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Baba A, Kurokawa R, Kurokawa M, Reifeiss S, Policeni BA, Ota Y, Srinivasan A. Advanced imaging of head and neck infections. J Neuroimaging 2023. [PMID: 36922159 DOI: 10.1111/jon.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
When head and neck infection is suspected, appropriate imaging contributes to treatment decisions and prognosis. While contrast-enhanced CT is the standard imaging modality for evaluating head and neck infections, MRI can better characterize the skull base, intracranial involvement, and osteomyelitis, implying that these are complementary techniques for a comprehensive assessment. Both CT and MRI are useful in the evaluation of abscesses and thrombophlebitis, while MRI is especially useful in the evaluation of intracranial inflammatory spread/abscess formation, differentiation of abscess from other conditions, evaluation of the presence and activity of inflammation and osteomyelitis, evaluation of mastoid extension in middle ear cholesteatoma, and evaluation of facial neuritis and labyrinthitis. Apparent diffusion coefficient derived from diffusion-weighted imaging is useful for differential diagnosis and treatment response of head and neck infections in various anatomical sites. Dynamic contrast-enhanced MRI perfusion may be useful in assessing the activity of skull base osteomyelitis. MR bone imaging may be of additional value in evaluating bony structures of the skull base and jaw. Dual-energy CT is helpful in reducing metal artifacts, evaluating deep neck abscess, and detecting salivary stones. Subtraction CT techniques are used to detect progressive bone-destructive changes and to reduce dental amalgam artifacts. This article provides a region-based approach to the imaging evaluation of head and neck infections, using both conventional and advanced imaging techniques.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Reifeiss
- Department of Radiology, Roy Caver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Bruno A Policeni
- Department of Radiology, Roy Caver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Gibney B, Redmond CE, Byrne D, Mathur S, Murray N. A Review of the Applications of Dual-Energy CT in Acute Neuroimaging. Can Assoc Radiol J 2020; 71:253-265. [PMID: 32106693 DOI: 10.1177/0846537120904347] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dual-energy computed tomography (CT) is a promising tool with increasing availability and multiple emerging and established clinical applications in neuroradiology. With its ability to allow characterization of materials based on their differential attenuation when imaged at two different energy levels, dual-energy CT can help identify the composition of brain, neck, and spinal components. Virtual monoenergetic imaging allows a range of simulated single energy-level reconstructions to be created with postprocessing. Low-energy reconstructions can aid identification of edema, ischemia, and subtle lesions due to increased soft tissue contrast as well as increasing contrast-to-noise ratios on angiographic imaging. Higher energy reconstructions can reduce image artifact from dental amalgam, aneurysm clips and coils, spinal hardware, dense contrast, and dense bones. Differentiating iodine from hemorrhage may help guide management of patients after thrombectomy and aid diagnosis of enhancing tumors within parenchymal hemorrhages. Iodine quantification may predict hematoma expansion in aneurysmal bleeds and outcomes in traumatic brain injury. Calcium and bone subtraction can be used to distinguish hemorrhage from brain parenchymal mineralization as well as improving visualization of extra-axial lesions and vessels adjacent to dense plaque or skull. This article reviews the basics of dual-energy CT and highlights many of its clinical applications in the evaluation of acute neurological presentations.
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Affiliation(s)
- Brian Gibney
- Division of Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ciaran E Redmond
- Division of Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Danielle Byrne
- Division of Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Shobhit Mathur
- Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Murray
- Division of Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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