Head and Neck Tumor Evaluation

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Head and neck tumors adjacent to major cervical vessels can be evaluated with MRA. (Fig. 27a-c) The relationship of the mass to the neck vessels and the presence of vessel displacement and/or vessel narrowing can be seen. Assessment is usually directed at determining the presence or absence of vessel wall involvement with tumor prior to attempting surgical resection. Signs of vessel wall involvement with tumor include loss of the normal wall outline and loss of the normal perivascular fat plane that defines the outer border vessel wall. Also narrowing and irregularity of the vessel lumen adjacent to the tumor is another indication of vessel wall involvement. Vascular encasement or vascular wall invasion will usually indicate non-oper-ability of a tumor [3,51 ]. In one noteworthy series, by Yousem, et al, it was determined that involvement of the vessel wall encompassing 270 degrees or more of the vessel circumference was a good indicator of inoperability [52]. Using this criteria the sensitivity of MR imaging for determination of unresectable neck tumor was 100% and specificity was 88%. MRA has proven less useful in determining vascularity of head and neck tumor or for detecting the presence of vascular neoplasms such as paragangliomas compared with contrast-enhanced MRI.

Benign tumors and associated complications can be evaluated by CE MRA. For example, an-giomatoid tumors of the head and neck area can be frequently found in children and are easily diagnosed and followed-up with MRA. Moreover, complications such as AV-shunts can be diagnosed and interventional treatment planned (Fig. 28a, b).

Tumor Neck

Fig. 27a-c. Time-resolved CE MRA for evaluation of a thyroid tumor at the base of the right neck and extending into the upper mediastinum.

a Coronal view of the arterial phase of the CE MRA shows the mass displacing the proximal portion of the right common carotid artery. The vessels are not narrowed by the mass and the other vessels within the neck appear normal.

b Rotated view of the CE MRA shows that the mass projects anteriorly. Note the degree of hypervascularity with vessels defined along the surface of the tumor as well as small vessels within the tumor.

c Venous phase of the time-resolved MRA shows displacement of the right internal jugular vein but, again, there is no evidence for invasion or narrowing of this vessel. The hypervascular nature of the tumor is again noted

Fig. 27a-c. Time-resolved CE MRA for evaluation of a thyroid tumor at the base of the right neck and extending into the upper mediastinum.

a Coronal view of the arterial phase of the CE MRA shows the mass displacing the proximal portion of the right common carotid artery. The vessels are not narrowed by the mass and the other vessels within the neck appear normal.

b Rotated view of the CE MRA shows that the mass projects anteriorly. Note the degree of hypervascularity with vessels defined along the surface of the tumor as well as small vessels within the tumor.

c Venous phase of the time-resolved MRA shows displacement of the right internal jugular vein but, again, there is no evidence for invasion or narrowing of this vessel. The hypervascular nature of the tumor is again noted

Fig. 28a, b. 12-year old boy with history of a large hemangioma of the right neck extending into the mediastinum. Post surgery and laser therapy a pulsating mass rapidly increasing in size, was observed. a Early arterial phase MRA shows aneurysm of the common carotid artery (arrow). Note that some early enhancement of residual hemangioma in the area of the right subclavian artery can also be visualized. b In a second acquisition the aneurysm is clearly shown not to connect to the angioma. Note the enhancing residual parts (arrows) of the angioma. Based on MR findings, coiling of the aneurysm was performed leading to its complete occlusion [Image courtesy of Dr. G. Schneider]

Neck Mra Aneurism

Fig. 28a, b. 12-year old boy with history of a large hemangioma of the right neck extending into the mediastinum. Post surgery and laser therapy a pulsating mass rapidly increasing in size, was observed. a Early arterial phase MRA shows aneurysm of the common carotid artery (arrow). Note that some early enhancement of residual hemangioma in the area of the right subclavian artery can also be visualized. b In a second acquisition the aneurysm is clearly shown not to connect to the angioma. Note the enhancing residual parts (arrows) of the angioma. Based on MR findings, coiling of the aneurysm was performed leading to its complete occlusion [Image courtesy of Dr. G. Schneider]

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