Magnetic resonance imaging in extracranial head and neck lesions

 

 

Abstract               Objective: The objective of our study was to evaluate the role of MRI imaging of extracranial head and neck lesion and to detect and characterize the lesions of different etiologies.Materials And Methods: In the present study 50 patients of all age group and sex with suspected extracranial head and neck lesions (detected by clinical history, USG or CT scan) presenting to the Department of Radio diagnosis and Imaging, Bharati Vidyapeeth Deemed University Medical College, Pune were imaged using Philips MRI System – “Philips Achieva”, 1.5 tesla super conducting system. A detailed history was taken before conducting a MRI scan for the patient. Results: Head and neck pathologies were seen predominantly in 4th to 6th decade of life. Male preponderance was seen. Out of 50 patients 37 patients had a neoplastic etiology while 13 had a benign disease. Oral cavity was the commonest locations for head neck neoplastic etiologies. Conclusion: Magnetic resonance imaging (MRI) is highly sensitive imaging modality in the evaluation of extracranial head and neck lesions, because of its excellent soft tissue contrast resolution and lack of ionizing radiation. It helps in determining the site of origin of the lesion and its characterization and extension / spread into the adjacent structures. It can also detect early bone involvement. MR imaging can be safely done in pregnant women and patients with deranged renal function tests. However, time of examination, patient co-operation and cost are limitations of MR imaging. Furthermore MR imaging cannot be performed in patients with dental implants and surgical clips.

Key Word: extracranial head, neck lesions.

 

 

INTRODUCTION

The expanding interest in the neck is majorly due to technical development and availability of cross-sectional imaging. imaging has become an indispensable tool in the characterization and staging head and neck pathologies. MR scans gives excellent tissue characterization over CT and hence helps in the exact delineation of tumor margins in the nasopharynx, oropharynx, and skull base regions⁵. MRI also depicts cross-sectional anatomy and pathology in three planes without intravenous contrast administration, patient manipulation, or ionizing irradiation. However, High quality MRI examinations of the head and neck consume more time than CT imaging and necessitates patient cooperation for a longer period of time.

 

MATERIALS AND METHODS

This was a Prospective, observational study. A total of 50 patients of all age group and sex with suspected extracranial head and neck lesions (detected by clinical history, USG or CT scan) presenting to the Department of Radio diagnosis and Imaging, Bharati Vidyapeeth Deemed University Medical College, Pune were included in the study. These patients underwent MR imaging of the extracranial All intracranial skull base and cervical spine lesions on a Philips MRI System – “Philips Achieva”, 1.5 tesla super conducting system.

 

 

RESULTS

50 patients with suspected extracranial head and neck lesions were evaluated in this study.

Age distribution:

In our study maximum number of patients were in the age group of 41-60 years, followed by age group of 21-40 years and 61-80 years. According to the study done by Bhurgari Y et al⁶¹, mean age of the patients was 53.0 years and peak incidence was at 64-69 years. Our results are consistent with the literature.

Table 1: AGE WISE DISTRIBUTION (IN YEARS).

In the present study 30 out of the 50 patients were males. Hence, a male preponderance was seen. Adeyami BF et al¹ reported male predominance in head and neck cancers with ratio being 1.8:1. Mahrotra R et al² reported 144 malignant lesions with 114 in males and 30 in females. According to Siddiqui MS et al³, malignant cases more commoner in males than in females with Male:Female ration being 3.1:1. The male predominance correlates well with our study.

Table 2: GENDER WISE DISTRIBUTION.

In our study there was male predominance (60 %) when compared to females (40 %).Female: Male ratio is - 3:2

 

Characterization of pathologies into benign and malignant:

Neoplastic lesions preponderance was seen in our study. Out of the 50 cases studied 37 patients had a malignant/neoplastic pathology while the rest 13 had a benign disease. Both the benign and neoplastic lesions were commoner in the age group of 41-60 years. Otto RA et al⁴ reported that neck lesions in children are most likely to be inflammatory or congenital. In older patients (>40 years) neoplastic lesions are more likely. Siddiqui MS et al³ studied 455 head and neck neoplasms with 241 being benign and 214 being malignant. This does not correlate with our study and this variation may be due to a larger older age patient sample size.

 

Distribution of neoplastic lesions

The table below shows the spectrum of neoplastic findings seen in our study. The most common of all these was tongue carcinoma (27.02 %) ( 10 cases) followed by buccal mucosal carcinoma (13.51 %) (5 cases),mandibular alveolar carcinoma (8.10 %) (3 cases ) and malignant lymphadenopathy (8.10%) (3 cases). The Commonest site for neoplastic lesions was oral cavity with 23 (46%) lesions. Andisheh Tadbir A et al⁷, found that the tongue was the most commonly affected site (53%) which correlates with our study.

 

Table 3: DISTRIBUTION OF NEOPLASTIC LESIONS

Table 8: DISTRIBUTION OF POST CONTRAST ENHANCEMENT PATTERN OF NEOPLASTIC and INFECTIVE/ INFLAMMATORY LESIONS

 

Association of lymphadenopathy in neoplastic and infective/ inflammatory lesions:

In our study lymphadenopathy was the commonest associated pathology, which was seen in 33 (66%) cases out of 50. The majority of benign lesions as well as the infective/ inflammatory lesions did not show associated lymphadenopathy while the majority of malignant lesions had lymphadenopathy associated with them.Lymphadenopathy was seen in malignant lesions accounting for 26 (87%) cases followed by 6 (46%) cases of infective / inflammatory etiology. Lymphadenopathy was seen in only 1 (14%) case of benign lesions.

 

Table 9: ASSOCIATION OF LYMPHADENOPATHY IN NEOPLASTIC and INFECTIVE/ INFLAMMATORY LESIONS