MRI in neck imaging

What is T1 ,T2,FAT SUPPRESSED SEQUENCE…?

T1T2 FAT

SUPPRESSED

Dark CSF , bright fat Bright CSF , bright fat

Bright CSF , dark fat

Why ideally at 1.5 T MRI..?

0.2 T MRI1.5 T advanced MRI

supraglottis

glottis

Case 1

• Recurrent pain and swelling right submandibular region , ? Submandibular sialdenitis.

MR SIALOGRAM

Dilated right submandibular duct with calculi. Normal left submandibular duct.

Axial projection

Longitudinal projection

• MR sialogram compares favorably with digital sialography in visualization of ducts and more easier to perform.

MR sialogram showing submandibular and parotid ducts.

Case 2

• Slow growing neck mass on left side.

T1 axial T2 axial

Post contrast T1 axial

A mass seen at left carotid bifurcation.

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 and inside spinal canal.

Normal angio

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.