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Role Of Mri In Ent Diseases PowerPoint Presentation

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ROLE OF MRI IN ENT DISEASES BY PROF. Dr. YASSER ABDEL AZEEM M.D. PROF. OF RADIODIAGNOSIS AIN SHAMS UNIVERSITY
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MR PHYSICS IN BRIEF Non invasive imaging using hydrogen protons abundant in human body tissues Placing the patient in a magnet and exposing him to various magnetic fields. This yields variations in the magnetic effect induced on protons .
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Computer softwares ------> image formation based on differences in magnetic relaxation properties basically the T1 & T2 differences -----> this is highlighted by the used parameters ( mainly TR & TE ) that yield T1W or T2W images or other. Sequence: the way we repeat our MR experiment to yield T1W, T2W, Proton density, Flair etc.
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Spin echo sequence (Basic sequence ) Good contrast Relatively long time Now less than 5 minutes Gradient echo sequence ( Fast sequence) Average contrast Fast scanning Used for MR angiography
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Inversion recovery sequence STIR--------------> Fat suppressed FLAIR------------> Water suppressed Echo planar techniques for functional imaging Diffusion Perfusion Brain activation MR cisternography Heavily T2W sequences emphasizing CSF
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Magnetization transfer technique Best for post contrast T1W images MR Spectroscopy Placing voxel or voxels over lesions to analyze the metabolic contents of lesions for characterization. MR angiography techniques Time of flight Phase contrast Contrast enhanced
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Bright signal on T1 spin echo - Blood - Fat including Bone marrow - Protenacious material - Melanin - Paramagnetic substances e.g. gadolinium Dark signal on T1 spin echo - Fluid - Most lesions - Metallic objects - Calcification & Air - Cortical bone
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Bright signals on T2 spin echo - Subacute blood - most lesions - Fluids - Melanin Dark signals on T2 spin echo - Fat - Calcification - Chronic blood (hemosiderin) - Air
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MAIN PATHOLOGIES WHERE MRI CAN HAVE A SIGNIFICANT ROLE Skull base lesions difficult or impossible to view on endoscopies or by direct examination. for origin, extent, perineural spread, vascular affection, intracranial extension. Marrow invasion is best detected in non contrast T1W & fat suppressed sequences, occasionally , CT may detect early cortical erosion not detected by MR yet CT consistently underestimate the extent of neoplastic skull base involvement e.g. nasopharyngeal carcinoma & MR is the recommended study of choice
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2- Neck compartments lesions specially the deep ones , better characterize lesions than CT scanning
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3. Cerebellopontine angle & internal auditary canal lesions
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4 - Better visualization and staging of cancer larynx the issue of laryngeal cartilage invasion which upstages tumors to T4 precluding organ preservation therapy
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5- Metastatic nodal detection, non contrast MR images are slightly better than CT yet also depend on size criteria. Recently tissue specific MR contrast agent can differentiate metastatic from benign cervical adenopathies
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6- Potential problems or complaints tinnitus specially the pulsatile type and also to detect for reterocochlear causes of the deafness
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Pulsatile tinnitus (subjective) 1-Benign increase ICP: usually female, obese, with headache, clinically she has papilledema, tinnitus. CT & MR empty sella, slit like ventricles or normal. Cause: increased resistance to CSF absorption interstitial brain edema  systolic CSF pulsations transmitted to dural sinuses  periodic compression of heir walls. 2-Otosclerosis: osseous dysplasia of the inner ear where abnormal foci of vascular haversian bone replaces the normal otic capsule. Abnormal intraosseous anastomosis and inflammation are responsible for the tinnitus. 3-Paget’s disease of the temporal bone: as in otosclerosis, abnormal intraosseous anastomosis.
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Pulsatile tinnitus (objective) 1-Vascular neoplasms: as glomus jugulare or glomus tympanicum 2-Congenital vascular anomalies: as aberrant or dehiscent internal carotid artery, dehiscent jugular vein, high jugular bulb, redundant arterial loop of AICA 3-Vascular malformations: dural AVM or AVF, pial (parenchymal) AVM. 4-Other vascular abnormalities: intracranial aneurysm, atherosclerotic carotid artery disease, fibromuscular dysplasia of ICA, carotid artery dissection.
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7- Congenital anomalies of the inner ear
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9- Better detection and characterization of the brain causes of ENT problems.
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9- Non invasive imaging of vascular lesions
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10- MR Spectroscopy has the potential to monitor surgical & radiotherapy or chemotherapy treatment & to identify early recurrent tumors of head & neck & differentiate them from post treatment changes by identifying the metabolic constituents of the lesion rather than depending on volume changes. Main indicator is the elevation of choline\creatinine ratio
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11- MR cisternography for CSF rhinorrhea & otorrhea
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CONCLUSION Full history & detailed clinical data are essential for the radiologist to tailor this MR study & to add other modalities if needed
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THANK YOU