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Vocal cord tumor

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

Patient history:

Patient presented with hoarseness.

Endoscopic examination shows a thickened left vocal cord, caused by a tumor.

An MR study was performed to evaluate depth of invasion.

MR examination:

The SENSE Flex S-coils were used to study the larynx.

The SENSE Head/Neck coil was used to visualize all lymph node areas.

CLEAR was applied in all sequences.

MR images and interpretation:

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

 

First image is an axial high resolution T2-weighted image through the true vocal cords.

The high signal intensity tumor can be seen in the left true vocal cord from the anterior

end to the vocal process of the arytenoid cartilage (white arrowheads). Note the detailed visualization of the normal ossified thyroid cartilage (white arrow) and paraglottic fat

spaces (black arrows).

 

The axial high resolution unenhanced T1-weighted image shows normal marrow in the left

thyroid cartilage (white arrow) and normal right para-glottic fat space (black arrowheads). Observe how the anterior part of the left para-glottic fat space is invaded by tumor and

how the high signal of the fat disappeared (white arrowhead).

 

On the Gd-enhanced T1-weighted image at the same level. The tumor is enhancing (white arrowheads) and has a higher signal than the normal triangular right thyroarytenoid muscle.

The tumor is compressing the anterior part of the right true vocal cord and only the

Gd-enhanced image shows that the tumor does not cross the midline (white arrow).

 

The Gd-enhanced T1-weighted image of the complete neck is made for lymph node evaluation. The resolution is reduced, but still the true vocal cord tumor (white arrow)

and the false cord (upper white arrow) and infraglottic (arrowhead) extension can be

seen. Normal signal in the right thyroarytenoid muscle (black arrow).

Working diagnosis:

Vocal cord tumor with infraglottic extension.

Impact of coil use and SENSE/CLEAR:

Acquiring high resolution head and neck images in an acceptable time, is enabled by two critical things: 

  1. SENSE Flex-S coils can be positioned close to the skin and thus receiving a maximum returned signal by virtue of their proximity to the region-of-interest.
  2. Using SENSE and CLEAR images with excellent SNR and high resolution can be acquired 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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Case Study
Intera 1.5T
Release 11
Explorer / Nova Dual, Master / Nova, Omni / Stellar, Power / Pulsar
Neck, Neuro
 

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