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Abscess or tumor in oral cavity

Case Study
Casselman, Jan, M.D., Ph.D. Brugge, AZ St. Jan AV Belgium

Patient history:

A patient that underwent tooth extraction from the right lower jaw was examined at General Hospital St. Jan. Thickening of the gingiva was noticed in this area, suggesting a possible secondary abscess or tumor.

MR examination:

The SENSE Head/Neck coil is used to scan the complete neck for lymph nodes.

The SENSE Flex-S coils are used to study the oral cavity locally.

Patient preparation:

 Coil positioning for oral cavity.
Coil positioning for oral cavity.

Coil positioning:

Both the SENSE Head-Neck coil and the 2-element SENSE Flex-S coils (white arrows) are positioned. To optimize the signal and spatial resolution the SENSE Flex-S coils are placed bilaterally on the cheek.

MR images and interpretation:

T2-weighted Click image to enlarge.T1-weighted Post-contrast
Click image to enlarge.


On the axial T2-weighted image of the oral cavity a squamous cell carcinoma is seen invading fat tissue of the right cheek (white arrow) and the mandible (arrowheads). The high resolution allows detailed visualization of the normal left lingual nerve (black arrow).


The unenhanced axial T1-weighted image with 1024 matrix shows the hypointense tumor (white arrow) invading the intra-mandibular marrow while also destroying the lingual and buccal cortex (arrowheads). Normal black lingual cortex is seen in the midline and left side of the mandible(black arrows).


The coronal post-contrast T1-weighted image clearly shows the enhancing tumor (white arrowheads) together with the disappearance of the normal cortex and marrow of the right mandible. The marrow of the remaining inferior part of the right mandible has a decreased signal intensity (black arrowhead) due to tumor invasion compared to the normal high signal intensity of the marrow in left mandible (black arrow).

Working diagnosis:

A tumor is invading the intra-mandibular marrow of the right mandible and destroying the lingual and buccal cortex.

Impact of coil use and SENSE/CLEAR:

Acquiring high resolution images of the oral cavity in an acceptable time, is enabled by: 

  1. Positioning the SENSE Flex-S coils close to the skin and thus receiving a maximum returned signal by virtue of their proximity to the region-of-interest.
  2. Use of SENSE and CLEAR enables acquisition of images with excellent SNR and image detail in just about four minutes. 


More information about head and neck MR imaging can be found in the Clinical View article by Dr. Casselman:

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Oct 26, 2006

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