Neuroradiology Back to the Future: Head and Neck Imaging

Abstract

SUMMARY:Imaging of the head and neck was initially described within the first year after Roentgen's discovery of the x-ray and was used to localize foreign bodies in the head and neck area, including the orbital, laryngeal, and esophageal regions. Subsequently, x-rays were used to evaluate the air-filled paranasal sinuses, the pneumatized temporal bone, and the upper aerodigestive tract. Special views for evaluating these structures were developed by early investigators. As contrast agents were developed, a variety of invasive procedures were developed to assess the structures of the head and neck. CT and MR imaging were applied to the extracranial head and neck slightly later than the brain and spine; these modalities revolutionized head and neck radiology, finally allowing assessment of the deeper structures of this complex anatomic region.

Large retropharyngeal abscess: a case of mistaken identity

“…Since all non-keratinising NPCs harbour EBV, methods to detect EBV have been invaluable in early identification of NPC cells. In situ hybridisation for EBER and, to a lesser extent, identification of the expression of LMP-1 are useful tools in EBV-associated NPC diagnosis 9 23. Indeed, EBER is the most sensitive and specific analysis available at present 21…”

“…Additionally, ∼90% of patients have EBV-positive serologies, and thus IgA against viral capsid antige (VCA) and early antigens (EAs) are useful screening tools to identify susceptible individuals, who may as yet be asymptomatic 9 20 23…”

“…Until the advent of cross-sectional radiology, only plain radiographs could be used to image soft tissue masses in the head and neck region, which predominantly assessed bone involvement and gave a rough estimation of the soft tissue lesion size 23 24…”

Challenges in early operative approaches to intramedullary spinal cord tumors: Harvey Cushing’s perspective

“…25 Cushing used x-rays in neurosurgical patients as early as 1897, and his first published spine case described the use of x-rays to localize bullets from a gunshot. 10,22,30 Contrast studies of the spine were developed in the 1920s.…”

“…37 Postulated in 1921 by Forestier and Sicard, Lipiodol myelography was one of the techniques used at that time for tumor localization. 25 Pain, inflammation, and arachnoiditis were common complications of the use of Lipiodol. 27 Harvey Cushing refused to use this technique because he was convinced that its complications outweighed its benefits, as was later demonstrated.…”