MRI THT-KL

MRI

MRI memberikan gambaran jaringan lunak yang

sangat unggul dalam bidang pencitraan apa pun
dan lebih disukai, misalnya, dalam
menggambarkan luasnya lesi kepala dan leher.
WEIGHTINGS AND SEQUENCES
T1-weighted (T1W)
 Sinyal cairan dalam cairan
serebrospinal (CSF) atau di bola mata
tampak gelap, sedangkan lemak
tampak cerah atau putih. Gambar T1W
berguna untuk melihat sejauh mana
tumor karena mereka cenderung
tumbuh melalui dan melenyapkan
bidang lemak. Hilangnya lemak normal
di sumsum tulang di mandibula dan di
dalam foramen dasar tengkorak pada
gambar T1W sangat berguna dalam
staging.
T2-weighted (T2W)
 Cairan tampaknya sinyal tinggi dan
lemak juga cerah atau putih. Gambar
T2W berguna untuk mencari nekrosis
cairan sinyal tinggi pada kelenjar
getah bening metastatik dari
karsinoma sel skuamosa (SCC) dan
untuk membedakan tumor sinus dari
sekresi cairan di sekitarnya.
WEIGHTINGS AND SEQUENCES
Diffusion-weighted imaging
 Membedakan kolesteatoma dari
sekresi cairan. Molekul air pada
kolesteatoma tidak bebas berdifusi
(yaitu dibatasi) sehingga tampak
cerah pada pemindaian berbobot
difusi. Pencitraan berbobot difusi juga
telah digunakan untuk membedakan
kekambuhan tumor dari perubahan
pasca-radiasi dan memiliki peran
dalam pencitraan otak pasien yang
menderita stroke akut.
Gadolinium
 Agen kontras paramagnetik yang
digunakan dalam MRI. Ini berperilaku
dengan cara yang persis sama seperti media
kontras berbasis yodium yang dijelaskan di
bagian CT. Gambar T1W jenuh lemak pasca-
gadolinium digunakan untuk menunjukkan
peningkatan (peningkatan sinyal) dan
berguna untuk menunjukkan peningkatan
pada dinding kelenjar getah bening nekrotik
atau untuk tumor yang berkembang. Lemak
jenuh berarti sinyal lemak terang ditekan
atau dihilangkan dari gambar, membuat
patologi lebih mencolok.
WEIGHTINGS AND SEQUENCES
Short-tau inversion recovery (STIR)
sequence
 Pemindaian T2W dengan penekanan
sinyal lemak. Ini menunjukkan
patologi dan cairan sebagai 'putih'
pada gambar dan karena itu lebih
mencolok daripada gambar T2W
biasa. Urutan ini sangat berharga
dalam penggambaran kanker kepala
dan leher.
Others
 FLAIR
 Penyakit leptomeningeal dengan penggantian
CSF normal oleh nanah (meningitis), darah
(subarachnoid perdarahan), atau sel tumor
(karsinoma leptomeningeal).
 Gradient Echo Sequence
 Produk darah (malformasi limfatik, granuloma
kolesterol, paraganglioma) atau kalsifikasi
(osteosarcoma, chondrosarcoma, meningioma), area
fokus darah akan menjadi sinyal rendah dan
berkembang pada urutan GRE.
MRI tidak dapat digunakan pada pasien dengan alat pacu jantung, klip otak yang
mengandung besi, katup dan implan prostetik jantung tertentu, dan pada trimester
pertama kehamilan. Gadolinium juga harus digunakan dengan hati-hati pada
pasien dengan gangguan ginjal. Pasien dapat mengalami reaksi anafilaksis
terhadap gadolinium IV; Namun, ini kurang umum dibandingkan dengan kontras
iodinasi IV.
OVERVIEW
 ACUTE OTITIS EXTERNA

Axial STIR Axial T1 Axial T2

• Female Patient 65 years old with Redness of ear pinna, ear discharge, pain and right trismus in a known diabetic.
• Tampak Inflamasi pada kartilago MAE dan pinna kanan serta inflamasi pada Soft tissue MAE kanan. Air fluid
levels terlihat pada mastoid air cells kanan. MAE kiri tampak normal.
 CYSTIC COCHLEO-VESTIBULAR ANOMALY WITH DYSPLASTIC SEMICIRCULAR CANALS
Presentation
Left sensorineural hearing
loss (SNHL) since birth
Patient Data
Age: 9 years
Gender: Female

Axial T2 Coronal 3D FIESTA 3D MIP (PJN)

• abnormal configuration of the left cochlea and vestibule which appear rudimentary with loss of
their internal architecture and appear cystic.
• the semicircular canals appear dysplastic and of relatively small size (red arrow and circle)
compared to the contra-lateral side (blue arrow and circle).
• normal right inner ear structures with intact vestibulo-cochlear system.
• no cerebello-pontine angle mass lesion.
• well-aerated aero-tympanic cavities and mastoid air cells on either side.
 Figure 1: MRI scans of inner auditory canal (IAC)
lipoma in a 54-year-old man demonstrate the
usefulness of fat saturation.
 A, Axial T2-weighted sampling perfection with
application-optimized contrasts by using flip angle
evolution (SPACE) image demonstrates a well-
circumscribed mass in the left IAC (arrow).
 B, Unenhanced T1-weighted SPACE image shows that
the mass (arrow) has substantial intralesional T1
hyperintensity, which drops out on,

 C, fat-saturated contrast-enhanced T1-weighted

SPACE image. Faint peripheral enhancement versus
incomplete signal drop out is noted (arrow).
 Figure 2: Normal inner auditory canal and labyrinthine anatomy in a 37-year-old woman. A, B, Axial and, C, reformatted
oblique sagittal T2-weighted sampling perfection with application-optimized contrasts by using flip angle evolution
(SPACE) MRI scans at 3 T show the expected appearance of the regional anatomic structures. A, On axial image, the facial
nerve (long straight black arrow), cochlear nerve (curved black arrow), and inferior vestibular nerve (short black arrow) are
all identified. Components of the cochlea, such as the interscalar septa (dashed white arrow) and modiolus (curved white
arrow) are easily visualized. The crista ampullaris of the posterior semicircular canal (solid straight white arrow) is also
seen. B, Within the cochlea, the spiral lamina/basilar membrane complex (short straight arrow) is seen as a clear border
between the scala vestibuli (curved arrow) and scala tympani (long straight arrow), particularly within the basal turn of the
cochlea. C, The nerves are often best seen on reformatted images. The facial nerve is located within the anterosuperior
cerebellopontine angle (long straight solid arrow), while the cochlea nerve is located anteroinferiorly (curved arrow). The
nervus intermedius is located just posterior to the facial nerve (dashed arrow). The superior and inferior divisions of the
vestibular nerve are often indistinguishable at this point of the canal (short straight arrow).
VESTIBULAR
SCHWANNOMA
 Figure 4: Abnormal fluid-attenuated inversion
recovery (FLAIR) signal intensity associated with a
vestibular schwannoma in a 67-yearold man.

 A, T2-weighted sampling perfection with

application-optimized contrasts by using flip angle
evolution (SPACE),
 B, T1-weighted SPACE
 C, contrast-enhanced T1-weighted SPACE images
demonstrate an avidly enhancing mass in the left
inner auditory canal (IAC) that extends through the
porus acousticus into the left cerebellopontine angle,
compatible with a vestibular schwannoma (arrows).
 D, Threedimensional T2-weighted FLAIR SPACE
image shows abnormal hypertense fluid within the
IAC fundus (straight solid arrow), cochlea (curved
arrow), and lateral semicircular canal (dashed
arrow).
 Figure 5: Illustrations and corresponding postoperative MRI scans of
the three primary surgical approaches used for resection of vestibular
schwannoma.

 A, The retrosigmoid (suboccipital) approach is performed though an

occipital craniotomy placed just posterior and inferior to the sigmoid-
transverse junction. The cerebellum is retracted and then bone is
removed over the medial two-thirds of the internal auditory canal.

 B, Postoperative scan demonstrates surgical absence of the posterior

wall of the right inner auditory canal (straight arrow); the
contralateral side is shown for comparison (curved arrow). Extra-
axial fluid related to surgical retraction (*) overlies the right
cerebellar hemisphere.

 C, The translabyrinthine approach entails a wide mastoidectomy,

decompression of the sigmoid sinus, labyrinthectomy, and bone
removal over the internal auditory canal and presigmoid posterior
fossa dura to expose the tumor.

 D, Postoperative T1-weighted image demonstrates the fat graft within

the postoperative site (arrows). E, The middle cranial fossa approach
involves a temporal craniotomy with subtemporal extradural brain
retraction. The bone overlying the internal auditory canal is then
drilled to access the tumor. F, Coronal postoperative image
demonstrates the fat graft laid along the roof of the right inner
auditory canal (arrows). (Image used with permission of Mayo
Foundation for Medical Education and Research, all rights reserved.)
 CHOLESTEATOMA
 Figure 12: Recurrent cholesteatoma in a 49-year-old
woman who underwent a canal wall up
tympanomastoidectomy and ossicular chain
reconstruction 10 years earlier for resection of a
cholesteatoma. The patient has had recurrent pressure and
a sensation of fluid in her ear.
 A, Axial and, B, coronal diffusion-weighted half-Fourier
acquisition single-shot turbo spin-echo images
demonstrate a focus of restricted diffusion (arrow) in her
operative site, compatible with a recurrent cholesteatoma.
 C, Axial T2-weighted sampling perfection with
application-optimized contrasts by using flip angle
evolution (SPACE) image and,
 D, axial contrast-enhanced T1-weighted SPACE image
show nonspecific soft-tissue signal intensity with faint
peripheral enhancement (arrows), highlighting the
usefulness of diffusion-weighted imaging.
POTONGAN
AXIAL
 Axial magnetic resonance imaging at the
level of the nasopharynx showing the
anatomy of the upper parapharyngeal
space.

 (A) T2-weighted sequence where the

parapharyngeal fat (PF) appears
hyperintense.

 (B) Contrast-enhanced T1-weighted

sequence where the PF appears
hypointense.

 LPM = lateral pterygoid muscle;

 LVP m = levator veli palatine muscle;

 ppICA = parapharyngeal internal carotid

artery;

 TVP m = tensor veli palatine muscle.

 POTONGAN SAGITAL
DAN MASSA PADA
POTONGAN AXIAL

 A: Midsagittal magnetic resonance image (MRI) of the head, showing the

nasopharynx and related structures. 

 B: Axial contrast-enhanced MRI showing a small tumor in the left fossa of

Rosenmüller (arrow) and normal structures in the rest of the nasopharynx.
 A: Axial T1-weighted magnetic resonance image
(MRI) demonstrating involvement of the maxillary
branch of the trigeminal nerve by nasopharyngeal
carcinoma (V2) (arrow). 
 B: Coronal contrast-enhanced MRI showing
involvement of the trigeminal cave (also known
as Meckel’s cave) by nasopharyngeal carcinoma
(arrow). 
 C: Coronal contrast-enhanced MRI showing
involvement of the maxillary branch of the
trigeminal nerve by nasopharyngeal carcinoma (V2)
(arrow).
  A: Axial T1-weighted magnetic resonance image (MRI) showing tumor infiltration of the right
parapharyngeal space (left arrow). Note the resultant serous otitis media (right arrow). 

 B: Axial contrast-enhanced MRI showing enhanced tumor involving the parapharyngeal space
and medial pterygoid muscles (arrow).
  A: Axial contrast-enhanced magnetic resonance image (MRI) demonstrating involvement of
the cavernous sinus by nasopharyngeal carcinoma. 
 B: Axial contrast-enhanced MRI showing invasion of pterygopalatine fossa (vertical arrow) with
spread to cavernous sinus (horizontal arrow).
 NORMAL PARANASAL
SINUSES
 Normal MRI study of the paranasal sinuses. Axial and coronal
scans are routinely obtained before and after intravenous
gadolinium chelate administration.

 (A) axial T1W,

 (B) axial T2W, (

 C) axial fat‐suppressed contrast‐enhanced T1W, and

 (D) coronal T2W scans. Additionally,

 (E) sagittal fat‐suppressed contrast‐enhanced T1W scans may

also be obtained. Note that on postcontrast images, the mucosa
enhances physiologically and should not be interpreted as
abnormal.

 M, maxillary sinus; E, ethmoid sinus; S, sphenoid sinus.

 NASAL POLYPS
 A 44‐year‐old female with aspirin intolerance and history of
allergic sinusitis. Axial

 (A) T1W,

 (B) T2W,

 (C) at‐suppressed contrast‐enhanced T1W images

demonstrate extensive polyps within the maxillary sinuses
and the nasal fossae, appearing hypointense on T1W
sequences, hyperintense on T2W images, and without
significant contrast enhancement. Some of the polyps
demonstrate mildly increased T1 and low T2 signal
(arrows) likely reflecting secretions of higher protein
concentration. Mucosa overlying the individual polyps
shows enhancement on the postcontrast sequences
(curved arrows). Also, note the fluid level within the left
sphenoid sinus is suggestive of acute sinusitis (asterisk).
SINUS MASSES
 (A) Coronal T2W,

 (B) axial T1W, and

 (C) fat‐suppressed contrast‐enhanced axial T1W scans

demonstrate a left maxillary sinus mass (arrow) extending
into the orbit that is hypointense on T1W and T2W
sequences and shows contrast enhancement.

 (D) Axial postcontrast CT soft‐tissue algorithm and

 (E) coregistered FDG PET images demonstrate a destructive

left maxillary sinus mass (centered in the red crosshairs) that
extends into the orbit and has significant FDG uptake (SUV
of 8.5). Histopathologic analysis confirmed the diagnosis of
squamous cell carcinoma. The diffuse FDG uptake within the
brain reflects its normal baseline metabolic rate.
SINUSITIS
WITH EPIDURAL
ABSCESS
 A 12‐year‐old boy with fever and headache.

 (A) Axial CT scan

 (B) Axial images just superior to the sinus, on the

contralateral side, reveal an epidural fluid collection
(arrows), which is relatively hyperintense on the T2W
image,

 (C) shows peripheral enhancement on the fat‐

suppressed contrast‐enhanced T1W image, and

 (D) exhibits restricted diffusion on the diffusion‐

weighted image. Findings are consistent with an
epidural abscess. Sinusitis rarely causes intracranial
complications as in this case, but the risk increases
significantly in immunocompromised patients.
ACUTE BACTERIAL
SINUSITIS
  Acute bacterial sinusitis in a 10-year-old boy.
 A, An axial T1-weighted magnetic resonance
(MR) image shows hypointense material in the
right maxillary sinus (arrows). 
 B, An axial T2-weighted MR image shows
corresponding T2-hyperintense material
(arrows). 
 C, An axial T1-weighted MR image with fat
saturation and contrast shows circumferential
mucosal enhancement. 
 D and E, Corresponding decreased diffusivity in
the right maxillary sinus is shown on diffusion-
weighted imaging and apparent diffusion
coefficient maps consistent with purulent
material.
Laryngeal Tymors
• Potongan Axial

Supraglottic tumor. A, Axial T1-weighted image. The tumor (T) fills most of the right supraglottic larynx and crosses
the midline. Paraglottic and preepiglottic spaces are invaded. Note that the tumor and the prelaryngeal strap
muscles (arrow) have the same signal intensity. The strap muscle would have the same signal as the thyroarytenoid
muscle (TAM). B, Axial T2-weighed image. The tumor has significantly more signal than the prelaryngeal strap
muscle. Arrowhead indicates fat in the medullary cavity of the ossified thyroid cartilage. 
 Potongan Sagital

MR imaging, larynx. Sagittal localizer showing the

epiglottis, valleculae, and base of the tongue.
 MR imaging, larynx. Sagittal T1-weighted MRI of the
larynx in a patient with squamous cell carcinoma.
Note extension into the supraglottis.
Squamous cell carcinoma of larynx
with transglottic spread - T4
  Potongan Koronal

Coronal postcontrast T1-weighted image. The tumor (T) fills MR imaging, larynx. Coronal T1-contrasted MRI
the supraglottis but is separated from the TAM and thus the showing a laryngeal schwannoma (T).
true fold by a small amount of fat (arrow) in the paraglottic
space at the level of the ventricle (V)
Vocal Cord Paralysis
The MRI features of recurrent laryngeal nerve paralysis are
explained by atrophy of the thyroarytenoid muscle and include an
enlarged ventricle, ipsilateral enlargement of the piriform sinus,
paramedian position, decreased size and/or fatty infiltration of the
true vocal cord.
Axial (B) and coronal (C) contrast-enhanced T1-weighted images
show atrophy of the right aryepiglottic fold (arrow in B) and
enlargement of the ipsilateral piriform sinus. The right laryngeal
ventricle is also enlarged (arrow in C) and the right thyroarytenoid
muscle is slightly hyperintense due to denervation atrophy. The
radiologic findings are characteristic for recurrent laryngeal nerve
paralysis.
 MRI scanning has become
the primary investigation in
the diagnosis of suspected
acoustic neuromas