Head and Neck Imaging: Case Review Series E-Book

David M. Yousem

• Publisher: Saunders
• Year: 2014
• ISBN:
  9780323187831
• Edition: 4
• Topic: Medizin
• Subtopic: Radiologie, Radiotherapie & Nuklearmedizin

Incorporate today's most advanced imaging techniques with the new 4 th edition of Head and Neck Imaging! A bestselling volume in the popular Case Review Series, this updated reference helps speed your differential diagnoses and ensure your proficiency, in addition to serving as a study guide for general radiology and neuroradiology subspecialty examinations, certificates of added qualification, and radiology/neuroradiology recertification. The all-inclusive volume can serve as a comprehensive review of the subspecialty and as a primer for excelling at the Head and Neck Tumor Boards.

• Efficiently study and review with help from a format that mimics the General Diagnostic Radiology and Neuroradiology Board Exams. Each case begins with a differential diagnosis question and follows with multiple-choice questions, answers with rationale, and an emphasis on clinical issues.
• Explore hot topics including CT and MR angiography of the neck; multi-detector CT with 3D reconstructions; post-transplant lymphoproliferative disorders; HIV infections; squamous cell carcinoma, diagnostic and therapeutic image-guided procedures; medical economics; and much more.

• Master the latest techniques with 150 new and 50 updated head and neck cases and over 800 images focusing on differential diagnosis, tumor staging, treatment options, and resectability issues.
• Enhance your understanding with multiple-choice questions accompanying each case, emphasizing cranial nerves, skull base lesions, sinonasal, orbital, salivary gland, aerodigestive system mucosal lesions and deep space neck masses.
• Utilize convenient cross-references to recent articles.
• Stay abreast of the most recent discoveries in HPV (+) squamous cell cancers, high-resolution imaging, and CTA, MRA, and CISS applications.
• Explore the differential diagnosis and/or anatomic details of every case presented.
• Understand the surgical and radiation therapy considerations for cosmetic and functional outcomes.

Fair Game

Case 51

Figure 51-1

History:

A patient has a 2-month history of globus sensation.

1. Which of the following should be included in the differential diagnosis? (Choose all that apply.)

A. Squamous cell carcinoma

B. Minor salivary gland cancer

C. Warthin tumor

D. Synovial sarcoma

2. In which part of the head and neck is the vallecula located?

A. Oral cavity

B. Oropharynx

C. Hypopharynx

D. Submental space

3. What structure separates the two sides of the vallecula?

A. The plica medialis

B. The pharyngoepiglottic fold

C. The plica anterialis

D. The median glossoepiglottic fold

4. Based on the appearance of this cancer in Figure 51-1, what tumor staging is represented?

A. T1

B. T2

C. T3

D. T4

See Supplemental Figures section for additional figures and legends for this case.

Answers

Case 51

Vallecula Squamous Cell Carcinoma

1. A and B. Squamous cell carcinoma is the most common aerodigestive tract tumor. Minor salivary gland cancer may also occur here. Warthin tumor occurs only in and around the parotid gland. Synovial sarcoma is not known to be in this location; it can, however, occur in the hypopharynx.

2. B. The vallecula is part of the oropharynx, along with the soft palate, base of tongue, tonsils, and posterior pharyngeal wall.

3. D. The median glossoepiglottic fold separates the two sides of the vallecula. The plica medialis does not exist here, and the pharyngoepiglottic fold is more lateral. There is no such structure as a plica anterialis.

4. A. T1 staging is indicated in this figure; the cancer is less than 2 cm large. T2 staging implies a size of 2 to 4 cm.

Comment

Treatment Considerations

The issues that are important in considering treatment options for oropharyngeal carcinomas include the following: (1) tumor stage; (2) whether the tumor crosses the midline (which would necessitate a total glossectomy); (3) whether the tumor has invaded mandibular or maxillary bone (which would necessitate flap reconstruction); (4) whether the tumor has invaded the pterygopalatine fossa, which could lead to perineural spread; (5) whether the internal carotid artery is encased, which would render the tumor unresectable; (6) whether the tumor has spread to muscles of mastication; (7) whether the tumor has invaded the skull base; and (8) nodal spread. All of these must be addressed on imaging.

Relevant Anatomy

The anatomic structures included in the oropharynx are the tongue base, soft palate, vallecula, tonsil, and posterolateral pharyngeal wall from the level of the hard palate to the pharyngoepiglottic fold. Below the pharyngoepiglottic fold are the larynx anteriorly and the hypopharynx posteriorly (Figure S51-1).

Imaging Findings

Advanced imaging techniques, such as those involving the apparent diffusion coefficient and perfusion parameters for primary tumors and nodal masses, can potentially differentiate patients who will respond to chemoradiation protocols for advanced cancers from patients who will not respond.

Reference

Kim S, Loevner LA, Quon H, Kilger A, Sherman E, Weinstein G, et al. Prediction of response to chemoradiation therapy in squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 2010;31(2):262-268.

Cross-Reference

Neuroradiology: The Requisites, 3rd ed, 388-389, 435-436, 457-468, 470-471, 486, 492, 494.

Case 52

Figure 52-1

Figure 52-2

History:

A 35-year-old woman complains about long-standing left-sided pain in the temporomandibular joint (TMJ).

1. Which of the following should be included in the differential diagnosis? (Choose all that apply.)

A. Anterior displacement with recapture

B. Anterior displacement without recapture

C. Normal

D. Posterior meniscus displacement with recapture

2. What does “sideways displacement of a meniscus” refer to?

A. Medial displacement

B. Lateral displacement

C. Medial o...