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Mandibular Lymphoma

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So this is an interesting case of a patient that

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presented with jaw pain with a history of lymphoma,

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and the patient did not have a palpable mass.

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But what was interesting in this particular case was

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as I was looking through this, it really made a couple

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of very interesting teaching points regarding MR

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and lymphoma, and especially with marrow diseases.

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So number one, when you're looking at

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MR, it's important that you perform

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all the appropriate sequences.

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So if you look at this sequence here, which is a

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T2-weighted sequence, and the patient has right jaw

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pain, the signal within the marrow looks like it's

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completely normal, and you can see the normal high

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signal T2 signal on the fat spin echo sequences.

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If you just looked at the T1

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weighted images with contrast,

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maybe you can see a little bit of low signal here,

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right at the root socket involving the mandible.

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And then you can say, well, is that just

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little sclerosis due to bad dentition?

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But on the other hand, when you look at the

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T1-weighted images without contrast, what we

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see here unequivocally, there is abnormal signal

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involving the anterior body of the right mandible.

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And then when we give contrast, we can see that

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there's diffuse enhancement within that marrow.

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So this was an example of mandibular lymphoma.

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And this mandibular lymphoma was just limited to

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the mandible, so there was no enlarged lymph nodes,

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rather this was all due to marrow replacement.

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So the specific teaching points on this is that when

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you are looking at lymphoma, make sure you look at

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the marrow, especially in the head and neck area.

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And number two, make sure that

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you look at all the sequences.

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And I always start with this sequence first,

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which is a non-contrast T1 weighted sequence.

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I wanna look at that replacement, then I do my T2s.

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Then I do my T1 weighted image with

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contrast, and then we always try to

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perform that fat suppressed sequence.

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And if you don't have good fat

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suppression, try to work with your magnet

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to make sure that you have good shim.

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Because when you see this, this is going to

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increase the conspicuity of this enhancement,

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and it's gonna be much greater and much more

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accurate than just looking at the T1 weighted

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images with contrast without the fat suppression.

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Description

Faculty

Suresh K Mukherji, MD, FACR, MBA

Clinical Professor, University of Illinois & Rutgers University. Faculty, Michigan State University. Director Head & Neck Radiology, ProScan Imaging

Tags

Oral Cavity/Oropharynx

Neuroradiology

Neuro

Neoplastic

MRI

Head and Neck

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