Magnetic resonance imaging of head and neck cancer.
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Biomedical subjects
Publications and source records attributed to W Hanafee.
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The purpose of this project was to examine the anatomy and pathology of the paranasal sinuses as seen by MR imaging. This was accomplished through correlations of MR images of normal volunteers with matched cadaver whole organ cryosections. The information obtained by MRI was compared to that of plain films and CT in the detection of a variety of conditions affecting the paranasal sinuses. The majority of the pathological processes could be quite adequately imaged by T1 weighted pulsing sequences. When more tissue specific information was required in some infiltrating malignant lesions, T2 weighting pulsing sequences are quite helpful for tumors that crossed the subarachnoid space into the central nervous system or in characterizing tissues in airless sinuses. Other than the single case of osteoid osteoma where X-ray studies were superior, magnetic resonance provided equal or superior information to the X-ray examinations.
Suspected post-traumatic deformity of the laryngeal cartilages can be diagnosed by using current magnetic resonance imaging (MRI) scanning techniques. This is of particular aid to the clinician who is evaluating a laryngeal mass with no history of injury to the neck. Computed tomography (CT) and magnetic resonance imaging are both effective in this situation, but MRI appreciates better soft tissue contrast, and can offer coronal and sagittal views.
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Eighteen patients with abnormalities of the mandible and two normal volunteers were studied with MRI. Correlation was made with MR, CT, plain X-rays, clinical examination, and surgical findings when possible. In primary tumors of the mandible, MR was able to differentiate between solid and cystic lesions. In the cases of secondary invasion of the mandible by malignant tumors, MR was able to demonstrate replacement of the normal high signal bone marrow by low signal tumor. In some cases, the extent of marrow involvement shown on MR and confirmed at surgery was significantly underestimated by clinical examination, plain films, and CT. From this limited experience, it appears that MR may play an important role in imaging pathology of the mandible.
Aspiration biopsy guided with computed tomography (CT) has long been a valuable tool in the evaluation of head and neck disease. The ability to obtain diagnoses without the need for surgery has had a significant effect on patient treatment. Magnetic resonance (MR) imaging is now rapidly replacing CT as the primary imaging study for many head and neck diseases. The standard stainless steel needles used for CT-guided biopsy are unsuitable for MR-guided biopsy because significant ferromagnetic artifacts obscure the underlying anatomy. A new needle has recently been designed specifically for use with MR imaging. This needle has far less magnetic susceptibility and therefore does not cause significant image distortion. The authors describe the use of this needle in MR-guided aspiration biopsy of a variety of lesions in the head and neck.
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Magnetic resonance imaging is rapidly becoming the study of choice for evaluating tumors of the larynx and pharynx. It is superior to computed tomography because of its multiplanar imaging capability and greater soft tissue contrast resolution. Other advantages are that it is a noninvasive procedure, gives three-dimensional images that are not degraded by bony or overshoot reconstruction artifacts, and is sensitive to flowing blood, thus obviating the use of x-ray techniques with IV contrast agents. MRI is particularly well suited to laryngeal and nasopharyngeal malignancies because the deep extent of these tumors is difficult to assess by clinical examination alone.
Magnetic resonance imaging has revolutionized the imaging of head and neck malignancies and is now rapidly replacing computed tomography as the study of choice in the majority of lesions in the head, neck, larynx, hypopharynx, oropharynx, paranasal sinuses, paranasopharynx, and skull base. CT scanning can be used in the same region; however, inflammation obtained in CT is not as clearly demonstrated and in some situations, such as malignancies of the tongue, the lesions may be missed entirely. There are still occasional difficult clinical problems when the two studies are complementary, but this situation will definitely be rare.
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The performance of frozen sections of a thickness varying between 5 and 50 microns in fresh undecalcified cadaveric human specimens was perfected in Sweden by one of the authors in 1983. This technique makes it possible to obtain anatomic images of high definition which were correlated with MRI sections made at intervals of 20 microns.
MR images of the intratemporal portion of the facial nerve were obtained with surface coils using a 0.3-T permanent magnet whole-body imaging system. Various 2DFT spin-echo pulse sequences were used to produce 5-mm thick sections with 0.5-mm pixels on a 512 X 512 acquisition matrix. The MR images from normal volunteers were correlated with cryosection specimens of three fresh human cadavers. The seventh nerve was followed in the internal auditory and fallopian canal and through temporal bone to the stylomastoid foramen. The entire labyrinthine, tympanic, and mastoid portions, as well as the geniculate ganglion, could be shown with appropriate scan planes. MR produces excellent images of the facial nerve with high-contrast resolution. Unlike CT, no beam-hardening artifact from the temporal bone is apparent. MR should be a sensitive study for the evaluation of intratemporal facial nerve disease.
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Improvements in photographic film and the availability of fluid light transmitters rather than fibro-optics permit endolaryngeal and nasopharyngeal photography to be conducted using the same light levels as simple diagnostic examinations of these areas. The added perspective of endoscopic examination can often clarify many confusing bulky lesions that distort CT and MR anatomy. Thus endoscopic photography is a tremendous teaching tool.
Ten normal human volunteers and 44 patients with pathology of the brainstem or cranial nerves were scanned using a. 3 Tesla permanent MR imaging system. MR images were obtained of the cranial nerves and brainstem using various spin-echo pulse sequences and scanning planes. 4 mm thick sections with .75 mm pixels on a 256 display matrix were used whenever possible. The normal MR images were correlated with thin section cryodissection specimens of fresh human cadavers. Brainstem structures including major nuclei and tracts were then identified. The cranial nerves were followed through the subarachnoid cisterns and the base of the skull. Pathological involvement of the brainstem by tumors, infarcts, and demyelinating disease was well shown and correlated with clinical findings. Examples of optic glioma, fifth, eighth, and twelfth nerve schwannomas as well as other cranial nerve pathology were also demonstrated. Magnetic resonance produces excellent images of cranial nerves and brainstem with high contrast resolution. Unlike CT, there is no beam hardening artifact from bone. T1 weighted images maximize brainstem-CSF contrast and are useful for demonstrating the external anatomy of the brainstem and cranial nerves. The T2 weighted images show internal brainstem anatomy, CSF within neural foramina, and highlight many pathological conditions.
An ordinary desk-top microcomputer was programmed to simulate MR images for specified spin-echo pulse sequences. Model pixel maps of proton density and T1 and T2 relaxation times were made from published estimated values for regions of the human head, neck, and spine. Images were generated and displayed from the model maps and user-specified pulse-sequence parameters in less than 30 sec/image. Models for various pathologic conditions, including calcification, subacute hemorrhage, porencephaly, lipoma, and multiple sclerosis, were superimposed on the images of normal anatomy to create unknown cases. Simulated images can easily demonstrate the effect of pulse-sequence selection on the contrast of normal structures and pathologic conditions. Use of simulated images is an excellent technique for gaining experience in pulse-sequence selection. Low-cost microcomputers can provide adequate image detail and reasonable image display time of synthetic MR images for teaching purposes.
Multiple-angle, variable-interval, nonorthogonal (MAVIN) MRI is a new, time-saving technique that allows for the independent choice of slice angle and position for each slice in a multiangle pulse sequence. By appropriate adjustment of the slice-select radiofrequency pulse and the slice-select and readout magnetic-field gradients, the interval and angle of each slice may be individually chosen. MAVIN can reduce examination time in studies of the lumbar spine, orbits, knees, and heart, where nonparallel oblique scanning may be necessary and would otherwise require the use of additional pulse sequences. Loss of signal in the region of intersection of multiple planes due to local changes in effective repetition time is a practical limitation. For this reason, scan planes are chosen so that the intersection does not overlie the region of interest.