Salivary gland nodules [Schreibgeschützt] - ESHNR · salivary gland nodules C. Czerny ... •...
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Transcript of Salivary gland nodules [Schreibgeschützt] - ESHNR · salivary gland nodules C. Czerny ... •...
28.10.2015
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next speaker:Christian Czerny
Diagnostic approach of large salivary gland nodules
C. CzernyDivision of Neuro-/Msk-Radiology
Department of Biomedical Imaging and Image-guidedTherapy
University Hospital AKH Vienna
Pathologies
• Stone• Inflammation acute – chronic• Tumor benign – malignant• Posttherapie
Introduction
US/CT/MRI characteristics:• Position: Deep/superficial part• Echogenity/Density/Signalintensity• Borders: Smooth/irregular
• Capsule/lobulated• Perilesional reaction• E.g. Lnn
Problem
• Exact localisation
• Differentiation benign-malignant
• Imaging not always characteristic
• Differentiation to other processes (e.g. inflammation-abscess)
• Lnn benign-malignant
Often correct diagnosis
Therapyplanning
Technique US
• High resolution US 7-15mHz• Linear transducer• Doppler• transversal/longitudinal• US guided Bx
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Technique CT and MRISCT/MDCT• Skullbase-Jugulum
• Spiral
• Axial/coronal (Recon)
• 3/3/1mm Xx0,6/Xx0,5mm
• 100-120ml CM i.v.
• Matrix 5122/7682
• Softtissue/Bone-WL
• PET-CT
MR• Skullbase-Jugulum
• Headcoil/Surfacecoils
• Axial/coronal
• STIR/TIRM/T2wFSE+FS
• T1wSE -/+ CM i.v., FS
• Diffusion
• Thk 3-4 mm
• Matrix 512x512/256x256
• MR-Sialography
• PET-MR
Anatomy
Anatomy
2. Molar
Anatomy
Glandula parotis
D
S
D S
Anatomy Anatomy
Glandula submandibularis
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Anatomic Variant
Accessory lobe
Pathology Tumor
Localisation Frequency Benign Malign.
Parotid 75% 80% 20%
Submandibular 15% 50% 50%
Sublingual 1% 10% 90%
Small glands 9% 40% 60%
Benign Tumors
Pleomorphic adenoma-polycyclic-heterogenous-++ echogenicity
Pleomorphic adenoma
Benign Tumors
Pleomorphic adenoma
Benign Tumors
Pleomorphic adenoma(Icebergtumor)
Benign Tumors
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Pleomorphic adenoma(Icebergtumor)
Benign Tumors
Pleomorphicadenoma
Benign Tumors
PerfusionNormale Parotis
PerfusionPleo Parotis
MR-Perfusion/DWI
Habermann CR et al. Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible?AJNR Am J Neuroradiol. 2009 Mar;30(3):591-6.
Espinoza S et al. Warthin's tumor of parotid gland : Surgery or follow-up? Diagnostic value of a decisional algorithm with functional MRI.Diagn Interv Imaging. 2014 Dec 17
Pleomorphic adenomaGl. submandibularis
Pleomorphic adenomaSmall salivary glands
Benign Tumors
Benign Tumors DD
CystCyst 2. 2. branchialbranchial cleftcleft
Harnsberger
Whartin-Tumor(Cystadenolymphoma)
Benign Tumors
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CystCyst 1. 1. branchialbranchial cleftcleft
Benign Tumors DD
Harnsberger
Benign Tumors DD
CystCyst 2. 2. branchialbranchial cleftcleft
Harnsberger
Mucoepidermoid-Ca
Malignant Tumors
Pleomorphic Carcinoma
Malignant Tumors
Adenocarcinoma with skininfiltration
Malignant Tumors
Carcinoma SCC
DWI
Frühwald, Czerny et alEur J Nucl 2011
Malignant Tumors
Fruehwald-Pallamar J, Czerny C et al. Functional imaging in head and neck squamouscell carcinoma: correlation of PET/CT anddiffusion-weighted imaging at 3 Tesla. Eur J Nucl Med Mol Imaging 2011;38:1009–19.
Varoquaux A, Becker M et al. Functionalimaging of head and neck squamous cellcarcinoma with diffusion-weighted MRI andFDG PET/CT: quantitative analysis of ADC andSUV. Eur J Nucl Med Mol Imaging 2013; Jun;40(6):842-52
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Frühwald, Czerny et alEur J Nucl 2011
Cystic LNN-Meta SCC
Malignant Tumors
Adenoidcyst. Ca. Parotidperineural VII
Malignant tumor with perineural infiltration
Malignant Tumors
Azinuscellcarcinoma
Juan CJ et al. Perusion characteristics of late radiation injury of parotid glands: quantitative evaluation with contrast-enhanced MRI. Eur Radiol. 2009 Jan;19(1):94-102
Bisdas S et al. Differentiation of bening and malignant parotid tumors using deconvolution-based perfusion CT imaging: feasibility of the method and initial results. Eur J Radiol. 2007 Nov;64(2):258-65
MALT-Lymphoma
Malignant Tumors
SarcomaFrühwald, Czerny et alEur J Nucl 2011
Fruehwald-Pallamar J, Czerny C et al. Functional imaging in head and neck squamous cell carcinoma: correlation of PET/CT and diffusion-weighted imaging at 3 Tesla. Eur J Nucl Med Mol Imaging 2011;38:1009–19.
Varoquaux A, Becker M et al. Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV.Eur J Nucl Med Mol Imaging 2013; Jun;40(6):842-52.
Malignant Tumors
St.p. ParotidectomySBL in Parotid region
Malignant Tumors
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SBL Melanoma in Parotid
Frühwald, CzernyEur J Nucl 2011
Malignant Tumors
Kubissa K et al. Initial clinical results ofsimultaneous 18F-FDG PET/MRI in comparison to 18F-FDG PET/CT in patientswith head and neck cancer. Eur J Nucl MedMol Imaging 2014 Apr;41(4):639-48
Becker M, Zaidi H. Imaging in head and neck squamous cell carcinoma: the potentialrole of PET/MRI. Br J Radiol 2014 Apr;87(1036):20130677
Malignant TumorsPET-MR
Malignant extraparotideal Tumor
PlasmocytomaRhabdomysarcomaParapharyngeal space
Malignant extraparotideal Tumor
Lymphangioma
DD‘sDD‘sMalformationMalformation DD MalformationDD Malformation
AVM
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Venous Malformation Parotid
DD MalformationDD Malformation RetentioncystRanula
Retentioncyst„diving“ Ranula
Macdonald AJ et al. Giant ranula of the neck: differentiation from cystic hygroma. AJNR Am J Neuroradiol. 2003 Apr;24(4):757-761
DD DD HerniationHerniation
DD inflammation
Parotid Viral
Bacterial
Autoimmune
Submandibularis Viral
Bacterial
Autoimmune
Inflammation
Sialadenitis viral
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Sono-CT Abscess
Inflammation
DuctectasyMicroabscess
Abscess
Inflammation
Sjögren ParotidHigher Incidence Lymphoma
Nocturne G, Mariette X. Sjögren Syndrome-associatedlymphomas: an update on pathogenesis andmanagement. Br J Haematol. 2015 Feb;168(3)317-327
Inflammation DD Stone
DD Stone
Stone Whartonduct
Cellulitis MR
Inflammation
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StoneComplication
Abscess
Take home
• US, CT and MRI important tools• Analyse imaging characteristics• Localisation• Surrounding structures (e.g. Lnn)• Differentialdiagnosis
Diagnosis often possiblepotentailly US-FNABimportant for therapy planning
Communication with clinician!!!
Unilateral swelling of the face
MasseterhypertrophyChewing