Face and neck

Published on 12/06/2015 by admin

Filed under Radiology

Last modified 12/06/2015

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11

Face and neck

11.1

Orbital mass lesions

Many lesions are inflammatory and/or vascular. Therefore enhancement following contrast is common and not a useful discriminatory feature. Classification by site: globe or relationship to muscle cone.

11.2

Optic nerve glioma versus optic nerve sheath meningioma – clinical and radiological differentiation

Glioma Meningioma
50% < 5 years of age Usually middle-aged women
± Bilateral Usually unilateral
Slowly progressive, painless loss of vision; central scotoma
Childhood tumours may remain quiescent for years, particularly in the presence of NF
Adult tumours more aggressive
Slowly progressive, painless loss of vision; proptosis
Neurofibromatosis*: NF-1 in 25%; 15% of NF-1 have optic nerve glioma; bilateral disease strongly suggests neurofibromatosis Neurofibromatosis (1 or 2) in 4–6%; bilateral disease may occur with or without NF
No orbital hyperostosis Hyperostosis
Widened optic canal in 90% but intracranial extension is unusual Widened optical canal in 10%
Kinking and buckling of the optic nerve is common. Smooth outline Straight optic nerve, but tumour may be eccentric
Well-defined margins More infiltrative
Localized or fusiform thickening
Calcification rare without prior radiotherapy Calcification (linear, plaque-like or granular) more common
Isointense to brain on T1W MRI; hyperintense on T2W MRI Similar signal to optic nerve on most unenhanced MR pulse sequences
Variable contrast enhancement with mottled lucencies due to mucinous degeneration Diffuse homogeneous enhancement ± serrated margins
  Negative image of optic nerve within the tumour (tram-track sign)