HEAD AND NECK

IMAGING

dr. Indrati Suroyo SpRad(K)

Head of Head and Neck division Radiology Department
Faculty of Medicine University of Indonesia

Jakarta March 2021

Head and neck Imaging

Face

Eye and orbits

Ear and Temporal bones

Region Paranasal sinuses

Nasopharynx, Oral cavity & Oropharynx

Jaw

Neck
Imaging Modalities

Plain film USG CT/MDCT MRI

CATHETER
ANGIOGRAPHY
Plain Film/ Plain Radiography
• Initial assessment : Facial fracture, jaws trauma,
radioopaque foreign body, sinus and ear infection
• Skull (AP, Lateral), Waters, Schuller (temporal
bone/ mastoid), Panoramic
• Modified Stenver 🡪 cochlear implant evaluation
• Lateral neck soft tissue : air way abnormality,
foreign body ingestion/ aspiration
• Spine skeletal : part of survey for non accidental
injury, skeletal dysplasia/ multiple congenital
anomalies
Digital Radiography
 Ultrasound
• High frequency : 7.5 -10 MHz
• Very useful evaluation head and neck masses with regards to size,
location and tissue characteristic (cystic or solid)
• Common use for Thyroid lesion.
• Ocular US is use in Ophthalmology
• Accuracy rate 90% 🡪 lymph node (LN) evaluation
• Guided FNAB of LN, tumors of salivary or thyroid glands 🡪 high
sensitivity and specificity
• Doppler US 🡪 information about vascularity (flow direction, pulsatility
differentiation artery from venous flow)
• Should be familiar with anatomy, be informed with clinical problem and
has experience in the interpretation
Ultrasound

https://radiologykey.com/normal-neck-anatomy-and-method-of-performing-ultrasound-examination/
 MSCT and MRI

• Cross sectional imaging 🡪 best evaluated for

inflammatory, traumatic and neoplastic disease.
• Primary modality in head and neck region (conventional
projection also is unreliable and carries a high risk of
misdiagnosis)
• Non enhanced CT 🡪 delineate bony, air space and soft
tissue abnormalities algorithms
• Definitive procedure for detecting and confirming
calcification
 MSCT and MRI
Contrast enhanced CT 🡪 demonstrates normal and abnormal
vascular structures (CTA), abnormal vascular permeability
(inflammation, neoplastic neovascularity) and especially for
intracranial extension
Complex anatomy structures and region (orbits, skull base,
paranasal sinuses, deep space of the neck, larynx and lymph
nodes)
• CT : The best risk benefit profile and high risk diagnostic value
🡪 radiation
• MRI : Best for bone and soft tissue diagnostic but consumes
more resources

Ref : Head and Neck Imaging chapter 10. Patrick D.Barnes

Cross sectional imaging

https://radiologykey.com/brain/
 Catheter Angiography
• X ray uses contrast and fluoroscopy camera to take
picture of blood flow
• Head and neck angiogram 🡪 carotid angiogram : the
largest arteries in the neck lead to the brain.
• Catheter placed into a blood vessel than contrast
material is injected 🡪 usually made in digital
substraction angiography (DSA)
• Findings : normal, aneurysm, stenosis/occlusion,
abnormal pattern of blood vessels (AVM) or abnormal
vessels near a tumor or intratumoral

https://www.uofmhealth.org/health-library/hw201050
Head and neck Imaging
FACIAL
NASAL BONE FRACTUCRE
FACIAL BONE FRACTURE
FACIAL BONE FRACTURE
BLOW OUT FRACTURE
BASALIOMA
BASALIOMA
FIBROUS DYSPLASIA
Head and neck Imaging
EYE AND ORBITS
GRAVE OPTHALMOPATHY
GIANT ANEURYSMA
RETINOBLASTOMA
Perempuan 70 th dengan proptosis mata kiri
Carotid Covernous Fistula :
Enlarge intra orbital vein, enlarge
left covernous sinus
Head and neck Imaging
EAR AND TEMPORAL BONE
SCHULLER-MASTOIDITIS
SCHULLER X-RAY
COCHLEAR IMPLANT
OTOMASTOIDITIS
VESTIBULAR SCHWANNOMA
Head and neck Imaging
PARANASAL SINUS
SINUSITIS - WATERS
WATERS - SINUSITIS
HRCT - SINUSITIS
SINONASAL MASS
Head and neck Imaging
NASOPHARYNX – OROPHARYNX – ORAL CAVITY
NPC
NPC
 JUVENILE NASOPHARYNX
ANGIOFIBROMA
INTRACRANIAL EXTENSION
Epistaxis in nasal mass
POST EMBOLISASI
 Male 65 yo post chemoradiation.
Mass filled nasopharynx that extent
to choana and nasal bilateral.
T1FS T2WI Restricted difussion on nasopharynx
bilateral with ADC: value 0,65x10-3
mm2/s with contrast enhancement.

DWI ADC
T1FS T2WI T1FS+C

DWI ADC
TONGUE CA
TONGUE CA
LARYNGEAL CA
LARYNGEAL CA
Head and neck Imaging
JAWS
MANDIBLE FRACTURE
AMELOBLASTOMA
Panoramic X-ray
Head and neck Imaging
NECK REGION
FOREIGN
BODY
FOREIGN
BODY
 USG
NORMAL NECK :
thyroid, salivary gland, parotid gland, LN

https://link.springer.com/chapter/10.1007/978-3-319-67238-0_4
STRUMA NODOSA
PARATHYROID ADENOMA
 USG

LN pathology

https://link.springer.com/chapter/10.1007/978-3-319-44100-9_20
THYROID CANCER
THYROID CANCER
 CONCLUSION

Imaging plays an important roles in

the management of head and neck
cases
THANK YOU