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02:02 CET
BS 1 - Head and neck: inflammation, tumour or something else?
Head and Neck General Radiography
Wednesday, February 28, 08:30 - 10:00
Room: F1
Moderator: B. Verbist (Leiden/NL)

A-023
08:30
Sinuses
R. Maroldi; Brescia/IT
Learning Objectives

1. To discuss current imaging techniques for evaluation of normal anatomy.
2. To describe common imaging manifestations of inflammatory diseases.
3. To review tumour and tumour-like lesions.

A-024
08:53
Thyroid and parathyroid
H. Imhof; Vienna/AT
Learning Objectives

1. To discuss current imaging techniques for evaluation of normal anatomy.
2. To describe common imaging manifestations of inflammatory diseases.
3. To identify and describe the imaging appearance of malignant pathologies.

Abstract

The thyroid gland consists of two lobes which are interconnected by the isthmus. The gland is directly attached to the larynx and trachea. The standard view is axial, visualising the main overlying (strap) muscles, the great vessels and lymphnodes and the oesophagus, as well. The main congenital abnormalities are thyroglossal duct cyst, lingual thyroid gland and aberrant thyroid tissue. Diagnosis of the thyroid masses/nodules is done by sonography using the TI-RADS classification and colour-doppler, lesion size suspicion grade, and fine needle aspiration biopsy (FNAB) reaching an accuracy of 94%. Very important is to differentiate malignancy (papillary /follicular/anaplastic/medullary carcinoma) and inflammatory changes (Hashimoto and DeQuervain thyroiditis). Standard imaging procedures for the parathyroidea are sonography and Sesta-MIBI-SPECT reaching an accuracy of 97%. In unclear cases 4D-CT and/or MRI + contrast may be used additionally.

A-025
09:15
Salivary glands
S. J. Golding; Oxford/GB
Learning Objectives

1. To discuss current imaging techniques for evaluation of normal anatomy.
2. To describe common imaging manifestations of inflammatory diseases.
3. To identify and describe the imaging appearance of malignant pathologies.

Abstract

This presentation offers a clinically orientated approach to imaging salivary gland disease in which the alignment between findings and further management is defined. Salivary imaging has been changed dramatically by the development of cross-sectional imaging. Ultrasound, CT and MRI have consigned radiographs and sialograms to a subsidiary role. Scintigraphy offers the best measure of global salivary gland function, but currently is not widely used in practice. Today investigation is closely related to the underlying pathology of salivary disorders and to provide reliable guide to surgical or medical treatment. Masses are well detected by cross-sectional imaging, which provides accurate guidance on appropriate approaches for surgical management. Differential diagnosis cannot always be achieved, but this is rarely a clinical problem because biopsy or resection are usually indicated. Sialography remains a reliable method of showing calculi and ductal changes in sialadenitis, but cross-sectional techniques, especially ultrasound and MRI, have advantages in inflammatory disease and complete sensitivity in detecting ductal disease may not be necessary in practice because patients may be treated symptomatically. A strong case can be made for using MRI as a sole investigation as this has been shown to be sensitive to both surgical and medical conditions. On this basis, the radiologist may be well placed to offer a primary referral service with triage, directing clinical management of patients or further referral on the basis of findings on MRI. Salivary interventional techniques have more recently extended the role of the radiologist.

A-026
09:38
Lymph nodes
S. S. Özbek; Izmir/TR
Learning Objectives

1. To discuss current imaging techniques for evaluation of normal anatomy.
2. To describe the imaging features of infectious and inflammatory disorders.
3. To describe the imaging appearance of neoplastic disorders.

Abstract

In case of a visible or palpated neck mass, lymph node enlargement is routinely included in the differential diagnosis list. Medical imaging can be effectively used to distinguish other causes of cervical swelling, as well as characterizing enlarged lymph nodes. Although commonly used as a criterion, nodal size is not reliable in characterization. Imaging parameters including internal structure, vascularity pattern, degree of enhancement, and perinodal tissue changes may shed light on the etiology of any lymphadenopathy, which may be reactive hyperplasia, infection, inflammation or neoplastic infiltration. Characteristically, reactive hyperplastic lymph nodes have well-defined borders, reniform shape and central fatty hilum contiguous with adjacent cervical fat tissue. In children, and in most of the adult cases with a low risk of malignancy, ultrasound is the first choice of imaging modality owing to its radiation-free nature, and due to practical reasons. However, when further characterization of nodal abnormality or evaluation of sonographically inaccessible anatomic locations is required, use of other cross-sectional techniques, like CT and MRI are mandatory. They provide not only more detailed information including anatomic localization, size, number, internal structure, and enhancement characteristics of lymph nodes, but also important data about perinodal soft tissue and other associated pathologic processes in the region. Although the choice of imaging modalities to be used in the evaluation of cervical lymph nodes changes according to the means, experience, and preferences of institutions, the role of medical imaging remains pivotal and decisive in this common indication.

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