0:00

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

0:24

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

0:32

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

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completely normal, and you can see the normal high

0:36

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,

0:48

right at the root socket involving the mandible.

0:52

And then you can say, well, is that just

0:54

little sclerosis due to bad dentition?

0:57

But on the other hand, when you look at the

0:59

T1-weighted images without contrast, what we

1:02

see here unequivocally, there is abnormal signal

1:06

involving the anterior body of the right mandible.

1:10

And then when we give contrast, we can see that

1:13

there's diffuse enhancement within that marrow.

1:15

So this was an example of mandibular lymphoma.

1:18

And this mandibular lymphoma was just limited to

1:21

the mandible, so there was no enlarged lymph nodes,

1:24

rather this was all due to marrow replacement.

1:27

So the specific teaching points on this is that when

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you are looking at lymphoma, make sure you look at

1:32

the marrow, especially in the head and neck area.

1:35

And number two, make sure that

1:37

you look at all the sequences.

1:39

And I always start with this sequence first,

1:41

which is a non-contrast T1 weighted sequence.

1:44

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

1:47

Then I do my T1 weighted image with

1:49

contrast, and then we always try to

1:51

perform that fat suppressed sequence.

1:53

And if you don't have good fat

1:54

suppression, try to work with your magnet

1:57

to make sure that you have good shim.

1:59

Because when you see this, this is going to

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increase the conspicuity of this enhancement,

2:04

and it's gonna be much greater and much more

2:07

accurate than just looking at the T1 weighted

2:10

images with contrast without the fat suppression.