An illustrated study which demonstrates the technical and diagnostic methods of medical resonance imaging (MRI) for diseases of the head and neck, comparing the merits and limitations of these methods to those produced by computer tomography, sonography and angiography.
Since the establishment of magnetic resonance imaging theclinical diagnostic of the head and neck has improvedsubstantially and, therefore, in many cases this techniqueis used in the first place of radiological diagnosis. Thefeasibility of non-invasive MR angiography and 3-dimensionalreconstruction has enlarged the indication field of MRI.This book presents the meaning of this imaging technique forthe diagnosis of diseases in head and neck. Excellentfigures show the technicaland diagnostical possibilities ofthis method, the advantages and limitations of which areexplained as well. A comprehensive diagnostic strategy foreach diagnostic region is presented. This book is disignedfor the use of especially radiologists, ENT specialists andsurgeins.
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 Sjogren'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.
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