoneuroma” and
“diktyoma)
• The malignant teratoid variant shows intratumoral calcifications.
• Differentiation from retinoblastoma by imaging is impossible.

27. #Differentials
Retinoblastoma
Site:- commonly in
the posterior ocular
pole.
- Has calcifications in
70% of patients.
- Usually lack
intratumoral cysts
Medulloepithelioma
Site:- in the ciliary
body
- Lack of calcifications in
the non teratoid variant.
- Intratumoral cysts is a
hallmark.
Melanoma
intensely
hyperintense to
vitreous on T1-
weighted
Toxocara endophthal-
mitis
Nonspecific mass of
increased attenuation
without calcification in
the posterior globe.

28. • Cochlear promontory hypodensity
• Cause ?

29. Epibulbar fatty masses
(in the lateral canthal area).
• Fatty mass at the temporal or
superotemporal epibulbar area, without
connection to the intraconal fat.
• Anterior to lateral rectus muscle insertion.
• Congenital
Dermolipoma
• Herniated fat at the superotemporal
epibulbar area, continuous with the
intraconal fat.
• Medial to lateral rectus.
• Acquired.
Subconjunctival
fat prolapse

30. Causes
• Congenital choristomatous
tumor containing dermis-like
connective tissue and
adipose tissue.
Dermolipoma
• Herniation of intraconal fat
due to weakness of the
Tenon capsule by the aging
process, trauma, or surgery
Subconjunctival
fat prolapse

31. Tenon’s capsule.(blue lines)
Like a glove for the whole eye.
- It starts at the limbus and lid
muscles.
- Initially fused to conjunctiva.
- Loose matrix.
- Follows sclera around globe.
- Sleeves around rectus oblique
muscles.
- Attaches to optic nerve
sheaths.

32. #Differentials
Volume loss of maxillary sinus
Silent sinus syndrome
Inward bowing of all four walls
Enophthalmos
Sinus hypoplasia
Thickened sinus walls.

33. Greisinger's sign
Lateral sinus
thrombosis

34. Greisinger's sign
• Oedema of the postauricular soft tissues overlying the mastoid process due to
thrombosis of the mastoid emissary vein ‘arrow’ complicating acute
otomastoiditis

35. Neck spaces
Suprahyoid
From hyoid bone to skull
base
Infrahyoid
From hyoid bone to thoracic
inlet.

36. Neck spaces
Suprahyoid
Infrahyoid
VS:- Vascular space
CS:- Carotid space.
PVS:- Perivertebral space.

42. Anatomic Variations of the Sphenoid Sinus and
Their Impact on Trans-sphenoid Pituitary Surgery
• Preoperative contrast-enhanced CT scan and MRI were routinely
done
• Patients were reviewed for the following four anatomical
variation:-

43. Degree of pneumatization
• Conchal, presellar, sellar, and postsellar.
- Absence of pneumatization of the sphenoid
sinus.

44. .
Type of sphenoid sinus pneumatization
on the
.
Absent sellar bulge

45. • Prominent sellar bulge (arrow)
• Pneumatized Dorsum sella (arrowhead).
Type of sphenoid sinus pneumatization
on the
.

46. Sellar configuration
• To evaluate the prominence (well
defined) or absence (ill defined) of
sellar bulge.
• Determined according to the degree of
pneumatization of the sinus in relation
to the sellar floor.
• Evaluate the pneumatization of the
planum sphenoidale and the Dorsum
sella, namely in the sagittal MRI.

47. Septation
• The presence or absence of an
intersphenoid septum: and the place of
its insertion, whether it is in the
at the , or at the
• Same done if more than one septum is
present(accessory septum).
• This was best evaluated on both axial
and coronal CT scans.
Intersphenoid septum pointing toward the left internal
carotid artery.

48. The intercarotid distance
Measured in mm between the
signal void intracavernous ICA in
axial and coronal MRI.