Nodular fasciitis in the head and neck: CT and MR imaging findings

BACKGROUND AND PURPOSE: The purpose of this study was to describe the CT and MR imaging findings of nodular fasciitis occurring in the head and neck region. METHODS: CT (n = 6) and MR (n = 4) images obtained from 7 patients (3 men and 4 women; mean age, 19.4 years; age range, 1-48 years) with surgically confirmed nodular fasciitis in the head and neck were retrospectively reviewed. All patients presented with a palpable mass in the head and neck that was noticed 1-3 months earlier: 5 in the face, one in the occipital scalp, and the remaining one in the supraclavicular fossa. We investigated the CT and MR imaging characteristics with emphasis on the location, size, internal content, margin, enhancement pattern, and signal intensity of the lesion. RESULTS: All lesions appeared as a discrete mass on imaging, ranging from 1.0 cm to 4.6 cm in diameter (mean, 2.2 cm). Six lesions, all of which appeared benign, were located in the subcutaneous tissue superficial to the deep cervical fascia. The remaining lesion was located deep to the temporalis muscle and showed an aggressive imaging appearance, markedly eroding the bony orbit and skull. Five lesions were solid, and 2 lesions were partly or completely cystic in appearance. Five lesions were well defined, whereas 2 lesions were ill defined. Four of 5 solid lesions showed moderate to marked diffuse enhancement, whereas the remaining lesion demonstrated mild enhancement. Two cystic lesions showed peripheral, nodular, or rim-like enhancement. Compared with muscle, both solid lesions had isointense signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images, whereas the signal intensity of the solid portions of the deep-seated, partly cystic lesion was isointense on both T1-weighted and T2-weighted images. CONCLUSION: Although rare, nodular fasciitis occurs as a discrete solid or cystic mass in the head and neck, depending on the predominant stromal components. When one sees a head and neck mass with a superficial location and moderate to marked enhancement on CT and MR imaging, nodular fasciitis should be included in the differential diagnosis, especially in patients with a recently developed, rapidly growing mass and a history of recent trauma.     

Necrotizing fasciitis: an urgent diagnosis

Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests—e.g., the “finger test” or biopsy—and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging.     

Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis

The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.     

Nodular fasciitis of the head and neck: radiographic findings

Nodular fasciitis is an unusual benign reactive process of the soft tissues related to the fascia and characterized by fibroblastic proliferation. Clinical findings and radiologic aspects of six cases are described [four computed tomography (CT), two ultrasonography (US), one magnetic resonance (MR)]. They were located in the infrahyoid anterior triangle (n=3), prevertebral space (n=2), and masticator space (n=1). Most of these lesions showed moderate to strong enhancement on CT or MR imaging, and were partially embedded in the adjacent muscle with preservation of smooth margin of the muscle. Most cases showed a benign nature, except one case in the prevertebral space which showed aggressive nature with jugular fossa destruction and intracranial extension.     

The role of PET/CT in the management of head and neck squamous cell carcinoma

Purpose

To assess the role of positron emission tomography/computed tomography (PET/CT) with ¹⁸F-fluorodeoxyglucose (FDG) in patients with head and neck squamous cell carcinoma and to assess the impact of PET/CT on the clinical management.

Patients and methods

Sixty-three patients with pathologically proven head and neck squamous cell carcinoma had 83 PET/CT and CT examinations. The first group includes 45 examinations performed as a pre treatment staging for 45 patients. The second group includes 38 examinations performed for 18 patients who had previous treatment.

Results

In the first group, FDG–PET/CT yielded additional diagnostic information in 44.4% of patients, with subsequent modification of treatment strategy in 11.1% and implementation of further curative therapy in 6.6%. Based on the findings of PET/CT, modification of radiotherapy was performed in 24.6% of patients in this group. In the second group, PET/CT altered further clinical management in 18.4% patients and induced a change in the planned therapeutic approach in 23.6%.

Conclusion

PET/CT is an imaging modality with high diagnostic performance in the assessment of head and squamous cell carcinoma, and induced a significant change in the management of the study population.     

Angiographic diagnosis and management of head and neck schwannomas

Schwannomas are tumors derived from nerve sheath cells, which are often located in the head and neck, including the CNS. Although a definitive vascular pattern has been previously characterized for these lesions, preoperative embolization of the more vascular schwannomas has not been described. In a review of eight patients with schwannomas who underwent angiography at our institution since 1987, a characteristic vascular pattern became apparent that helped distinguish these lesions from other lesions of the head and neck. The lesions were moderately vascular with tortuous tumor vessels. Scattered, small puddles of contrast medium seen in the mid-arterial, capillary, and venous phases were believed to be characteristic of these lesions. Multiple feeding vessels were noted in all but one case, but these were only minimally enlarged. No arteriovenous shunting or vascular encasement was identified. Six of eight lesions were embolized with significant devascularization and no morbidity or mortality. In patients with head and neck tumors whose angiographic findings include a pattern of moderate hypervascularity, tortuous tumor vessels, and, in particular, scattered contrast puddles without arteriovenous shunting or vascular encasement, schwannoma should be suspected. Embolization is a useful and safe presurgical adjunct in the treatment of vascular schwannomas.     

Gastric pneumatosis: the role of CT in diagnosis and patient management

Gastric pneumatosis is rare, with causes ranging from benign to lethal. The purpose of this pictorial essay is to present a series of cases of gastric pneumatosis, review the causes, and demonstrate how computed tomography (CT) can help guide management. A range of primary gastric pathology can cause air in the wall of the stomach. However, gastric pneumatosis may reflect intraabdominal pathology arising from other hollow viscera, with indicators of the extragastric etiology on CT.     

头颈部腺样囊性癌的CT、MRI诊断

目的 探讨CT、MR1对头颈部腺样囊性癌的诊断价值.方法 回顾性分析20例经病理证实的头颈部腺样囊性癌的临床及CT、MRI资料.结果 病变发生于上腭者5例,口底4例,腮腺4例,鼻腔及上颌窦3例,颌下腺2例,泪腺及面颊部各1例.CT表现为类圆形或不规则形的软组织肿块,增强后不均匀强化,侵犯邻近骨质3例.MRI平扫病灶呈等或稍长T1信号,长T2信号,增强后病灶明显不均匀强化,2例可见神经侵犯征象.结论 CT对肿瘤周围骨质破坏情况显示较好,MR1能够更清晰显示病变形态、轮廓及侵犯范围.两者结合可为该病的诊断和治疗提供更全面的影像信息.     

Necrotizing fasciitis of soft tissues: role of diagnostic imaging and review of the literature

PURPOSE: We retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of our cases of necrotizing fascitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. MATERIAL AND METHODS: May 1991 to February 1998 we examined 130 patients with progressive necrotizing soft tissue infections; in 32 of them (22-84 years old) the retrospective pathologic diagnosis was necrotizing fascitis. Involved sites were the limbs (26/32), the cervical region (5/32) and the perineal region (1/32). Nineteen patients were submitted to conventional radiography, also for soft tissue studies. US was performed in an emergency setting in all the 32 cases, by a selected group of US operators particularly skilled in this kind of soft tissue condition. Contrast enhanced CT was performed in 9 cases. RESULTS: B-mode and Doppler US yielded useful and reliable information for prompt and correct diagnosis. Particularly these techniques showed changes in subcutaneous adipose tissue (28/32), fascia (18/32) and muscle (15/32). We found a good correlation between tissue changes as shown at US and histologic findings, but US missed changes in subcutaneous soft tissue and muscle in 11 cases (3/32 and 8/32, respectively) with subsequent histologic confirmation. Contrast enhanced CT better defined the extent of disease and possible complications, especially in sites that are difficult to study with US. DISCUSSION AND CONCLUSIONS: Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fascitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment.     

结节性筋膜炎的临床和CT诊断

目的：探讨结节性筋膜炎的CT表现。方法：对12例经手术病理证实为结节性筋膜炎患者的临床及CT 检查资料进行回顾性分析。结果：12例中病变位于上肢5例、下肢4例、颈部、腹壁和腰背部各1例,病灶最大径1．0～4．0 cm,11例为单发肿块,1例于腰背部可见2个肿块。主要CT表现：病灶均为实性软组织肿块,呈扁平状或椭圆形,与周围肌肉密度相比呈均匀等密度,增强扫描示肿块明显强化;肿块与周围脂肪层及邻近肌肉分界清晰10例,边界不清2例,其中1例颈部肿块侵及颌下腺及周围颈部肌群;8例可见“筋膜尾征”,未见肿块突破筋膜面向浅（深）侧侵犯。结论：结节性筋膜炎的CT表现有一定特征性,结合其临床表现,有助于结节性筋膜炎的诊断。     

CT对小儿头颈部横纹肌肉瘤的诊断价值

目的:探讨CT对小儿头颈部横纹肌肉瘤(RMS)的诊断价值.方法:回顾性分析14例经病理证实的小儿头颈部横纹肌肉瘤的CT表现.其中男9例,女5例,年龄1～12岁.12例经手术、2例经穿刺活检病理证实.结果:胚胎型13例,腺泡型1例.发生在鼻咽部7例,中耳乳突3例,眼眶3例,眼睑部1例.肿瘤呈浸润生长,增强后明显强化,邻近骨溶骨性骨质破坏.结论:小儿头颈部RMS CT表现有一定的特点,结合年龄可提示诊断;并有助于了解病变的范围、治疗措施的制定和治疗效果的评价.     

18F-氟脱氧葡萄糖PET-CT在头颈部肿瘤临床诊治中的价值

PET-CT图像融合技术将CT解剖结构信息与PET功能代谢信息结合在一起,能更准确地显示肿瘤组织,18F-氟脱氧葡萄糖(18F-FDG)PET-CT在头颈部肿瘤明确原发灶、治疗前分期、监测治疗反应和复发、制定放疗计划等方面具有一定的临床价值。     

Pilomatricoma in the head and neck: CT findings in three patients

We report three cases of pilomatricoma, one in the infrahyoid neck and the others in the preauricular area. In all cases, CT showed well marginated soft tissue masses that were located mainly in the subcutaneous fat, partly attaching to the overlying skin. There was no evidence of infiltration to deeper structures. Substantial amounts of calcification were found in one tumor. Pilomatricoma should be included in diagnostic consideration when CT shows a well marginated subcutaneous soft tissue mass adherent to the skin with or without visible calcification in the head and neck region.     

Perfusion CT of head and neck cancer

We aim to review the technique and clinical applications of perfusion CT (PCT) of head and neck cancer. The clinical value of PCT in the head and neck includes detection of head and neck squamous cell carcinoma (HNSCC) as it allows differentiation of HNSCC from normal muscles, demarcation of tumor boundaries and tumor local extension, evaluation of metastatic cervical lymph nodes as well as determination of the viable tumor portions as target for imaging-guided biopsy. PCT has been used for prediction of treatment outcome, differentiation between post-therapeutic changes and tumor recurrence as well as monitoring patient after radiotherapy and/or chemotherapy. PCT has a role in cervical lymphoma as it may help in detection of response to chemotherapy and early diagnosis of relapsing tumors.