Salivary Glands

Imaging of cancer of the minor salivary glands is covered in the corresponding sub-sites. Imaging of the major salivary gland masses is usually performed when the clinical exam does not provide accurate assessment of the anatomic extent of the tumor or when surgical excision is likely to have a positive margin on a vital structure. Imaging

Figure 3-21. Contrast CT images of left pyriform squamous cell carcinoma. Clockwise from upper left: serial images through the laryngo-pharynx. (1) Diseased left pyriform aperture. (2) Preserved left pyriform apex.

Figure 3-21. Contrast CT images of left pyriform squamous cell carcinoma. Clockwise from upper left: serial images through the laryngo-pharynx. (1) Diseased left pyriform aperture. (2) Preserved left pyriform apex.

should also be considered in the setting of cranial nerve palsy.55

Parotid lesions are easily outlined with CT when high quality multiplanar images can be acquired and intravenous contrast used. Contrast helps outline the lesion relative to the gland and provides better characterization of the vascular margin at the carotid sheath. The benefits of MRI over CT are better discrimination of the lesion relative to background parotid tissue (Figure 3-23) and slightly better discrimination of proximal neurotropic extension of disease along the Vllth nerve.

Image-guided biopsy is helpful when there is a need to establish the diagnosis prior to treatment. Follow-up imaging is best performed with the modality that revealed the lesion prior to treatment. Radiation changes produce extensive regional hyperintensity22 of the parotid bed and mastoid, limiting the value of T2-weighted images. Contrast-enhanced fat-suppressed T1-weighted images are important at this stage.1

Submandibular lesions are often managed without imaging prior to resection. Imaging of the neck can be performed to confirm the completeness of the resection and determine whether a limited neck dissection

Figure 3-22. Anterior esophagram of squamous cell carcinoma upper esophagus. (1) Varicoid appearance of squamous cancer cer-vicothoracic esophagus. (2) Trachea.

is appropriate. Both sublingual and submandibular salivary gland lesions are imaged with an oral cavity-type imaging protocol with careful attention to the floor of mouth and the status of Wharton's duct.

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