Wednesday 19 January 2011
Post-treatment imaging appearances in head and neck cancer
Clinical information:
Histopathology:
TNM staging:
Surgery: Radical/ modified radical neck dissection, laser, no surgery
Reconstruction surgery: yes/ no
If yes, flap details:
Radiotherapy: yes/ no
If yes, type of radiotherapy
Primary site review:
Residual disease/ recurrence/ post-op change
Radiation induced sarcoma: latent period is 5 years, radiation induces SCC, lymphoma and meningioma
Post RT changes:
Acute post-RT changes (within 2-4 weeks): skin, platysma, neck space edema, enhancing salivary glands, enhancement of mucosal lining, increased attenuation of paralaryngeal fat
Subacute post-RT changes (few months to 18 months): chronic mucositis (polyps), chronic sialadenitis, i.e, loss of volume (virtually in ALL), especially parotids, fibrosis (may or may not enhance, stop enhancing after 18 months), persistent reactive nodes
Radionecrosis:
Sites: larynx, mandible, temporal bone, basisphenoid, maxillary bone
6- 15 months
Sclerosis, fragmentation, mottled appearance, sloughing, break of cartilage and bone with sequestration, pathological fracture, loss of trabeculae. Subluxation/ dislocation (of arytenoids). Soft tissue thickening, abscess, fistula, gas in the soft tissue. Enhancement of the adjacent muscles and fat.
Neurological changes:
Radiation cerebral necrosis: Deep white matter of medial and inferior temporal lobes or frontal lobes (depending on site of RT)
Brainstem encepahlopathy, myelopathy and transverse myelitis
RT induced brachial plexopathy
Traumatic neuroma
Denervation od V, XI and XII nerves
Reference:
Post-treatment imaging appearances in head and neck cancer patients
Thursday 26 November 2009
Vestibular schwannoma
90% from inferior division (superior division 6%) of vestibular nerve, within or near vestibular (Scarpa) ganglion, at porus acousticus, or just within IAC (near Obersteiner-Redlich zone = transition from glial cells to Schwann cells)
Surgerical approach:
Middle cranial fossa, translabyrinthine and suboccipital (retrosigmoid)
Reference:
http://radiographics.rsna.org/content/29/7/1955.abstract
Skull base foramen
Superior orbital fissure: Nerves III, IV, V1 and VI, superior ophthalmic vein
Inferior orbital fissure:
Foramen ovale: Mandibular divison of trigeminal (V3)
Foramen rotundum: maxillary division of trigeminal (V2)
Foramen spinosum: Middle meningeal artery
Foramen lacerum: Meningeal branches of ascending pharyngeal artery
Vidian canal: Vidian artery and nerve
Stylomastoid foramen: exit of facial nerve
Hypoglossal canal: XII cranial nerve
IAC: VII and VIII cranial nerves
Jugular foramen/fossa: IX, X, XI cranial nerves, IJV
Carotid canal: ICA
Monday 29 December 2008
Imaging cholesteatoma
Classification:
Congenital (2%)
Acquired (98%)
--Pars flaccida (82%)
--Pars tensa (18%)
---- Posterosuperior (78%)
---- Anteroinferior (22%)
Congenital cholesteatoma:
= Epidermoid Epithelial rest cells
Can be seen in middle ear, mastoid, squamous temporal, petrous apex, CP angle
Common in anterior middle ear cavity near ET tube and stepes
Acquired cholesteatoma:
= Prusaac's cholesteaoma, attic cholesteatoma
Sequele to middle ear infection
MRI:
Useful in evaluating post operative/ recurrent cholesteatomas; differentiating
Delayed post-Gd T1 SE is useful
Cholesterol granuloma: increased signal on T1, no change on delayed Gd T1, low signal on DWI
with b factor of 800 sec/mm2.
Granulation tissue without recurrence: low signal on T1, high signal on T2, enhance on delayed
Gd T1, low signal on DWI b factor of 800 sec/mm2
Recurrent cholesteatoma: low signal on T1, no change on delayed Gd T1, and high signal on DWI
with b factor of 800 sec/mm2
Cholesteatoma shows increased signal on DWI, whereas granulation tissue, fibrous tissue, cholesterol granuloma, or serous fluid show low
signal intensity.
Reference:
http://radiology.rsnajnls.org/cgi/content/full/238/2/604
Diffusion-weighted MR Imaging Sequence in the Detection of Postoperative Recurrent Cholesteatoma
Radiology 2005;238:604-610