- Email: [email protected]
Magnetic resonance angiography in neck masses
Computerized
Pergamon
Medical Imaging and Graphics, Vol. 20, No. 5, pp. 379-388, 1996 Copyright 0 1996 Elsevier Sciena Ltd. Ail rights msezved Printed in Great Britain 089541 l/96 $15.00 + .OO
PII: so895-6111(%)ooo52-3
MAGNETIC
RESONANCE
ANGIOGRAPHY
IN NECK MASSES
Patrick M. Colletti,* Michael R. Terk and Chi-Shing Zee Department of Radiology, University of Southern California School of Medicine, 1744 Zonal Avenue, Los Angeles, CA 90033, USA (Received
1 March
1995; revised 3 April 1996)
Abstract-Carotid MR angiographyhasprimarily beenusedto evaluatefor stenoticlesions.We performed2D time of flight MR angiographyin 25 patientswith palpableneck masses. There were 23 massesconfirmedhistologically.Two of tbe masses representedabnormal carotid arteries. Carotid deviationwasseeniu 23 of 25 (92%) of patients.Wideningof the carotid bifurcation waside.ntHied iu seven patieuts,iucludiugfour carotid body tumors,one inflammatorymass,one benignsalivary glaud tumor, and one schwannoma.Iucreasedvascularity was identified in one carotid body tumor and in one metastatic papillary carelnomaof the thyroid. MR augiograpbymay beusefidto demonstrateflow witbin vessels audrepresents a familiar imagiugdisplayfor surgicalphmiug. Splaying of tbe carotid bifurcation is usefulin demonstratingcarotid spacelesions.Copyright 0 1996ElsevierScienceLtd.
Key Word& MR angiography,Neck mass,Neck mass, MR angiography,Carotid MR angiography,Neck mass by imaging. Histologic findings include nine squamous cell carcinomas, one metastatic melanoma, four carotid body tumors, three benign salivary gland tumors, two thyroid carcinoma metastasis, one paraganglioma, one neurofibroma, one schwannoma, and one inflammatory node mass.
INTRODUCTION Extracranial magnetic resonance angiography has been primarily used to demonstrate stenotic lesions in the carotid arteries (l), (2). There has been limited experience in the medical literature regarding the use of MR angiography in masses in the neck (35). We describe the findings in MR angiography of the carotid arteries in 25 patients with palpable neck masses. MATERIALS
Imaging results
There was deviation of the carotid bifurcation in 23 of the 25 patients (92%, Table 1). Of the two patients without carotid system deviation, one had a 2 cm squamous cell metastasis and the other had a carotid aneurysm with dissection and vasculitis confirmed by angiography (Fig. 1). Widening of the carotid bifurcation was identified in seven patients including four carotid body tumors (Figs 2 and 3), one inflammatory mass, one benign salivary gland tumor, and one schwannoma. Anterior medial deviation was identified in four squamous cell carcinoma metastasis. Anterior lateral deviation was identified in one case of ectatic carotid (Fig. 4), one squamous cell carcinoma, and one metastatic thyroid carcinoma. Medial deviation of the carotid system was identified in one squamous cell carcinoma, one metastatic melanoma, and one neurofibroma (Fig. 5). Lateral deviation of the carotid system was identified in one benign salivary gland tumor. Posterior lateral deviation of the carotid was identified in one paraganglioma (Fig. 6), one
AND METHODS
Two-dimensional time of flight MR angiography (TR 45 ms, TE 7-14 ms, 45” flip angle, 2 mm slice thickness) with superior pre-saturation was performed on 25 patients with palpable neck masses. Coronal short TR, TE and axial long TR, multiecho images were also acquired. There were eight males and 17 females with an age range from 9 to 86 yr with a mean of 54 yr. Neck masses measured from 1 to 10 cm with a mean size of 4.2 cm. Six of the patients received contrast enhanced CT. RESULTS Twenty-three histologically.
of the 25 masses were confirmed Two vascular masses were confirmed
* Author to whom correspondenceshould be addressedat LAC/USC Imaging Science Center, 1744 Zonal Avenue, Los Angeles, CA 90033, USA. Tel: 213/221-1934; Fax: 213/221-2982. 379
380
Computer&d
Medical Imaging and Graphics
September-October/l996,
Volume 20, Number 5
Table 1. Carotid deviation by MR angiography Carotid deviation
Anatomical space
Pathology
Separation
Carotid space
Four carotid body tumor One inflammatory One benign salivary gland One schwannoma
Anteromedial
Posterior cervical space
Four squamous cell
Anterolateral
Carotid space Posterior cervical space Parapharyngeal space
One ectasia One squamous cell One thyroid metastatic carcinoma
Medial
Posterior cervical space Parotid space Posterior cervical space
One squamous cell One neurofibroma One metastatic melanoma
Lateral
Parapharyngeal space
One benign salivary gland
Posterolateral
Parapharyngeal space Pharyngeal mucosal space Retropharyngeal space
One paraganglioma One squamous cell One thyroid cancer metastasis
Posterior
Pharyngeal mucosal space Parapharyngeal space
One squamous cell One benign salivary gland
squamous cell carcinoma, and one metastatic thyroid carcinoma. Posterior deviation of the carotid system was identified in one squamous cell carcinoma and in one benign salivary gland mass. Increased vascularity was identified with magnetic resonance angiography in one case of carotid body tumor and one case of metastatic papillary carcinoma of the thyroid (Fig. 7). Large branches of the external carotid including the ascending pharyngeal artery could be identified in these two cases. DISCUSSION While standard axial and coronal MR imaging of neck masses can generally identify the common carotid artery and external and internal carotid arteries, this may be somewhat difficult with large neck masses. MR angiography is useful to demonstrate flow within these vessels. MR angiography also provides a familiar imaging display which may be useful as a roadmap for surgical planning. Twodimensional time of flight MR angiography is ideal for this purpose because it is reliable in showing slow flow within vessels as well as excluding venous structures by the use of selective saturation. The axial basis images are most useful to demonstrate the relationship of neck masses to the carotid system. Other MR angiography techniques may also be used. Three-dimensional time of flight MR angiography is similar to 2D time of tlight in its ability to display the axial anatomy along with the vessels,
although it may be more difficult to utilize saturation slabs to reduce signal from venous structures and saturation effects may limit depth of coverage. Phase contrast MR angiography certainly can be used to demonstrate neck vessels and might be particularly useful for demonstrating the carotid bifurcation. The basis images may be less useful for identifying reference anatomy. Spiral CT with contrast agent administration also is quite good for identifying and locating neck vessels, although it relies on iodinated contrast agent administration and ionizing radiation. CT angiography of the neck would likely also be useful for evaluation of neck masses. Lesions within the carotid space show splaying of the carotid bifurcation. Adenopathy in the posterior cervical chain will tend to deviate the carotid system anteromedially as we saw in four of seven cases, although there may be medial deviation as we saw in two of seven cases or anterolateral deviation as we saw in one of seven cases. Obviously, the exact location of the adenopathy with respect to the carotid artery is important in predicting the direction of carotid deviation, and the ectatic carotid artery may be initially positioned more laterally or posteriorly in some older patients. Parapharyngeal space lesions will tend to be medial to the carotid system and thus may cause anterolateral, lateral, or posterior lateral carotid deviation depending upon the exact location of the mass. While it is difficult to demonstrate tumor vascular&y, occasionally large vessels within neck
Magnetic resonanceangiographyin neck masses P. M. COLLETTI l
et al.
381
Fig. 1. This 23 yr old man presented with a pulsatile left neck mass. Axial TR 2OOO/TE 80 image (A) shows dilated left common carotid artery with intimal elevation (arrowheads). Frontal projection 2D time of flight MR angiography (B) shows irregular common carotid arteries with dilatation in the left common carotid artery with intimal irregularly (arrowheads). Aortic arch conventional angiogram (C) showsmultiple areas of narrowing and dilatation in this patient with non-specific vascuhtis. masses can be identified as seen in Fig. 7. It is likely that as MR angiography improves, smaller vessels may become visible. MR angiography is also useful in demonstrating carotid ectasia and carotid artery aneurysms.
SUMMARY Two-dimensional time of flight MR angiography of the carotid arteries was performed in 25 patients with palpable neck masses. These neck masses measured
382
Computerized Medical Imaging and Graphics
September-Gctober/l996, Volume 20, Number 5
Fig. 2. This 70 yr old female shows a large mass (M) in the right carotid space which has intermediate signal on Tl-weighted images (A) and high signal on T2-weighted images (B). 2D time of flight MR angiography with lateral oblique view (C) shows splaying (arrows) of the external (e) and internal (i) carotid arteries. Carotid body tumor.
Magnetic resonance angiography in neck masses P. M. l
COLLETTI
et al.
Fig. 3. A 57 yr old woman presents with a mass (m) in the right carotid space with intermediate low signal on Tlweight1ed images (A) and high signal on TZweighted images (B). The internal carotid artery (i) traverses the center of the mass. The external carotid artery (e) is deviated laterally. Note the high signal in the right lateral tongue from fatty changes associated with atrophy secondary to denervation. Frontal (C) and lateral (D) 2D time of‘flight MR angiography shows straightening and anterior deviation (arrows) of the internal carotid artery (i) and lateral deviation (arrows) of the external carotid artery (e). Carotid body tumor. The patient suffered massive bleeding from the mass during an open biopsy procedure.
383
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Computerized Medical Imaging and Graphics
Fig. 4. Tll Ii5 elonga.ted fr’ om 21
yr old woman had a 10 yr history c4munon carotid artery (arrows).
SeptemberAIctolxr/l996, Volume 20, Number 5
of a right neck mass. Axial Tl-weighted im:ages show the This is confirmed on the source images (b) and mtal \ : of flight MR angiogram (curved open arrow) (c). Ectatic right common catroti d a:rtery.
t2
Magnetic resonanceangiography in neck masses P. M. Cot~a-rrr et al.
385
l
Fig. 5. ?‘his 12yr 01 Id grl presentedwith a right neck mass.The axial Tl-weighted images(a) show a Itid spa ce ne ck mass@I) with lateral deviation of the facial artery (arrow), 2D time of ti PlrojcXti Oil view (b) showslateral deviation (arrows) of the right facial artery (f). Neur‘ofibro
ge Iight
frcmtal
386
Computer&d Medical Imaging and Graphics
sCptember-Gctobcr/l996, Volume 20, Number 5
Fig. 6. This 15 yr old girl presented with a large left neck mass. Axial TR 2OOO/TE 100 images (a) show a large mass (M) in the left parapharyngeal space. Frontal (b) and lateral (c) 2D time of flight MR angiography shows lateral (arrows) and posterior (open arrow) deviation of the carotid bifurcation. Post-operative repeat frontal 2D time of tight MR angiogram (d) shows return to normal position of the left carotid system. Paraganglioma.
Fig;. 7. This 48 yr old woman presented with bilateral pharyngeal masses. Axial TR 2W#TE 20 (a) and 100 (b) show bilateral parapharyngeal space masses (OF*II arrows). Lateral projection 2D time of Bight MR angiogram of the right carotid (c) shows prominent vascularity in the right mass. This is conkned by reviewing the axial source images (d), tumor vascularity (arrows). Surgical pathology showed metastatic papillary carcinoma of the thyroid.
388
Computerized Medical Imaging and Graphics
between 1 and 10 cm with a mean size of 4.2 cm. Histologic findings include nine squamous cell carcinomas, four carotid body tumors, three salivary gland tumors, two thyroid carcinoma metastases, one metastatic melanoma, one paraganglioma, one neurofibroma, one schwannoma, and one inflammatory node. There was one carotid aneurysm with dissection secondary to vasculitis and one ectatic carotid artery. Carotid deviation was identified in 23 of 25 patients (92%). Widening of the carotid bifurcation was seen in seven patients carotid space lesions, including four carotid body tumors. Squamous cell carcinoma was the most common neck lesion and was associated with anteromedial deviation in four of the 10 cases with posterior cervical adenopathy, while there was anterolateral deviation in one of the cases, medial deviation in two of the 10 cases, posterolateral deviation in one of the 10 cases and posterior deviation in one of the 10 cases. MR angiography is useful to demonstrate patency of carotid vessels in patients with neck masses. The angiograpbic display can provide a familiar roadmap in aiding surgical planning.
September-oCtober/l996,
Volume 20, Number 5
REFERJ3NCES 1. Rosovsky, M.A.; Litt, A.W. MR angiography of the extracranial carotid arteries. MRI Clin. N. Am. 3:439; 1995. 2. Lamparello, P.J.; Riles, T.S. MR angiography in carotid stenosis. MRI Clin. N. Am. 3:455; 1995. 3. Gomori, J.G. Vascular evaluation of head and neck masses by magnetic resonance imaging. Israel J. Med. Scl. 28:262-267; 1992. 4. Vogl, T.J.; Dresel, S.H.J. New developments in magnetic resonance imaging of the nasopharynx and face. Current Opinion Radiol. 3:61-66; 1991. 5. Vogl, T.J.; Jeurgens, M.; Balzer, J.; Ma&, M.; Bergman, C.; Grevers, G.; Lissner, J.; Felix, R. Glomus tumors of the skull base: combine use of MR angiography and spin-echo imaging. Radiol. 192:103-110: 1994. About the AU~~O+PATRICIC M. COLLETTI, MD, is the chief of Magnetic Resonance Imaging in the Department of Radiology at the University of Soutbem California School of Medicine. About the Author-M~cx~~~ R. ?)BRK, MD, is the chief of Muscnloskeletal Imaging in the Department of Radiology at the University of Southern California School of Medicine.
About the Auih~r-Ch ZEB, MD, is the chief of Neuroradiology in the Department of Radiology at the University of Southern California School of Medicine.
Pergamon
Medical Imaging and Graphics, Vol. 20, No. 5, pp. 379-388, 1996 Copyright 0 1996 Elsevier Sciena Ltd. Ail rights msezved Printed in Great Britain 089541 l/96 $15.00 + .OO
PII: so895-6111(%)ooo52-3
MAGNETIC
RESONANCE
ANGIOGRAPHY
IN NECK MASSES
Patrick M. Colletti,* Michael R. Terk and Chi-Shing Zee Department of Radiology, University of Southern California School of Medicine, 1744 Zonal Avenue, Los Angeles, CA 90033, USA (Received
1 March
1995; revised 3 April 1996)
Abstract-Carotid MR angiographyhasprimarily beenusedto evaluatefor stenoticlesions.We performed2D time of flight MR angiographyin 25 patientswith palpableneck masses. There were 23 massesconfirmedhistologically.Two of tbe masses representedabnormal carotid arteries. Carotid deviationwasseeniu 23 of 25 (92%) of patients.Wideningof the carotid bifurcation waside.ntHied iu seven patieuts,iucludiugfour carotid body tumors,one inflammatorymass,one benignsalivary glaud tumor, and one schwannoma.Iucreasedvascularity was identified in one carotid body tumor and in one metastatic papillary carelnomaof the thyroid. MR augiograpbymay beusefidto demonstrateflow witbin vessels audrepresents a familiar imagiugdisplayfor surgicalphmiug. Splaying of tbe carotid bifurcation is usefulin demonstratingcarotid spacelesions.Copyright 0 1996ElsevierScienceLtd.
Key Word& MR angiography,Neck mass,Neck mass, MR angiography,Carotid MR angiography,Neck mass by imaging. Histologic findings include nine squamous cell carcinomas, one metastatic melanoma, four carotid body tumors, three benign salivary gland tumors, two thyroid carcinoma metastasis, one paraganglioma, one neurofibroma, one schwannoma, and one inflammatory node mass.
INTRODUCTION Extracranial magnetic resonance angiography has been primarily used to demonstrate stenotic lesions in the carotid arteries (l), (2). There has been limited experience in the medical literature regarding the use of MR angiography in masses in the neck (35). We describe the findings in MR angiography of the carotid arteries in 25 patients with palpable neck masses. MATERIALS
Imaging results
There was deviation of the carotid bifurcation in 23 of the 25 patients (92%, Table 1). Of the two patients without carotid system deviation, one had a 2 cm squamous cell metastasis and the other had a carotid aneurysm with dissection and vasculitis confirmed by angiography (Fig. 1). Widening of the carotid bifurcation was identified in seven patients including four carotid body tumors (Figs 2 and 3), one inflammatory mass, one benign salivary gland tumor, and one schwannoma. Anterior medial deviation was identified in four squamous cell carcinoma metastasis. Anterior lateral deviation was identified in one case of ectatic carotid (Fig. 4), one squamous cell carcinoma, and one metastatic thyroid carcinoma. Medial deviation of the carotid system was identified in one squamous cell carcinoma, one metastatic melanoma, and one neurofibroma (Fig. 5). Lateral deviation of the carotid system was identified in one benign salivary gland tumor. Posterior lateral deviation of the carotid was identified in one paraganglioma (Fig. 6), one
AND METHODS
Two-dimensional time of flight MR angiography (TR 45 ms, TE 7-14 ms, 45” flip angle, 2 mm slice thickness) with superior pre-saturation was performed on 25 patients with palpable neck masses. Coronal short TR, TE and axial long TR, multiecho images were also acquired. There were eight males and 17 females with an age range from 9 to 86 yr with a mean of 54 yr. Neck masses measured from 1 to 10 cm with a mean size of 4.2 cm. Six of the patients received contrast enhanced CT. RESULTS Twenty-three histologically.
of the 25 masses were confirmed Two vascular masses were confirmed
* Author to whom correspondenceshould be addressedat LAC/USC Imaging Science Center, 1744 Zonal Avenue, Los Angeles, CA 90033, USA. Tel: 213/221-1934; Fax: 213/221-2982. 379
380
Computer&d
Medical Imaging and Graphics
September-October/l996,
Volume 20, Number 5
Table 1. Carotid deviation by MR angiography Carotid deviation
Anatomical space
Pathology
Separation
Carotid space
Four carotid body tumor One inflammatory One benign salivary gland One schwannoma
Anteromedial
Posterior cervical space
Four squamous cell
Anterolateral
Carotid space Posterior cervical space Parapharyngeal space
One ectasia One squamous cell One thyroid metastatic carcinoma
Medial
Posterior cervical space Parotid space Posterior cervical space
One squamous cell One neurofibroma One metastatic melanoma
Lateral
Parapharyngeal space
One benign salivary gland
Posterolateral
Parapharyngeal space Pharyngeal mucosal space Retropharyngeal space
One paraganglioma One squamous cell One thyroid cancer metastasis
Posterior
Pharyngeal mucosal space Parapharyngeal space
One squamous cell One benign salivary gland
squamous cell carcinoma, and one metastatic thyroid carcinoma. Posterior deviation of the carotid system was identified in one squamous cell carcinoma and in one benign salivary gland mass. Increased vascularity was identified with magnetic resonance angiography in one case of carotid body tumor and one case of metastatic papillary carcinoma of the thyroid (Fig. 7). Large branches of the external carotid including the ascending pharyngeal artery could be identified in these two cases. DISCUSSION While standard axial and coronal MR imaging of neck masses can generally identify the common carotid artery and external and internal carotid arteries, this may be somewhat difficult with large neck masses. MR angiography is useful to demonstrate flow within these vessels. MR angiography also provides a familiar imaging display which may be useful as a roadmap for surgical planning. Twodimensional time of flight MR angiography is ideal for this purpose because it is reliable in showing slow flow within vessels as well as excluding venous structures by the use of selective saturation. The axial basis images are most useful to demonstrate the relationship of neck masses to the carotid system. Other MR angiography techniques may also be used. Three-dimensional time of flight MR angiography is similar to 2D time of tlight in its ability to display the axial anatomy along with the vessels,
although it may be more difficult to utilize saturation slabs to reduce signal from venous structures and saturation effects may limit depth of coverage. Phase contrast MR angiography certainly can be used to demonstrate neck vessels and might be particularly useful for demonstrating the carotid bifurcation. The basis images may be less useful for identifying reference anatomy. Spiral CT with contrast agent administration also is quite good for identifying and locating neck vessels, although it relies on iodinated contrast agent administration and ionizing radiation. CT angiography of the neck would likely also be useful for evaluation of neck masses. Lesions within the carotid space show splaying of the carotid bifurcation. Adenopathy in the posterior cervical chain will tend to deviate the carotid system anteromedially as we saw in four of seven cases, although there may be medial deviation as we saw in two of seven cases or anterolateral deviation as we saw in one of seven cases. Obviously, the exact location of the adenopathy with respect to the carotid artery is important in predicting the direction of carotid deviation, and the ectatic carotid artery may be initially positioned more laterally or posteriorly in some older patients. Parapharyngeal space lesions will tend to be medial to the carotid system and thus may cause anterolateral, lateral, or posterior lateral carotid deviation depending upon the exact location of the mass. While it is difficult to demonstrate tumor vascular&y, occasionally large vessels within neck
Magnetic resonanceangiographyin neck masses P. M. COLLETTI l
et al.
381
Fig. 1. This 23 yr old man presented with a pulsatile left neck mass. Axial TR 2OOO/TE 80 image (A) shows dilated left common carotid artery with intimal elevation (arrowheads). Frontal projection 2D time of flight MR angiography (B) shows irregular common carotid arteries with dilatation in the left common carotid artery with intimal irregularly (arrowheads). Aortic arch conventional angiogram (C) showsmultiple areas of narrowing and dilatation in this patient with non-specific vascuhtis. masses can be identified as seen in Fig. 7. It is likely that as MR angiography improves, smaller vessels may become visible. MR angiography is also useful in demonstrating carotid ectasia and carotid artery aneurysms.
SUMMARY Two-dimensional time of flight MR angiography of the carotid arteries was performed in 25 patients with palpable neck masses. These neck masses measured
382
Computerized Medical Imaging and Graphics
September-Gctober/l996, Volume 20, Number 5
Fig. 2. This 70 yr old female shows a large mass (M) in the right carotid space which has intermediate signal on Tl-weighted images (A) and high signal on T2-weighted images (B). 2D time of flight MR angiography with lateral oblique view (C) shows splaying (arrows) of the external (e) and internal (i) carotid arteries. Carotid body tumor.
Magnetic resonance angiography in neck masses P. M. l
COLLETTI
et al.
Fig. 3. A 57 yr old woman presents with a mass (m) in the right carotid space with intermediate low signal on Tlweight1ed images (A) and high signal on TZweighted images (B). The internal carotid artery (i) traverses the center of the mass. The external carotid artery (e) is deviated laterally. Note the high signal in the right lateral tongue from fatty changes associated with atrophy secondary to denervation. Frontal (C) and lateral (D) 2D time of‘flight MR angiography shows straightening and anterior deviation (arrows) of the internal carotid artery (i) and lateral deviation (arrows) of the external carotid artery (e). Carotid body tumor. The patient suffered massive bleeding from the mass during an open biopsy procedure.
383
384
Computerized Medical Imaging and Graphics
Fig. 4. Tll Ii5 elonga.ted fr’ om 21
yr old woman had a 10 yr history c4munon carotid artery (arrows).
SeptemberAIctolxr/l996, Volume 20, Number 5
of a right neck mass. Axial Tl-weighted im:ages show the This is confirmed on the source images (b) and mtal \ : of flight MR angiogram (curved open arrow) (c). Ectatic right common catroti d a:rtery.
t2
Magnetic resonanceangiography in neck masses P. M. Cot~a-rrr et al.
385
l
Fig. 5. ?‘his 12yr 01 Id grl presentedwith a right neck mass.The axial Tl-weighted images(a) show a Itid spa ce ne ck mass@I) with lateral deviation of the facial artery (arrow), 2D time of ti PlrojcXti Oil view (b) showslateral deviation (arrows) of the right facial artery (f). Neur‘ofibro
ge Iight
frcmtal
386
Computer&d Medical Imaging and Graphics
sCptember-Gctobcr/l996, Volume 20, Number 5
Fig. 6. This 15 yr old girl presented with a large left neck mass. Axial TR 2OOO/TE 100 images (a) show a large mass (M) in the left parapharyngeal space. Frontal (b) and lateral (c) 2D time of flight MR angiography shows lateral (arrows) and posterior (open arrow) deviation of the carotid bifurcation. Post-operative repeat frontal 2D time of tight MR angiogram (d) shows return to normal position of the left carotid system. Paraganglioma.
Fig;. 7. This 48 yr old woman presented with bilateral pharyngeal masses. Axial TR 2W#TE 20 (a) and 100 (b) show bilateral parapharyngeal space masses (OF*II arrows). Lateral projection 2D time of Bight MR angiogram of the right carotid (c) shows prominent vascularity in the right mass. This is conkned by reviewing the axial source images (d), tumor vascularity (arrows). Surgical pathology showed metastatic papillary carcinoma of the thyroid.
388
Computerized Medical Imaging and Graphics
between 1 and 10 cm with a mean size of 4.2 cm. Histologic findings include nine squamous cell carcinomas, four carotid body tumors, three salivary gland tumors, two thyroid carcinoma metastases, one metastatic melanoma, one paraganglioma, one neurofibroma, one schwannoma, and one inflammatory node. There was one carotid aneurysm with dissection secondary to vasculitis and one ectatic carotid artery. Carotid deviation was identified in 23 of 25 patients (92%). Widening of the carotid bifurcation was seen in seven patients carotid space lesions, including four carotid body tumors. Squamous cell carcinoma was the most common neck lesion and was associated with anteromedial deviation in four of the 10 cases with posterior cervical adenopathy, while there was anterolateral deviation in one of the cases, medial deviation in two of the 10 cases, posterolateral deviation in one of the 10 cases and posterior deviation in one of the 10 cases. MR angiography is useful to demonstrate patency of carotid vessels in patients with neck masses. The angiograpbic display can provide a familiar roadmap in aiding surgical planning.
September-oCtober/l996,
Volume 20, Number 5
REFERJ3NCES 1. Rosovsky, M.A.; Litt, A.W. MR angiography of the extracranial carotid arteries. MRI Clin. N. Am. 3:439; 1995. 2. Lamparello, P.J.; Riles, T.S. MR angiography in carotid stenosis. MRI Clin. N. Am. 3:455; 1995. 3. Gomori, J.G. Vascular evaluation of head and neck masses by magnetic resonance imaging. Israel J. Med. Scl. 28:262-267; 1992. 4. Vogl, T.J.; Dresel, S.H.J. New developments in magnetic resonance imaging of the nasopharynx and face. Current Opinion Radiol. 3:61-66; 1991. 5. Vogl, T.J.; Jeurgens, M.; Balzer, J.; Ma&, M.; Bergman, C.; Grevers, G.; Lissner, J.; Felix, R. Glomus tumors of the skull base: combine use of MR angiography and spin-echo imaging. Radiol. 192:103-110: 1994. About the AU~~O+PATRICIC M. COLLETTI, MD, is the chief of Magnetic Resonance Imaging in the Department of Radiology at the University of Soutbem California School of Medicine. About the Author-M~cx~~~ R. ?)BRK, MD, is the chief of Muscnloskeletal Imaging in the Department of Radiology at the University of Southern California School of Medicine.
About the Auih~r-Ch ZEB, MD, is the chief of Neuroradiology in the Department of Radiology at the University of Southern California School of Medicine.