Radiological anatomy of the neck

Dr ABD ALLAH NAZEER MD

Neck anatomySuperficial neck structuresnasopharynxoropharynxoral cavityDeep neck structuresThe deep anatomy is separated by fascial planes into seven deep compartments of the head and neckpharyngeal (superficial) mucosal spaceparapharyngeal spaceparotid spacecarotid spacemasticator spaceretropharyngeal spaceperivertebral space

Neck anatomySuperficial neck structuresnasopharynxoropharynxoral cavityDeep neck structuresThe deep anatomy is separated by fascial planes into seven deep compartments of the head and neckpharyngeal (superficial) mucosal spaceparapharyngeal spaceparotid spacecarotid spacemasticator spaceretropharyngeal spaceperivertebral space

Spaces of the neckOral cavity

retromolar trigone tongue oral mucosal space submental space submandibular space superficial spaces (pharynx) nasopharynx Rosenmuller fossa oropharynx hypopharynx hypopharyngealsubsites larynx supraglottic spaceEpiglottis false vocal cords

aryepiglotic folds glottis true vocal cords subglottic space

Deep spaces of the neckpharyngeal (superficial) mucosal space parapharyngeal space styloid apparatus retropharyngeal space danger space parotid space carotid space carotid sheathmasticator space perivertebral space suprasternal space (of Burns) pterygopalatine fossa pterygomaxillary fissure infratemporal fossa

1 Lat amp Med ptyergoid plate

2 Ethmoid Sinus

3 Odontoid Process

4 Sphenoid Sinus

5 Foramen ovale

6 Maxillary Sinus

7 Mastoid air cells

8 Ant arch of C-1

9 Margin of foramen magnum

10 Ext auditory canal

LATERAL NECK

1 Hard pallate

2 Soft pallate

3 Nasopharynx

4 Oropharynx

AIRWAY

1 Calcified tracheal

cartilage rings

2 Hyoid bone

3 Epiglottis

4 Thyroid cartilage5 Cricoid cartilage

Thyroid US imaging

Neck Spacesbull Suprahyoid neck spacesndash Pharyngeal mucosalndash Masticatorndash Parotidndash Carotidndash Buccalndash Parapharyngealndash Retropharyngealndash Prevertebral

Anatomic Localizationbull Pharyngeal mucosal spacendash Nasopharynxndash Oropharynxndash Hypopharynx

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

LATERAL NECK

1 Hard pallate

2 Soft pallate

3 Nasopharynx

4 Oropharynx

AIRWAY

1 Calcified tracheal

cartilage rings

2 Hyoid bone

3 Epiglottis

4 Thyroid cartilage5 Cricoid cartilage

Thyroid US imaging

Neck Spacesbull Suprahyoid neck spacesndash Pharyngeal mucosalndash Masticatorndash Parotidndash Carotidndash Buccalndash Parapharyngealndash Retropharyngealndash Prevertebral

Anatomic Localizationbull Pharyngeal mucosal spacendash Nasopharynxndash Oropharynxndash Hypopharynx

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

AIRWAY

1 Calcified tracheal

cartilage rings

2 Hyoid bone

3 Epiglottis

4 Thyroid cartilage5 Cricoid cartilage

Thyroid US imaging

Neck Spacesbull Suprahyoid neck spacesndash Pharyngeal mucosalndash Masticatorndash Parotidndash Carotidndash Buccalndash Parapharyngealndash Retropharyngealndash Prevertebral

Anatomic Localizationbull Pharyngeal mucosal spacendash Nasopharynxndash Oropharynxndash Hypopharynx

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Thyroid US imaging

Neck Spacesbull Suprahyoid neck spacesndash Pharyngeal mucosalndash Masticatorndash Parotidndash Carotidndash Buccalndash Parapharyngealndash Retropharyngealndash Prevertebral

Anatomic Localizationbull Pharyngeal mucosal spacendash Nasopharynxndash Oropharynxndash Hypopharynx

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Neck Spacesbull Suprahyoid neck spacesndash Pharyngeal mucosalndash Masticatorndash Parotidndash Carotidndash Buccalndash Parapharyngealndash Retropharyngealndash Prevertebral

Anatomic Localizationbull Pharyngeal mucosal spacendash Nasopharynxndash Oropharynxndash Hypopharynx

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Anatomic Localizationbull Pharyngeal mucosal spacendash Nasopharynxndash Oropharynxndash Hypopharynx

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Neck Spacesbull Infrahyoid neck spacesndash Visceral spacendash Posterior cervical spacendash Anterior cervical spacendash Retropharyngeal spacendash Prevertebral spacendash Carotid space

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Larynxbull Larynxndash Glottisndash Subglottisndash Supraglottis

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Lymph nodesbull Level I (1)bull Level II (2)bull Level III (3)bull Level IV (4)bull Level V (5)bull Level VI (6)bull Level VII (7)

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

bull Better soft tissue differentiationbull Gadolinium enhancementbull Recognize basic sequences T1

T2 fat saturated enhancedbull Lymph nodes can be better

seen than on CT

Neck MR Imaging Anatomy

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Protocol

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Suprahyoid neck anatomy

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Fig 1 Suprahyoid neck anatomy (A) Sagittal T1-weighted midline image of the neck demarcating the

level of the hyoid bone (blue line) separating the suprahyoid neck above from the infrahyoid neck below Other colored lines demarcate the various levels listed below (red line B orange line C yellow line D green line E) (B) Axial T2- weighted image at the skull base the cephaled-most aspect of the masticator space (red outline) extends superior to the zygomatic arch (arrow) Any disease process that occurs in this space warrants evaluation superiorly to the aponeurosis of the temporalis muscle (T) along the calvarium GS greater wing of sphenoid Max maxillary sinus m mandible asterisk pterygopalatine fossa (C) Axial T1-weighted image more inferiorly at the alveolar ridge The parapharyngeal space (PPS black outline) is readily apparent as a T1 hyperintense region relating to its fat content Anterolateral is the masticator space (red border) containing the masseter (M) lateral pterygoid (lp) and medial pterygoid (mp) muscles The buccal space is located just anterior to the masticator space (B asterisk border) Lateral to the parapharyngeal space is the parotid space (green border) which encompasses the isointense gland itself along with the retromandibular vein (v) within the substance of the parotid parenchyma The carotid space encompassing the internal carotid artery (IC) and internal jugular vein (IJ) provides an additional lateral border to the PPS Note the T1 isointense mucosal space medial to the PPS including the torus tubaris (arrow) Posteriorly is the perivertebral space (yellow border) containing the longus colli muscle (D) Axial T2-weighted image more inferiorly at the level of the oropharynx Note the continuation of the masticator space (red outline) containing the mandible (m) and masseter (M) The parotid (green border) and parapharyngeal spaces have tapered down The perivertebral space (yellow outline) is again noted located just dorsal to the retropharyngeal space (blue border) Ton palatine tonsils IJ internal jugular vein IC internal carotid artery v retromandibular vein LC longus colli (E) Axial T1-weighted image at the level of the submandibular glands and hyoid bone (labeled) As the other suprahyoid neck spaces continue to taper down the submandibular space appears (orange outline) This is bordered medially and superiorly by the isointense mylohyoid muscle (labeled) and contains the submandibular gland (labeled) as well as fat The median raphe of the tongue is denoted by an arrow and the epiglottic valeculla can be seen posteriorly (v)

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Coronal T1-weighted imaging of the suprahyoid neck at several levels

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Fig 2 Coronal T1-weighted imaging of the suprahyoid neck at several levels (A) Just dorsal

to the mandibular mentum the sublingual glands (slg) are present between the mylohyoid (mylo) and genioglossus (GG) muscles They are of increased signal intensity in comparison with muscle Inferior to the mylohyoid muscle is the anterior belly of the digastric (Dig) The fatty T1-hyperintense median raphe of the tongue is present superiorly between the genioglossus muscles (white arrow) Just inferior to the hard palate (white arrowheads) which is hyperintense because of marrow fat is the apposed tongue surface with intrinsic musculature (labeled) noted The buccal mucosa and buccinator musculature are noted along the lateral border of the oral cavity (black arrow) Max maxillary sinus (B C) More posteriorly the masticator space is noted with the masseter (Masseter) and temporalis (Temp) muscles now identified (labeled) along with the T1 hyperintense zygomatic arch (Z) The buccal fatspace is well demonstrated (Buc) and the geniohyoid muscle (GH) is noted along the floor of the mouth Stensen duct is present lateral to the buccal mucosa (black arrowhead) and the parotid gland comes into view (black arrow) (D) At the level of the nasal choana the oral cavity structures are again well seen including the mylohyoid muscle which divides the submandibular space inferiorly from the sublingual space superiorly The hyoglossus muscle is noted along the lateral margin of the tongue providing the medial margin of the sublingual space Within the masticator space the medial and lateral pterygoids are identifiable (mp lp) The soft palate (labeled) is also now noted (E) At the level of the mandibular rami the submandibular glands (SMG) are visualized inferiorly as are the parotid glands (PG) superiorly Posterior and medial to the masticator space is the fat filled T1-hyperintense parapharyngeal space (PPS) The longus colli (LC) muscles of the prevertebral space are well seen as are the lingual (labeled) and palatine tonsils (PT)

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Imaging of the infrahyoid neck

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Fig 3 Imaging of the infrahyoid neck (A) Sagittal T1-weighted image demonstrates

the geniohyoid (labeled) and genioglossus (GG) muscles along the floor of the mouth attaching to the T1-hyperintense mandible (M) The intrinsic tongue muscles (ITM) lie essentially apposed to the hard (black arrow) and soft (SP) palates The epiglottis (white arrow) lies posterior to the vallecula (v) The air-filled T1-hypointense trachea (T) is noted inferiorly Posteriorly the vertebrae are noted (C2 and T1 labeled) (B) Coronal T1-weighted image highlights the false (black arrow) and true (white arrow) vocal cords with a small amount of T1-hyperintense fat noted along the false cord The hyoid bone is visualized (labeled) and the mylohyoid (MH) mandible (M) and masseter (Mass) muscle are seen (C D) Axial T1-weighted image through the larynx Superior image (C) demonstrates the false vocal cords (black arrow) with the paired air-filled T1 hypointense pyriform sinuses noted posteriorly (asterisk) Subjacent to the sternocleidomastoid muscle are the common carotid artery (cc) internal jugular vein (IJ) and jugular chain lymph nodes (N) The vertebral artery (v) is noted traversing the foramen transversarium whereas the spinal cord (SC) is noted posteriorly Inferiorly (D) the true cords (v) are noted with a portion of the cricoid cartilage seen posteriorly (C) (E) Axial T2-weighted fat-suppressed image at the same level Most of the neck tissues lose signal A few small nodes are again present (circled) and a venous plexus is noted along the spinal column (arrowhead) The T2-hyperintense cerebrospinal fluid surrounds the spinal cord (F) Axial T1-weighted image at the level of the thyroid gland (Thy) The thyroid borders the trachea and the esophagus (E) The brachial plexus (asterisk) is noted traveling between the anterior (AS) and middle (MS) scalene muscles

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Brachial plexus imaging

Brachial plexus imaging (AndashC) Sagittal T1-weighted imaging of the brachial plexus (A) Along the lateral aspect of the cervical spine the originating nerve roots can be seen as they exit the neural foramina (circles) (B) As the plexus forms (circled) it can be seen posterior to the anterior scalene muscle (white arrow) and superior to the subclavian artery (black arrow) (C) Laterally the plexus (circled) is best seen superior to the axillary artery (black arrow) (D E) Coronal T1-weighted (D) and STIR (E) imaging of the plexus Note the plexus descending through the thoracic inlet (white arrowheads) (F) Axial T2-weighted image at the thoracic inlet demonstrates bilateral plexi(white arrows) traveling posterior to the anterior scalene (AS) Midline trachea (T) and esophagus (E) are present and the spinal cord is noted centrally (black arrow)

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

Contrast-enhanced MR angiogram of the neck was obtained and presented as MIP images (A anteroposterior view B oblique) The aortic arch most commonly gives rise to 3 great vessels the innominate (or brachiocephalic) artery (IA) the left subclavian artery (LSA) and the left common carotid artery (LCC) The right common carotid artery (RCC) arises off of the innominate distally Both common carotids travel anteriorly within the carotid space of the neck and bifurcate (white arrows) at approximately the level of the hyoid bone into external (black arrowhead) and internal carotid arteries (ICA white arrowhead) The vertebral arteries (black arrows) are typically the first branches off of the subclavian arteries and ascend posteriorly along the transverse foramina entering the skull base through the foramen magnum

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

ARTERIOGRAM

1 Internal Carotid Artery

2 Intracranial Carotid

3 Maxillary Artery

4 Occipital Artery

5 External Carotid Artery

6 Common Carotid Artery

7 Facial Artery

THYROID SCAN

Nuclear Medicine

Thank You

THYROID SCAN

Nuclear Medicine

Thank You

Thank You