DOI: http://dx.doi.org/10.18203/2349-3933.ijam20160189

Imaging in benign and malignant mass lesions of the tongue

Kavitha Subramanian, Rajoo Ramachandran, Anupama Chandrasekharan, Rajeswaran Rangasami, Venkata Sai P. M., Santhosh Joseph

Abstract


Background: The purpose of this study was to determine the value of CT or MR imaging in demonstrating benign, malignant, congenital and iatrogenic mass lesions of the tongue. Although the vast majority of tongue masses are squamous cell carcinomas, a variety of unusual lesions may affect the tongue. Thus the characteristics and extent of these unusual lesions may be recognized only on cross sectional CT or MR images. In this article we describe the imaging findings of the various lingual masses, provide radio-pathological correlation and discuss the role of CT and MRI in diagnostic work-up of these uncommon lesions in clinical practice.

Methods: Twenty nine patients with mass lesions in tongue were prospectively examined for a period of seven months from March to October 2014 with CT or MR imaging after physical examination. The imaging protocol includes contrast enhanced axial, coronal and sagittal images acquired with 64 slice GE VCT. MR imaging protocol includes three plane contrast-enhanced and non-contrast-enhanced T1-weighted turbo spin-echo sequences, T2-weighted turbo spin-echo sequences, T1-weighted fat saturated images (T1-FATSAT). Diffusion weighted imaging (DWI) and gradient imaging (GRE) acquired with GE 16 channel 1.5 Tesla MRI. The findings were further compared with surgical and histopathological results.

Results: Among the twenty nine patients who were examined with CT or MRI six patients were found normal. The rest of the twenty three patients who had positive findings on imaging include seventeen squamous cell carcinoma (SCC), one thyroglossal duct cyst, two venous malformations, one hemangioma, one case of lipoma and macroglossia.

Conclusions: Though MR is the sensitive imaging modality for tongue evaluation, CT is most commonly used in preoperative assessment and post-operative surveillance. CT and MRI provide good anatomic detail, precise delineation of the extent of mass lesions and their relation to surrounding structures. In addition, MR imaging is helpful when flow void is identified, it can further characterize the type of flow present. Angiography is valuable for delineating feeding and draining vessels and in defining the hemodynamic of vascular lesions.


Keywords


Tongue, Computed tomography, Magnetic resonance imaging

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References


MacDonald AJ, Harnsberger HR. Oral cavity anatomy and imaging issues. Harnsberger HR, Wiggins RH, Hudgins PA, Michel MA, Swartz J, Davidson HC, et al editors. Diagnostic imaging: head and neck. Salt lake city, UT: Amirsys; 2004;III:42-45.

Hollinshead W. Anatomy for surgeons. The head and neck, vol.1. 3rd edition. Hagerstow (NJ ): Harper and Row;1982.

Last RJ. Anatomy: regional and applied. 6th edition. Edindurgh (United Kingdom); London; and New York: Churchill Livingstone;1978.

Meesa IR, Srinivasan A. Imaging of the oral cavity. Radiologic Clinics. 2015;53(1):99-114.

Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev. 2006;7:108-12.

Arya S, Chaukar D, Pai P. Imaging in oral cancers. IJRI. 2012;22:195-208.

Huang SH, Hwang D, Lockwood G, Goldstein DP, O'Sullivan B. Predictive value of tumour thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: A meta-analysis of reported studies. Cancer. 2009;115:1489-97.

Arakawa A, Tsuruta J, Nishimura R, Sakamoto Y, Korogi Y, Baba Y et al. MR imaging of lingual carcinoma: Comparison with surgical staging. Radiat Med. 1996;14:25-9.

Iwai H, Kyomoto R, Ha-Kawa SK, Lee S, Yamashita T. Magnetic resonance determination of tumour thickness as predictive factor of cervical metastasis in oral tongue carcinoma. Laryngoscope. 2002;112:457-61.

Lam P, Au-Yeung KM, Cheng PW, Wei WI, Yuen AP, Trendell-Smith N et al. Correlating MRI and histologic tumour thickness in the assessment of oral tongue cancer. Am J Roentgenol. 2004;182:803-8.

Preda L, Chiesa F, Calabrese L, Latronico A, Bruschini R, Leon ME et al. Relationship between histologic thickness of tongue carcinoma and thickness estimated from preoperative MRI. Eur Radiol. 2006;16:2242-8.

Okura M, Iida S, Aikawa T, Adachi T, Yoshimura N, Yamada T et al. Tumour thickness and Para lingual distance of coronal MR imaging predicts cervical node metastases in oral tongue carcinoma. Am J Neuroradiol. 2008;29:45-50.

Dammann F, Horger M, Mueller-Berg M, Schlemmer H, Claussen CD, Hoffman J et al. Rational diagnosis of squamous cell carcinoma of the head and neck region: comparative evaluation of CT, MRI, and 18 FDG PET. Am J Roentgenol. 2005;184:1326-31.

Lufkin RB, Wortham DG, Dietrich RB, Hoover LA, Larrsen SG, Kangarloo H et al. Tongue and oropharynx: Findings on MR imaging. Radiology. 1986;161:69-75.

Sigal R, Zagdanski AM, Schwaab G, Bosq J, Auperin A, Laplanche A et al. CT and MR imaging of squamous cell carcinoma of tongue and floor of mouth. Radiographics. 1996;16:787-810.

Yousem DM, Gad K, Tufano RP. Resectability issues with head and neck cancer. Am J Neuroradiol. 2006;27:2024-36.

Mukherji SK, Weeks SM, Castillo M, Yankaskas BC. Krishnan LAG, Schiro S. Squamous cell carcinomas that arise in the oral cavity and tongue base: can CT help predict perineural or vascular invasion? Radiology. 1996;198:157-62.

Chung TS, Yousem DM, Seigerman HM, Schalkman BN, Weinstein GS, Hayden RE. MR of mandibular invasion in patients with oral and oropharyngeal malignant neoplasms. Am J Neuroradiol. 1994;15:1949-55.

Imaizumi A, Yoshino N, Yamada I, Nagumo K, Amagasa T, Omura K. A potential pitfall of MR imaging for assessing mandibular invasion of squamous cell carcinoma in the oral cavity. Am J Neuroradiol. 2006;27:114-22.

Fletcher CDM, Unni KK, Mertens F. Adipocytic tumors. In: Pathology and genetics: tumours of soft tissue and bone. World Health Organization classification of tumours. Lyon, France:IARC Press; 2002:9-46.

Dattilo DJ, Ige JT, Nwana EJC: intraoral lipoma of the tongue and submandibular space. J Oral Maxillofac Surg. 1996;54:915-7.

Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA: lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg. 2003;32:49-53.

Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: site and sub classification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:441-50.

Ahmed W, Amin M, Shafiullah. Intraoral lipoma-an unusual site and size. PAFMJ. 2009;2.

Bataineh AB, Mansour MJ, Abalkhail A. Oral infiltrating lipomas. Br J Oral Maxillofac Surg. 1996;34:520.

Donnelly LF, Jones BV, Janet L. Strife imaging of pediatric tongue abnormalities. AJR. 2000;175:489-93.

Morgan WE, Friedman EM, Duncan NO, Sulek M. Surgical management of macroglossia in children. Arch Otolaryngol Head Neck Surg. 1996;122:326-9.

Gibson SE, Myer CM 3rd, Strife JL, O’Connor DM. Sleep fluoroscopy for localization of upper airway obstruction in children. Ann Otol Rhinol Laryngol. 1996;105:678-83.

Josephson GD, Spencer WR, Josephson JS. Thyroglossal duct cyst: the New York eye and ear in- firmary experience and a literature review. Ear Nose Throat J. 1998;77:642-4.

Ahuja AT, Wong KT, King AD, Yuen EH. Imaging for thyroglossal duct cyst: the bare essentials. Clin Radiol. 2005;60(2):141-8.

Laitman J. Congenital lesions of the neck. In: Som PM, Curtin HD, eds. Head and neck imaging. 5th ed. St Louis, Mo: Mosby; 2011:2235-2286.

David A. Zander, MD Wendy R. K. Smoker, MD. Imaging of ectopic thyroid tissue and thyroglossal duct cysts. Radiographics. 2014; 34:37-50.

Batsakis JG. Tumors of the head and neck: clinical and pathological considerations. 2nd ed. Baltimore: Williams and Wilkins; 1979:291-312.

Dillon WP, Hieshima GB, Dowd CF, Frieden IJ. Hemangiomas and vascular malformations of the head and neck: MR characterization. Am J Neuroradiol. 1993;14(2):307-14.