Diagnostic Imaging Principles and Applications in Head and Neck Pathology
Head and neck pathology encompasses multiple, diverse conditions and disease processes, many of which are complex and require imaging as adjunct to clinical examination. Imaging techniques can provide anatomical or functional information, some using ionizing radiation while others do not. Plain radiographs provide a two-dimensional overview of the region of interest, and cross-sectional imaging modalities such as computed tomography (CT), cone beam computed tomography (CBCT), and magnetic resonance imaging (MRI) provide multiplanar evaluation of osseous structures of the oral and maxillofacial region. CT and MRI have the additional advantage of providing high-resolution imaging of soft tissues. Initial evaluation of superficially located head and neck soft tissue lesions frequently utilize ultrasound. Nuclear medicine techniques provide functional information, evaluating metabolic turnover of tissue and differentiating pathological from normal tissue. The applications of these imaging techniques are discussed in several clinical scenarios under the headings of mass lesions, salivary gland disease, oral cavity malignancy, osteonecrosis of the jaws, temporomandibular joint disorders, orofacial pain, obstructive sleep apnea, and headaches. This chapter provides the most current data regarding the advantages and disadvantages of imaging techniques as they relate to head and neck pathology.
KeywordsMaxillofacial imaging Cross-sectional imaging Cone beam computed tomography Magnetic resonance imaging Ultrasound Dental panoramic tomography Nuclear medicine Computed tomography Osteonecrosis of jaws Temporomandibular disorders Obstructive sleep apnea Headache
The authors acknowledge Dr Andrew Patrikeos (MBBS, MRCP(UK), FRANZCR, ANZAPNM), Perth Radiological Clinic, for advice and input on nuclear medicine techniques.
- Australian Radiation Protection and Nuclear Safety Agency. Radiation protection and health [Internet]. 2015 [updated 2015 September 25; cited 2017 June 08]. Available from http://www.arpansa.gov.au/RadiationProtection/Factsheets/is_ionising.cfm.
- Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, John MT, Schiffman EL. Research criteria for temporomandibular disorders: development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6): 844–60.Google Scholar
- Alkureishi LW, Ross GL, Shoaib T, Soutar DS, Robertson AG, Thompson R, Hunter KD, Sorensen JA, Thomsen J, Krogdahl A, Alvarez J, Barbier L, Santamaria J, Poli T, Sesenna E, Kovacs AF, Grunwald F, Barzan L, Sulfaro S, Alberti F. Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial. Ann Surg Oncol. 2010;17(9):2459–64.PubMedCrossRefPubMedCentralGoogle Scholar
- Enders J, Zimmermann E, Rief M, Martus P, Klingebiel R, Asbach P, Klessen C, Diederichs G, Bengner T, Teichgraber U, Hamm B, Dewey M. Reduction of claustrophobia during magnetic resonance imaging: methods and design of the "CLAUSTRO" randomized controlled trial. BMC Med Imaging. 2011;11:4.PubMedPubMedCentralCrossRefGoogle Scholar
- Filippi M, Rocca MA, Ciccarelli O, De Stefano N, Evangelou N, Kappos L, Rovira A, Sastre-Garriga J, Tintore M, Frederiksen JL, Gasperini C, Palace J, Reich DS, Banwell B, Montalban X, Barkhof F, M. S. Group. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol. 2016;15(3):292–303.PubMedPubMedCentralCrossRefGoogle Scholar
- Headache Classification Committee of the International Headache Society. The International classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.Google Scholar
- Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology. 2014;270(3):834–41.PubMedCrossRefPubMedCentralGoogle Scholar
- Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, Giles GG, Wallace AB, Anderson PR, Guiver TA, McGale P, Cain TM, Dowty JG, Bickerstaffe AC, Darby SC. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360.PubMedPubMedCentralCrossRefGoogle Scholar
- Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de Gonzalez A. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505.PubMedPubMedCentralCrossRefGoogle Scholar
- Perry JJ, Stiell IG, Sivilotti MLA, Bullard MJ, Emond M, Symington C, Sutherland J, Worster A, Hohl C, Lee JS, Eisenhauer MA, Mortensen M, Mackey D, Pauls M, Lesiuk H, Wells GA. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ (Clinical research ed). 2011;343:d4277.CrossRefGoogle Scholar
- Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O’Ryan F. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw – 014 update. J Oral Maxillofac Surg Official J American Assoc Oral and Maxillofac Surg. 2014;72(10):1938–56.CrossRefGoogle Scholar
- Saito N, Nadgir RN, Nakahira M, Takahashi M, Uchino A, Kimura F, Truong MT, Sakai O. Posttreatment CT and MR imaging in head and neck cancer: what the radiologist needs to know. Radiographics: A Review Publication of the Radiological Society of North America, Inc. 2012;32(5):1261–82. discussion 1282–1264CrossRefGoogle Scholar
- Scrivani SJ, Becerra L, DaSilva A, Moulton E, Pendse G, Morris S, Aiello-Lammens M, Borsook D. Functional brain imaging of facial pain: functional magnetic resonance imaging (FMRI) studies of the trigeminal system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(6):795.Google Scholar
- Yesuratnam A, Wiesenfeld D, Tsui A, Iseli TA, Hoorn SV, Ang MT, Guiney A, Phal PM. Preoperative evaluation of oral tongue squamous cell carcinoma with intraoral ultrasound and magnetic resonance imaging-comparison with histopathological tumour thickness and accuracy in guiding patient management. Int J Oral Maxillofac Surg. 2014;43(7):787–94.PubMedCrossRefPubMedCentralGoogle Scholar