MRI of neck nodes in non-Hodgkin's lymphoma of the head and neck

The aim of this study is to describe the imaging features of neck nodes in non-Hodgkin's lymphoma (NHL). The MR scans of 61 patients undergoing staging of a primary extranodal NHL of the head and neck were reviewed retrospectively. Those MR images with nodal disease were assessed for (a) the pattern of nodal disease, (b) presence of nodal necrosis and (c) presence of extracapsular neoplastic spread (ENS) and nodal matting. The features of the nodal disease were analysed in relationship to the sites of the primary NHL (palatine tonsil (PT) n=23, nasal cavity (NC) n=24, nasopharynx (NP) n=6, other extralymphatic sites (OES) n=8), and histology (natural killer/T-cell (NK/T) n=26, diffuse large cell (DLC) n=24, other subtypes (OS) n=11). Nodal disease was present in 26 patients (43%) and occurred in NHL of the PT n=16 (70%), NP n=3 (50%), NC n=5 (21%) and OES n=2 (25%) and in DLC n=15 (63%), NK/T n=6 (23%) and OS n=5 (45%). Nodal disease was significantly more frequent in DLC than NK/T lymphomas (p=0.0053). Nodal disease spread in a contiguous fashion in 25 (96%) patients with nodes. Necrosis was present in 7 of 26 (27%) being present in DLC of the PT in 5, NK/T of the NP in one and NK/T of the NC in one. ENS and matting were present in 19 (73%) and 13 (50%) patients with nodes, respectively. ENS was found in DLC, NK/T, OS, NC, NP, PT, OES (11, 4, 4,1, 2, 14, 2, respectively) and matting was found in DLC, NK/T, OS, NC, NP, PT, OES (9, 3, 1, 0, 2, 10, 1, respectively). Nodal NHL spreads in a contiguous fashion and is most commonly associated with DLC lymphoma of the NP and PT in Waldeyer's ring. Extracapsular nodal spread is frequent and found in most histological subtypes especially those arising from Waldeyer's ring. Necrosis is more common than previously believed.     

Imaging of lymphadenopathy in the neck

Imaging is playing a major role in the assessment of cervical lymphadenopathy. In infectious disease, the assessment of abscess formation and the relation of the abscess to surrounding vital structures is crucial for its management. In head and neck malignancies, imaging can be helpful for staging. Imaging of the neck for the assessment of nodal metastases can be used to detect occult metastases or to assess operability of palpable metastases. The detection of small occult metastases has limitations, as micrometastases cannot be depicted; however, imaging can fulfill a role in diminishing the risk of occult metastases, and thus influence management. For this purpose a very sensitive technique is necessary. The currently used radiological criteria are not sensitive enough to accomplish enough reduction of the risk of occult metastases; therefore, more sensitive CT and MRI criteria, but especially ultrasound-guided aspiration, should be employed to assess the clinically negative neck.     

Elastofibroma of the neck

Elastofibromas are benign lesions of the chest wall. We describe the first reported case of elastofibroma in the neck. Imaging features as well as location of the lesion were atypical. On computed tomography and magnetic resonance imaging the lesion contained a marked preponderance of fat, because the lesion arose within fat. Received: 12 November 1998 Revision requested: 18 November 1998 Revision received: 16 August 1999 Accepted: 24 August 1999     

Inflammation of the neck

Summary In the evaluation of a large series of infectious processes in the cervical region, certain diagnostic sonographic patterns have been established, which prove very helpful in differentiating the various stages and the extension of inflammatory processes. The advantages of sonographic imaging are demonstrated.     

Imaging of the neck

The neck encloses a tremendous spectrum of tissues in a compact space. The normal and pathologic anatomy of the neck can be exquisitely displayed with high-resolution CT and MR imaging. Accurate assessment of the neck requires a thorough knowledge of both its complex anatomy and the scope of pathologic entities that may affect the various cervical compartments. We review the advances in the past year that serve to improve our ability to identify and characterize pathology of the cervical soft tissues.     

Ultrasound of the neck

Sonography, when performed by an experienced examiner, can be used for evaluation of many pathologies in the head and neck area. Some benign neck lesions, such as cysts, lipomas, carotid body tumors, and hyperplastic lymph nodes, have typical sonomorphology. Sonography has an accuracy rate of about 90% in cervical lymph node staging and can delineate subclinical lymph node recurrences. It is the method of choice for evaluation of tumor infiltrations of the wall of the great vessels. Salivary gland tumors in the superficial lobe can be delineated completely by sonography. Salivary stones can be detected and localized. Carcinoma of the tongue and floor of the mouth with T1 and T2 staging can be assessed by US. The use and contribution of color Doppler sonography for the assessment of pathologic entities in the neck is a method under clinical investigation. US-guided fine-needle aspiration biopsy of lymph nodes and tumors of the salivary glands is easy to perform and is characterized by high sensitivity and specificity. To perform US examinations of the head and neck area of the highest quality the examiner should be familiar with the anatomy of the head and neck, be informed about the clinical problem, and have experience in the interpretation of abnormal US findings. US of the head and neck area is one of the most difficult sonographic examinations and should be performed by an experienced physician.     

Computed tomography of the neck in the postoperative patient: radical neck dissection and the myocutaneous flap

Ninety-two consecutive neonates were prospectively evaluated with real-time ultrasound to assess the frequency of adrenal visualization. The right gland was identified in 97% of neonates and the left in 83%. Criteria for normal length and width are presented. The characteristic sonographic appearance of the neonatal adrenal is described and correlated with histologic data. Ultrasound is the examination of choice for evaluating the neonatal adrenal gland.     

颈部肺疝2例

颈部肺疝十分罕见,文献仅见个案报告。我们得见2例,临床及X线表现均较为典型,结合文献就其X线表现、临床表现、发病机制作一复习,以提高对本病的认识。1病例资料例1女,45岁。常年咳嗽,有慢支病史6年,2 d前发现右颈部无痛性肿物,平静呼吸时消失。否认外伤史。体格检查:右颈部可触及类圆形肿物,有弹性,质软,无明显压痛,包块处可闻及呼吸音,未闻及捻发音。X线检查:平静呼吸时双上肺透视未见特殊,呼气时屏气颈部侧位片显示右肺尖疝向颈部,于气管后方呈圆顶状透光区,顶端位于第7颈椎水平,气管无移位。X线诊断:右颈部肺疝(见图1)。例2男,50岁。…     

Neurogenic tumors of the neck

Neurogenic tumors of the neck occur in children and adults. Important parameters to aid in the differential diagnosis are age at presentation, location, and a history of NF or multiple endocrine neoplasia. Schwannoma is the most common solitary neurogenic tumor in the neck and is usually seen in patients between 20 and 50 years of age. The plexiform neurofibroma and multiple localized neurofibromas are characteristic of NF1. MPNSTs are uncommon aggressive lesions that can arise de novo in patients with NF (10% to 30%) and postirradiation. Neuroblastic tumors consist of neuroblastoma, ganglioneuroblastoma, and ganglioneuroma. These tumors typically arise in the chest and abdomen but occasionally present as a primary neck mass. A neck mass with a histologic diagnosis of neuroblastoma is, however, more commonly metastatic from an abdominal neuroblastoma.     

Ultrasonography of the neck.

The anatomic and pathologic involvement of the structures in the neck can be accurately studied with small parts ultrasonography. The thyroid and parathyroid glands and nodal chains are treated in this article; masses of the neck spaces are not considered because of their relative rarity.     

Sectional anatomy of the neck

This is the first in a series of articles structured to provide anatomically accurate functional schematics of the motor and sensory innervation of the face, neck, and trunk. This article provides radiographically oriented cross sections through the neck to assist in identifying clinically significant structures on diagnostic images and for injection procedures. Future articles will present the same information for the face, chest, and abdominal regions, respectively.     

Calcific tendinitis of the neck

When a calcific deposit in the shoulder, hip or elbow ruptures, it results in severe pain and tenderness. Few clinicians are aware that the longus colli muscle of the neck is also subject to acute tendinitis. When it occurs, the pain and spasm mimic infectious spondylitis or meningitis. Four patients are presented with acute tendinitis of the longus colli muscle and the classic radiographic findings of soft-tissue swelling and amorphous calcium deposits in the tendon.     

Cardiovascular sequel of neck irradiation in head and neck cancer patients

Purpose: The baroreflex is an important afferent mechanism controlling autonomic functions. As afferent nerves course through the neck, they are susceptible to damage by neck irradiation in head and neck cancer patients. With increased survival of head and neck cancer patients because of improved therapy, the cardiovascular morbidity and mortality in them have become apparent and this is of clinical concern. There are few case reports of baroreflex failure as a chronic sequel to neck irradiation.

Objectives: The present study evaluated the changes in cardio-autonomic tone and postural cardiovascular reflex in neck-irradiated patients.

Methods: Head and neck cancer patients who had received neck irradiation (n?=?15) and healthy controls (n?=?15) were evaluated for heart rate variability with time domain analysis of 5?min ECG recording. Postural cardiovascular reflexes were studied with changes in blood pressure and heart rate in the lying to standing test.

Results: Our results suggest that there is a reduction in overall time domain measures of heart rate variability and weakened postural reflexes in neck-irradiated patients.

Conclusion: Decreased heart rate variability in neck-irradiated patients reflects an independent risk of cardiovascular morbidity. The early detection of cardiovascular impairment in such patients may help healthcare professionals in providing better care. Furthermore, the dose delivered to the carotid sinus should be monitored and restricted.