MRI of the Head and Neck : Functional Anatomy - Clinical Findings - Pathology - Imaging

Since the establishment of magnetic resonance imaging the clinical diagnostic of the head and neck has improved substantially and, therefore, in many cases this technique is used in the first place of radiological diagnosis. The feasibility of non-invasive MR angiography and 3-dimensional reconstruction has enlarged the indication field of MRI. This book presents the meaning of this imaging technique for the diagnosis of diseases in head and neck. Excellent figures show the technicaland diagnostical possibilities of this method, the advantages and limitations of which are explained as well. A comprehensive diagnostic strategy for each diagnostic region is presented. This book is disigned for the use of especially radiologists, ENT specialists and surgeins.

1 Introduction.- 1.1 The Problem and the Goal.- 1.2 Clinical Presentation.- 1.2.1 Temporal Bone, Skull Base, and Cerebellopontine Angle.- 1.2.2 Orbit.- 1.2.3 Nasopharynx and Paranasal Sinuses.- 1.2.4 Salivary Glands.- 1.2.5 Oral Cavity and Oropharynx.- 1.2.6 Hypopharynx and Larynx.- 1.2.7 Neck.- 1.2.8 Temporomandibular Joint.- 1.3 Imaging Modalities in the Head and Neck.- 1.3.1 Conventional Roentgenology.- 1.3.2 Angiography.- 1.3.3 Ultrasound.- 1.3.4 Computer-Assisted Techniques.- 1.4 Methods of Treatment.- 1.4.1 Surgery.- 1.4.2 Radiotherapy.- 1.4.3 Chemotherapy and Radiochemotherapy.- 2 Basics of Magnetic Resonance Imaging.- 2.1 Principles of Magnetic Resonance.- 2.1.1 Magnetism at the Atomic and Nuclear Level.- 2.1.2 Resonance.- 2.1.3 Relaxation.- 2.1.4 Image Acquisition.- 2.2 Parameters of MRI.- 2.2.1 Field Strength.- 2.2.2 Repetition Time.- 2.2.3 Echo Time.- 2.2.4 Resolution.- 2.2.5 Multiple Acquisitions.- 2.2.6 Signal-to-Noise Ratio.- 2.2.7 Contrast-to-Noise Ratio.- 2.3 Equipment.- 2.3.1 Magnets.- 2.3.2 Radiofrequency Equipment.- 2.4 Pulse Sequences and Special Techniques.- 2.4.1 Spin-Echo Sequences.- 2.4.2 Fast Imaging.- 2.4.3 MR Angiography: Basic Physics.- 2.4.4 3D Imaging.- 2.5 Biologic Effects and Safety Considerations.- 2.5.1 Biologic Effects.- 2.5.2 Safety Considerations.- 2.5.3 Summary.- 3 Examination Technique.- 3.1 Coil Technology.- 3.2 Sequences and Specific Examination Protocols.- 3.2.1 Petrous Part, Middle Skull Base, and Face.- 3.2.2 Oropharynx and Neck.- 3.3 Fast Sequences and Dynamic MRI.- 4 Contrast Media.- 4.1 Basic Principles.- 4.1.1 The Theory of Proton Relaxation.- 4.1.2 Contrast Enhancement.- 4.2 Pharmacology of Gd-DTPA.- 4.3 Safety Profile of Gd-DTPA.- 4.4 Examination Protocols.- 4.4.1 Sequences.- 4.4.2 Subtraction Technique.- 4.4.3 Dynamic MRI.- 4.4.4 Oral Administration of Contrast Medium.- 4.5 Clinical Indications.- 4.5.1 Normal Topography.- 4.5.2 Benign Tumors.- 4.5.3 Malignant Tumors.- 4.5.4 Posttreatment Control.- 4.5.5 Inflammatory Disease.- 4.6 Summary.- 5 Signal Intensity and Relaxation.- 5.1 In Vivo Results.- 6 Temporal Bone, Middle Skull Base, and Cerebellopontine Angle.- 6.1 Clinical Findings.- 6.2 Examination Technique.- 6.3 The Topographic Basis for the Evaluation of MR Images.- 6.4 Sensitivity and Specificity of MRI in Relation to Other Imaging Modalities.- 6.4.1 The Value of the Various MRI Sequences.- 6.5 Acoustic Neuroma.- 6.5.1 Classification.- 6.5.2 MRI Characteristics.- 6.6 Other Neuromas.- 6.7 Glomus Tumors.- 6.7.1 Classification.- 6.7.2 MRI Characteristics.- 6.8 Meningioma.- 6.9 Epidermoid.- 6.10 Cholesteatoma and Other Tumors of the Pyramid Apex.- 6.11 Tumors of the Posterior Cranial Fossa.- 6.12 Overall Efficacy of MRI.- 6.13 Diagnostic Strategy.- 7 Orbit.- 7.1 Clinical Findings.- 7.2 Examination Technique.- 7.3 Topographic Relations.- 7.3.1 Eyeball.- 7.3.2 Nerves.- 7.3.3 Blood Vessels.- 7.3.4 Muscles and Fatty Tissue.- 7.3.5 Lacrimal Gland.- 7.3.6 Bony Borders.- 7.4 Ocular Lesions.- 7.4.1 Congenital Lesions.- 7.4.2 Traumatic Lesions.- 7.4.3 Inflammation.- 7.4.4 Tumors.- 7.5 Optic Nerve/Sheath Lesions.- 7.5.1 Nontumorous Enlargement.- 7.5.2 Tumorous Enlargement.- 7.6 Intra- and Extraconal Lesions.- 7.6.1 Pseudotumor.- 7.6.2 Tolosa-Hunt Syndrome.- 7.6.3 Graves’ Disease.- 7.6.4 Lymphoma.- 7.6.5 Malignant Lesions.- 7.6.6 Benign Lesions.- 7.6.7 Vascular Lesions.- 7.6.8 Lacrimal Gland Lesions.- 7.7 Summary.- 8 Nasopharynx and Paranasal Sinuses.- 8.1 Clinical Findings.- 8.2 Examination Technique.- 8.3 Topographic Relations.- 8.3.1 Nasopharynx.- 8.3.2 Parapharyngeal Space.- 8.3.3 Nose and Paranasal Sinuses.- 8.4 Lesions of the Nasopharynx.- 8.4.1 Squamous Cell Carcinoma.- 8.4.2 Lymphoepithelial and Adenoid-Cystic Carcinomas.- 8.4.3 Juvenile Angiofibroma.- 8.4.4 Lymphoid Hyperplasia and Lymphomas.- 8.5 Lesions of the Parapharyngeal Space.- 8.6 Lesions of the Nose and Paranasal Sinuses.- 8.6.1 Inflammatory Changes.- 8.6.2 Squamous Cell Carcinoma.- 8.6.3 Rare Lesions.- 8.7 Value of MRI and Diagnostic Procedure.- 9 Salivary Glands.- 9.1 Clinical Findings.- 9.2 Examination Technique.- 9.3 Topographic Relations.- 9.3.1 Parotid Gland.- 9.3.2 Submandibular and Sublingual Glands.- 9.4 Inflammatory Changes.- 9.4.1 Parotitis.- 9.4.2 Sjögren’s Syndrome.- 9.5 Benign Lesions.- 9.5.1 Pleomorphic Adenoma.- 9.5.2 Lymphoepithelial Cysts.- 9.5.3 Warthin’s Tumor.- 9.6 Malignant Lesions.- 9.6.1 Adenocarcinoma.- 9.6.2 Adenoid-Cystic Carcinoma.- 9.6.3 Squamous Cell Carcinoma.- 9.6.4 Lymphoma.- 9.6.5 Recurrent Lesions.- 9.7 Value of MRI and Diagnostic Procedure.- 10 Oral Cavity and Oropharynx.- 10.1 Clinical Findings.- 10.2 Examination Technique.- 10.3 Topographic Relations.- 10.4 Squamous Cell Carcinoma.- 10.4.1 Tumor Classification.- 10.4.2 Tonsils and Parapharyngeal Space.- 10.4.3 Oral Cavity and Body of Tongue.- 10.4.4 Vallecula and Base of Tongue.- 10.5 Other Lesions.- 10.5.1 Kaposi Sarcoma.- 10.5.2 Glomus Tumor.- 10.5.3 Adenoma.- 10.5.4 Metastatic Lymph Nodes.- 10.5.5 Paresis of the Hypoglossal Nerve.- 10.5.6 Hemangioma.- 10.5.7 Plasmocytoma.- 10.5.8 Others.- 10.6 Diagnostic Strategy.- 11 Larynx and Hypopharynx.- 11.1 Clinical Findings.- 11.2 Examination Technique.- 11.3 Topographic Relations.- 11.3.1 Hypopharynx.- 11.3.2 Larynx.- 11.4 Tumor Classification.- 11.5 Differential Diagnosis.- 11.6 Characteristic Diagnostic Findings.- 11.6.1 Principles of MRI.- 11.6.2 Tumors.- 11.6.3 Trauma.- 11.6.4 Diagnostic Strategy.- 12 Neck.- 12.1 Clinical Findings.- 12.2 Examination Technique.- 12.3 Topographic Relations.- 12.3.1 Neck Compartments.- 12.3.2 Thyroid Gland.- 12.3.3 Parathyroid Glands.- 12.3.4 Lymph Nodes.- 12.4 Thyroid Gland.- 12.4.1 Diagnostic Concept.- 12.4.2 Anatomic Abnormalities.- 12.4.3 Goiter.- 12.4.4 Nodular Disease.- 12.4.5 Adenoma.- 12.4.6 Conclusions.- 12.5 Parathyroid Glands.- 12.5.1 Diagnostic Concept.- 12.5.2 Nodular Disease.- 12.5.3 Conclusions.- 12.6 Lymph Nodes.- 12.6.1 Diagnostic Concept.- 12.6.2 Inflammatory Lesions.- 12.6.3 Malignant Lymphoma.- 12.6.4 Metastatic Cancer.- 12.6.5 Conclusions.- 12.7 Soft Tissue Masses.- 12.7.1 Inflammation, Abscess.- 12.7.2 Cysts.- 12.7.3 Lipoma.- 12.7.4 Neural Tumors.- 12.7.5 Rhabdomyoma, Rhabdomyosarcoma.- 12.7.6 Chordoma.- 12.7.7 Others.- 12.7.8 Conclusions.- 12.8 Vascular Lesions.- 12.8.1 Glomus Tumor.- 12.8.2 Hemangioma.- 12.9 Value of MRI and Diagnostic Strategy.- 13 Temporomandibular Joint.- 13.1 Clinical Approach.- 13.2 Examination Technique.- 13.3 Topographic Relations.- 13.3.1 Mandibular Condyle.- 13.3.2 Mandibular Fossa.- 13.3.3 Articular Disk.- 13.3.4 Mandibular Movement.- 13.4 MRI and Clinical Findings.- 13.4.1 Traumatic Injuries.- 13.4.2 Arthritis.- 13.4.3 Internal Derangement.- 13.4.4 Hypermobility of the Mandibular Condyle.- 14 Three Dimensional MRI.- 14.1 Principles.- 14.1.1 Equipment and Sequences.- 14.1.2 Value of Different Sequences.- 14.1.3 Value of Gd-DTPA.- 14.2 Skull Base, Face, and Neck.- 14.3 Technique and Prospects.- 15 Clinical Application of Magnetic Resonance Angiography.- 15.1 Selective Arterial MRA.- 15.1.1 Technique and Indications.- 15.1.2 Normal Topography.- 15.1.3 Pathological Findings.- 15.2 Selective Venous MRA.- 15.2.1 Technique and Indications.- 15.2.2 Normal Topography.- 15.2.3 Pathologic Findings.- 16 Magnetic Resonance Spectroscopy.- 16.1 Technical Considerations.- 16.1.1 Introduction.- 16.1.2 Basic Physics of MRS.- 16.1.3 Field Strength.- 16.1.4 Appropriate Nuclei.- 16.1.5 Calculation of pH.- 16.1.6 Examples of Localization Techniques.- 16.1.7 MRS Investigation Procedure.- 16.2 Clinical Spectroscopy of the Head and Neck.- 16.2.1 Examination by Means of Surface Coils.- 16.2.2 Examination by Means of ISIS.- 16.2.3 Follow-Up Studies During Therapy.- 16.3 Discussion.- 16.4 Prospects.- 17 Conclusions.