MRI FINDING IN LINGUAL HEMANGIOMA

M. AMOR, S . MA JDOUB, M . DHIFALL AH, H. ZAGHOUA NI , T. RZ IGA , H. AMARA , D . BAK IR , C .KRA IEM RAD IOLOGY SERV ICE , UN IVERS ITY HOSPITAL FARHAT HACHED SOUSSE , TUNIS IA

HN8

To describe the plain and enhanced MRI findings of lingual hemangioma.

To discuss the importance of contrast medium in the differential diagnosis of high intensity lesions of the tongue on T2 weighted images.

OBJECTIVES

The clinical records and MR images of two patients affected by a lingual hemangioma were reviewed.

Patients presented with a palpable submucosal bluish-red soft mass in the tongue.

MATERIALS AND METHODS

MRI examinations were performed. Plain and enhanced SE (spin echo) T1 weighted and FSE (fast spin echo) T2 weighted images were acquired in axial, sagittal and coronal planes.

Axial T1 weighted images were also obtained before and after intravenous injection of paramagnetic contrast medium.

MATERIALS AND METHODS

The two cases MR imaging shows the lesion as a solid mass with iso or slightly high signal intensity to muscle on T1-weighted images (figure 1) and heterogeneous signal intensity on T2-weighted images (figure 2 and 3).

RESULTS

Figure 1: axial fat sat T1-weighted

Figure 2: axial fat sat T2- weighted

Figure 3: sagittal fat sat T2-weighted

Postcontrast T1-weighted imaging commonly demonstrates prominent enhancement (figure 4, 5 and 6).

Due to the presence of multiple low signal intensity vessels with rapidly flowing blood, the hemangiomas have a typical serpentine appearance.

RESULTS

Figure 4: axial fat sat T1-weighted+gado

Figure 5: sagittal fat sat T1-

weighted+gado

Figure 6: coronal fat sat T1-

weighted+gado

Hemangioma is the most common tumor of infancy.

The basis of the cellular features described by Mulliken and Glowacki in 1982, vascular lesions may be classified as either hemangioma or vascular malformation.

They proposed that the term ‘hemangioma’ should be limited to those lesions that show increased mitotic activity.

DISCUSSION

Most hemangiomas are present at birth, but some do not manifest clinically until early childhood. They may regress spontaneously due to internal bleeding, thrombosis, or organization.

The most common sites of oral occurrence are the lip, buccal mucosa, tongue, and palate.

Lingual hemangiomas may remain indolent or may produce obstructive symptoms or alarming hemorrhage

DISCUSSION

Most lingual tumors present as mucosal changes and tongue being superficially located and easily accessed, these can be diagnosed without imaging analysis.

However, the characteristic and extent of lesions situated at deep portion of tongue, such as its base or submucosal lesions can be recognized only on cross- sectional CT scan or MRI.

DISCUSSION

MR imaging shows the lesion as a solid mass with iso- or slightly high signal intensity to muscle on T1-weighted images and heterogeneous signal intensity on T2-weighted images.

Postcontrast T1-weighted imaging commonly demonstrates prominent enhancement.

DISCUSSION

Due to the presence of multiple low signal intensity vessels with rapidly flowing blood.

Some hemangiomas have a typical serpentine appearance. The conspicuity of these signal void areas increases with tumor size.

DISCUSSION

Small lesions can be excised with impunity. Large lesions, if excised, could result in

significant functional  disability.  This is why several modalities of less invasive treatment have recently been advocated (Argon laser, YAG laser, or both to avoid functional disability caused by tissue loss).

There have been reports of treatment with superselective embolization using polyvinyl alcohol foam and absorbable gelatin sponge particulates.

DISCUSSION

Haemangiomas are among the most common neoplasms encountered in the paediatric age group.

Knowledge of MRI findings of lingual hemangioma is useful for differential diagnosis with other high intensity lingual lesions on T2 weighted images.

This discrimination is achievable using iv paramagnetic contrast medium.

CONCLUSION