Head and Neck Imaging

Imaging of the head and neck can be a real challenge for the beginning radiologist as well as other physicians taking care of patients with disease of the ear, skull base, face, and neck soft tissues. The anatomy is challenging because it is small and complex, and many of the disease processes are quite subtle. To address this challenge, you should have some strategic approaches to the anatomy and pathology that is present in this area.

General Head and Neck Imaging

First things first in head and neck imaging. You need to figure out what exactly you are looking at and looking for. In most cases, we evaluate the head and neck with computed tomography with contrast. Then, you need to figure out a couple of basic things, like where lymph nodes are and how they are named, how the aerodigestive tract is divided up into regions, and what the soft tissue spaces are. Check out the following videos to learn more.

Head and neck imaging landmarks

In this video, you can learn to quickly differentiate the important anatomical subsites of the head and neck on computed tomography. These sites are important because pathology at that location, particularly squamous cell carcinoma, can be staged and treated differently. This makes it important for you to be able to differentiate between these different sites.

 

Spaces of the head and neck

This video describes the soft tissue spaces of the head and neck, including common normal anatomy and structures found in each region as well as potential pathology that can commonly arise there. By knowing the spaces, you can be more prepared to determine what diseases might occur there and formulate a better differential diagnosis.

 

Skull Base Foramina Imaging Anatomy

In this video, Dr. Bailey reviews the most important things you should know about the skull base anatomy with an emphasis on CT imaging. With this quick video, in just a few minutes you can learn about the most important skull base foramina when reviewing CT.

 

Cervical lymph node stations

This quick video walks us through 6 of the common cervical nodal stations in the neck. Each lymph node in the neck is assigned one of these 6 levels based on their relationship with normal anatomic structures in the neck. These stations are important in communicating with other physicians which abnormal nodes we are talking about

 

Temporal bone

One of the common challenges to the beginning radiologist is the temporal bone. It is small, hard to see, and the range of pathology that can affect it is highly varied and complex. When approaching the temporal bone, it is great to have a strategic approach to how you look at the scan as well as an expectation of what the common pathologies are.

Adult Temporal Bone CT search pattern

When approaching the temporal bone, it is great to have a strategy for how you go through the images. We advocate an outside-in approach, where you start at the external auditory canal and move medially into the middle ear, inner ear, and internal auditory canal. An easy way to do this is on the coronal images, although you can take the same approach on axial images. This type of structured approach will give you the best chances of success in finding pathology and learning normal anatomy.

 

Temporal bone CT – Pathology based approach

There are some common pathologies to consider when evaluating the temporal bone. You can think about which diseases are most prevalent in each compartment based on location. A general differential of infection, inflammation, and tumor is a good place to start. Learn more about specific common diseases in this video.

 

Head and Neck Cases

If you want to see all of the head and neck related pages and cases, click here.

Summary

Head and neck imaging is challenging for all physicians from the new resident to the seasoned veteran. Practice and correlation with clinical findings helps, and hopefully you found these resources useful.