Presentation1.pptx, radiological anatomy of the neck.

1. Radiological anatomy of the neck. Dr/ ABD ALLAH NAZEER. MD.

2. Neck anatomy. Superficial neck structures. nasopharynx oropharynx oral cavity Deep neck structures. The deep anatomy is separated by fascial planes into seven deep compartments of the head and neck : pharyngeal (superficial) mucosal space parapharyngeal space parotid space carotid space masticator space retropharyngeal space perivertebral space

3. Spaces of the neck. O ral cavity, retromolar trigone , tongue , oral mucosal space , submental space , submandibular space , superficial spaces ( pharynx ), nasopharynx , Rosenmuller fossa , oropharynx ., hypopharynx , hypopharyngeal subsites , larynx , supraglottic space , Epiglottis , false vocal cords , aryepiglotic folds , glottis , ​ true vocal cords , subglottic space Deep spaces of the neck: pharyngeal (superficial) mucosal space , parapharyngeal space , styloid apparatus , retropharyngeal space , danger space , parotid space , carotid space , carotid sheath masticator space , perivertebral space , suprasternal space (of Burns ) , pterygopalatine fossa , pterygomaxillary fissure , infratemporal fossa

4. 1. Lat. & Med. ptyergoid plate 2. Ethmoid Sinus 3. Odontoid Process 4. Sphenoid Sinus 5. Foramen ovale 6. Maxillary Sinus 7. Mastoid air cells 8. Ant arch of C-1 9. Margin of foramen magnum 10. Ext. auditory canal

5. LATERAL NECK Hard pallate Soft pallate Nasopharynx Oropharynx

6. AIRWAY Calcified tracheal cartilage rings Hyoid bone Epiglottis Thyroid cartilage Cricoid cartilage

7. Thyroid US imaging.

8. Neck Spaces • Suprahyoid neck spaces: – Pharyngeal mucosal – Masticator – Parotid – Carotid – Buccal – Parapharyngeal – Retropharyngeal – Prevertebral

9. Anatomic Localization. • Pharyngeal mucosal space: – Nasopharynx – Oropharynx – Hypopharynx

10. Neck Spaces • Infrahyoid neck spaces: – Visceral space – Posterior cervical space – Anterior cervical space – Retropharyngeal space – Prevertebral space – Carotid space

11. Larynx • Larynx: – Glottis – Subglottis – Supraglottis

12. Lymph nodes. • Level I (1) • Level II (2) • Level III (3) • Level IV (4) • Level V (5) • Level VI (6) • Level VII (7)

13. • Better soft tissue differentiation • Gadolinium enhancement • Recognize basic sequences: T1, T2 , fat saturated , enhanced • Lymph nodes can be better seen than on CT. Neck MR Imaging Anatomy.

14. Protocol.

15. Suprahyoid neck anatomy:

16. Fig. 1 . Suprahyoid neck anatomy: (A) Sagittal T1-weighted midline image of the neck demarcating the level of the hyoid bone (blue line), separating the suprahyoid neck above from the infrahyoid neck below. Other colored lines demarcate the various levels listed below (red line, B; orange line, C; yellow line, D; green line, E). (B) Axial T2- weighted image at the skull base: the cephaled -most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow). Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium. GS, greater wing of sphenoid; Max, maxillary sinus ; m , mandible; asterisk, pterygopalatine fossa. (C) Axial T1-weighted image more inferiorly at the alveolar ridge : The parapharyngeal space (PPS, black outline) is readily apparent as a T1 hyperintense region, relating to its fat content . Anterolateral is the masticator space (red border) containing the masseter (M), lateral pterygoid ( lp ), and medial pterygoid (mp) muscles. The buccal space is located just anterior to the masticator space (B, asterisk border ). Lateral to the parapharyngeal space is the parotid space (green border), which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma. The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS. Note the T1 isointense mucosal space medial to the PPS, including the torus tubaris (arrow). Posteriorly is the perivertebral space ( yellow border ) containing the longus colli muscle . (D) Axial T2-weighted image more inferiorly at the level of the oropharynx: Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M). The parotid (green border) and parapharyngeal spaces have tapered down. The perivertebral space ( yellow outline) is again noted, located just dorsal to the retropharyngeal space (blue border). Ton, palatine tonsils ; IJ , internal jugular vein; IC, internal carotid artery; v, retromandibular vein; LC, longus colli. (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled): As the other suprahyoid neck spaces continue to taper down, the submandibular space appears (orange outline). This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat. The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v).

17. Coronal T1-weighted imaging of the suprahyoid neck at several levels.

18. Fig. 2. Coronal T1-weighted imaging of the suprahyoid neck at several levels. (A) Just dorsal to the mandibular mentum , the sublingual glands ( slg ) are present between the mylohyoid (mylo) and genioglossus (GG) muscles . They are of increased signal intensity in comparison with muscle. Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig). The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow). Just inferior to the hard palate (white arrowheads), which is hyperintense because of marrow fat, is the apposed tongue surface with intrinsic musculature (labeled) noted. The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow ). Max , maxillary sinus. (B, C) More posteriorly, the masticator space is noted with the masseter (Masseter) and temporalis ( Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z). The buccal fat/space is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth. Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view ( black arrow ). (D) At the level of the nasal choana, the oral cavity structures are again well seen, including the mylohyoid muscle , which divides the submandibular space inferiorly from the sublingual space superiorly. The hyoglossus muscle is noted along the lateral margin of the tongue, providing the medial margin of the sublingual space . Within the masticator space, the medial and lateral pterygoids are identifiable (mp, lp ). The soft palate ( labeled) is also now noted. (E) At the level of the mandibular rami, the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly. Posterior and medial to the masticator space is the fat filled, T1-hyperintense parapharyngeal space (PPS). The longus colli (LC) muscles of the prevertebral space are well seen, as are the lingual (labeled) and palatine tonsils (PT ).

19. Imaging of the infrahyoid neck.

20. Fig. 3. Imaging of the infrahyoid neck. (A) Sagittal T1-weighted image demonstrates the geniohyoid (labeled ) and genioglossus (GG) muscles along the floor of the mouth, attaching to the T1-hyperintense mandible (M ). The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates. The epiglottis (white arrow) lies posterior to the vallecula (v). The air-filled T1-hypointense trachea (T) is noted inferiorly . Posteriorly , the vertebrae are noted (C2 and T1 labeled). (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords, with a small amount of T1-hyperintense fat noted along the false cord. The hyoid bone is visualized (labeled) and the mylohyoid (MH), mandible (M), and masseter (Mass ) muscle are seen. (C, D) Axial T1-weighted image through the larynx. Superior image (C) demonstrates the false vocal cords (black arrow) with the paired, air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk ). Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc), internal jugular vein (IJ), and jugular chain lymph nodes (N). The vertebral artery (v) is noted traversing the foramen transversarium, whereas the spinal cord (SC) is noted posteriorly. Inferiorly, (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C). (E) Axial T2-weighted fat-suppressed image at the same level. Most of the neck tissues lose signal. A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead). The T2-hyperintense cerebrospinal fluid surrounds the spinal cord. (F) Axial T1-weighted image at the level of the thyroid gland (Thy). The thyroid borders the trachea and the esophagus (E). The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles.

21. Brachial plexus imaging. Brachial plexus imaging. (A–C) Sagittal T1-weighted imaging of the brachial plexus. (A) Along the lateral aspect of the cervical spine, the originating nerve roots can be seen as they exit the neural foramina (circles). (B ) As the plexus forms (circled), it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow). (C) Laterally, the plexus (circled) is best seen superior to the axillary artery ( black arrow). (D, E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus. Note the plexus descending through the thoracic inlet (white arrowheads). (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi (white arrows) traveling posterior to the anterior scalene (AS). Midline trachea (T) and esophagus ( E) are present and the spinal cord is noted centrally (black arrow).

22. Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A, anteroposterior view ; B, oblique). The aortic arch most commonly gives rise to 3 great vessels: the innominate ( or brachiocephalic) artery (IA), the left subclavian artery (LSA), and the left common carotid artery ( LCC). The right common carotid artery (RCC) arises off of the innominate distally. Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA, white arrowhead). The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina, entering the skull base through the foramen magnum.

23. ARTERIOGRAM Internal Carotid Artery Intracranial Carotid Maxillary Artery Occipital Artery External Carotid Artery Common Carotid Artery Facial Artery

24. THYROID SCAN Nuclear Medicine

25. Thank You.