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Open Access 01-12-2023 | Peritonsillar Abscess | Educational Review

MRI of acute neck infections: evidence summary and pictorial review

Authors: Jussi Hirvonen, Jaakko Heikkinen, Mikko Nyman, Tatu Happonen, Jarno Velhonoja, Heikki Irjala, Tero Soukka, Kimmo Mattila, Janne Nurminen

Published in: Insights into Imaging | Issue 1/2023

Abstract

Infection of the deep neck spaces is a life-threatening acute illness that requires prompt diagnosis and treatment. Magnetic resonance imaging (MRI) offers unsurpassed soft tissue discrimination and is therefore well suited for imaging neck infections. Recently, the feasibility, diagnostic accuracy, and clinical significance of this method have been documented in patients with acute neck infections. This review article summarizes the scientific evidence, provides a practical guide to image acquisition and interpretation, reviews the most common imaging findings, and discusses some difficult diagnoses and pitfalls in acute neck infections, to help both radiologists and clinicians in managing these critically ill patients.

Boscolo-Rizzo P, Stellin M, Muzzi E et al (2012) Deep neck infections: a study of 365 cases highlighting recommendations for management and treatment. Eur Arch Otorhinolaryngol 269:1241–1249. https://doi.org/10.1007/s00405-011-1761-1CrossRef

Nurminen J, Velhonoja J, Heikkinen J et al (2021) Emergency neck MRI: feasibility and diagnostic accuracy in cases of neck infection. Acta Radiol 62:735–742. https://doi.org/10.1177/0284185120940242CrossRef

Kamalian S, Avery L, Lev MH et al (2019) Nontraumatic head and neck emergencies. Radiographics 39:1808–1823. https://doi.org/10.1148/rg.2019190159CrossRef

Holt GR, McManus K, Newman RK et al (1982) Computed tomography in the diagnosis of deep-neck infections. Arch Otolaryngol 108:693–696CrossRef

Chuang S, Lin H, Wen Y, Hsu F (2013) Pitfalls of CT for deep neck abscess imaging assessment: a retrospective review of 162 cases. B-ENT 9:45–52

Elden LM, Grundfast KM, Vezina G (2001) Accuracy and usefulness of radiographic assessment of cervical neck infections in children. J Otolaryngol 30:82–89. https://doi.org/10.2310/7070.2001.20808CrossRef

Freling N, Roele E, Schaefer-Prokop C, Fokkens W (2009) Prediction of deep neck abscesses by contrast-enhanced computerized tomography in 76 clinically suspect consecutive patients. Laryngoscope 119:1745–1752. https://doi.org/10.1002/lary.20606CrossRef

Nurminen J, Heikkinen J, Happonen T et al (2022) Magnetic resonance imaging findings in pediatric neck infections—a comparison with adult patients. Pediatr Radiol 52:1158–1166. https://doi.org/10.1007/s00247-021-05275-6CrossRef

Alaia EF, Chhabra A, Simpfendorfer CS et al (2021) MRI nomenclature for musculoskeletal infection. Skeletal Radiol 50:2319–2347. https://doi.org/10.1007/s00256-021-03807-7CrossRef

10.

Heikkinen J, Nurminen J, Velhonoja J et al (2022) MRI findings in acute tonsillar infections. AJNR Am J Neuroradiol 43:286–291. https://doi.org/10.3174/ajnr.A7368CrossRef

11.

Heikkinen J, Jokihaka V, Nurminen J et al (2022) MRI of odontogenic maxillofacial infections: diagnostic accuracy and reliability. Oral Radiol. https://doi.org/10.1007/s11282-022-00646-7CrossRef

12.

Heikkinen J, Nurminen J, Velhonoja J et al (2022) Clinical and prognostic significance of emergency MRI findings in neck infections. Eur Radiol 32:1078–1086. https://doi.org/10.1007/s00330-021-08200-5.CrossRef

13.

Hoang JK, Branstetter BF, Eastwood JD, Glastonbury CM (2011) Multiplanar CT and MRI of collections in the retropharyngeal space: Is it an abscess? AJR Am J Roentgenol 196:W426–W432. https://doi.org/10.2214/AJR.10.5116CrossRef

14.

Bhatt AA (2018) Non-traumatic causes of fluid in the retropharyngeal space. Emerg Radiol 25:547–551. https://doi.org/10.1007/s10140-018-1619-6CrossRef

15.

Tomita H, Yamashiro T, Ikeda H et al (2016) Fluid collection in the retropharyngeal space: a wide spectrum of various emergency diseases. Eur J Radiol 85:1247–1256. https://doi.org/10.1016/j.ejrad.2016.04.001CrossRef

16.

Kirse DJ, Roberson DW (2001) Surgical management of retropharyngeal space infections in children. Laryngoscope 111:1413–1422. https://doi.org/10.1097/00005537-200108000-00018CrossRef

17.

Gavid M, Dumollard JM, Habougit C et al (2018) Anatomical and histological study of the deep neck fasciae: does the alar fascia exist? Surg Radiol Anat 40:917–922. https://doi.org/10.1007/s00276-018-1977-5CrossRef

18.

Snosek M, Macchi V, Stecco C et al (2021) Anatomical and histological study of the alar fascia. Clin Anat 34:609–616. https://doi.org/10.1002/ca.23644CrossRef

19.

Klug TE (2017) Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess. Dan Med J 64:B5333

20.

Vanhapiha N, Sanmark E, Blomgren K, Wikstén J (2022) Minor salivary gland infection as origin of peritonsillitis—novel theory and preliminary results. Acta Otolaryngol 142:182–186. https://doi.org/10.1080/00016489.2022.2026003CrossRef

21.

Klug TE, Rusan M, Fuursted K, Ovesen T (2016) Peritonsillar abscess: complication of acute tonsillitis or weber’s glands infection? Otolaryngol Head Neck Surg 155:199–207. https://doi.org/10.1177/0194599816639551CrossRef

22.

Blair AB, Booth R, Baugh R (2015) A unifying theory of tonsillitis, intratonsillar abscess and peritonsillar abscess. Am J Otolaryngol 36:517–520. https://doi.org/10.1016/j.amjoto.2015.03.002CrossRef

23.

Ahmed Ali S, Kovatch KJ, Smith J et al (2018) Predictors of intratonsillar abscess versus peritonsillar abscess in the pediatric patient. Int J Pediatr Otorhinolaryngol 114:143–146. https://doi.org/10.1016/j.ijporl.2018.08.042CrossRef

24.

Ali SA, Kovatch KJ, Smith J et al (2019) Predictors of intratonsillar versus peritonsillar abscess: a case-control series. Laryngoscope 129:1354–1359. https://doi.org/10.1002/lary.27615CrossRef

25.

Giurintano JP, Kortebein S, Sebelik M et al (2019) Intratonsillar abscess: a not-so-rare clinical entity. Int J Pediatr Otorhinolaryngol 119:38–40. https://doi.org/10.1016/j.ijporl.2018.12.039CrossRef

26.

Singh GB, Kumar D, Arora R et al (2015) A rare case of intratonsillar abscess in an adult. Clin Pract. https://doi.org/10.4081/cp.2015.804CrossRef

27.

Wang AS, Stater BJ, Kacker A (2013) Intratonsillar abscess: 3 case reports and a review of the literature. Int J Pediatr Otorhinolaryngol 77:605–607. https://doi.org/10.1016/j.ijporl.2012.12.034CrossRef

28.

Klug TE, Fischer ASL, Antonsen C et al (2014) Parapharyngeal abscess is frequently associated with concomitant peritonsillar abscess. Eur Arch Otorhinolaryngol 271:1701–1707. https://doi.org/10.1007/s00405-013-2667-xCrossRef

29.

Patel S, Bhatt AA (2018) Imaging of the sublingual and submandibular spaces. Insights Imaging 9:391–401. https://doi.org/10.1007/s13244-018-0615-4CrossRef

30.

Callahan MJ, Cravero JP (2022) Should I irradiate with computed tomography or sedate for magnetic resonance imaging? Pediatr Radiol 52:340–344. https://doi.org/10.1007/s00247-021-04984-2CrossRef

31.

Abdel Razek AAK, Mukherji S (2017) Imaging of sialadenitis. Neuroradiol J 30:205–215. https://doi.org/10.1177/1971400916682752CrossRef

32.

Bridwell RE, Koyfman A, Long B (2022) High risk and low prevalence diseases: adult epiglottitis. Am J Emerg Med 57:14–20. https://doi.org/10.1016/j.ajem.2022.04.018CrossRef

33.

De Crop A, Casselman J, Van Hoof T et al (2015) Analysis of metal artifact reduction tools for dental hardware in CT scans of the oral cavity: kVp, iterative reconstruction, dual-energy CT, metal artifact reduction software: does it make a difference? Neuroradiology 57:841–849. https://doi.org/10.1007/s00234-015-1537-1CrossRef

34.

Lee W-S, Jean S-S, Chen F-L et al (2020) Lemierre’s syndrome: a forgotten and re-emerging infection. J Microbiol Immunol Infect 53:513–517. https://doi.org/10.1016/j.jmii.2020.03.027CrossRef

35.

Jain K, Gupta N, Yadav M et al (2019) Radiological evaluation of airway—What an anaesthesiologist needs to know! Indian J Anaesth 63:257. https://doi.org/10.4103/ija.IJA_488_18CrossRef

36.

Wolf H, Rusan M, Lambertsen K, Ovesen T (2010) Necrotizing fasciitis of the head and neck. Head Neck 32:1592–1596. https://doi.org/10.1002/hed.21367CrossRef

37.

Goh T, Goh LG, Ang CH, Wong CH (2014) Early diagnosis of necrotizing fasciitis. Br J Surg 101:e119–e125. https://doi.org/10.1002/bjs.9371CrossRef

38.

Langner S, Ginzkey C, Mlynski R, Weiss NM (2020) Differentiation of retropharyngeal calcific tendinitis and retropharyngeal abscess: a case series and review of the literature. Eur Arch Otorhinolaryngol 277:2631–2636. https://doi.org/10.1007/s00405-020-06057-wCrossRef

39.

Lecler A, Obadia M, Savatovsky J et al (2017) TIPIC syndrome: beyond the myth of Carotidynia, a new distinct unclassified entity. AJNR Am J Neuroradiol 38:1391–1398. https://doi.org/10.3174/ajnr.A5214CrossRef

40.

Pines JM, Poarch K, Hughes S (2021) Recognition and differential diagnosis of hereditary angioedema in the emergency department. J Emerg Med 60:35–43. https://doi.org/10.1016/j.jemermed.2020.09.044CrossRef

41.

Grist TM (2019) The next chapter in MRI: back to the future? Radiology 293:394–395. https://doi.org/10.1148/radiol.2019192011CrossRef

42.

Wald LL, McDaniel PC, Witzel T et al (2020) Low-cost and portable MRI. J Magn Reson Imaging 52:686–696. https://doi.org/10.1002/jmri.26942CrossRef

43.

Ye JC (2019) Compressed sensing MRI: a review from signal processing perspective. BMC Biomed Eng 1:8. https://doi.org/10.1186/s42490-019-0006-zCrossRef

44.

Sandino CM, Cole EK, Alkan C et al (2021) Upstream machine learning in radiology. Radiol Clin N Am 59:967–985. https://doi.org/10.1016/j.rcl.2021.07.009CrossRef

45.

Tanenbaum LN, Tsiouris AJ, Johnson AN et al (2017) Synthetic MRI for clinical neuroimaging: results of the magnetic resonance image compilation (MAGiC) prospective, multicenter, multireader trial. AJNR Am J Neuroradiol 38:1103–1110. https://doi.org/10.3174/ajnr.A5227CrossRef

46.

Staw BM (1976) Knee-deep in the big muddy: a study of escalating commitment to a chosen course of action. Organ Behav Hum Perform 16:27–44. https://doi.org/10.1016/0030-5073(76)90005-2CrossRef

47.

Mellers BA, Erev I, Fessler DMT, et al (2001) Group report: effects of emotions and social processes on bounded rationality. In: Bounded rationality: the adaptive toolbox. The MIT Press, Cambridge, MA, pp 263–279.

48.

Samuelson W, Zeckhauser R (1988) Status quo bias in decision making. J Risk Uncertainty 1:7–59. https://doi.org/10.1007/BF00055564CrossRef

49.

Sananmuang T, Agarwal M, Maleki F et al (2020) Dual energy computed tomography in head and neck imaging: pushing the envelope. Neuroimaging Clin N Am 30:311–323. https://doi.org/10.1016/j.nic.2020.04.003CrossRef

50.

Forghani R, Mukherji SK (2018) Advanced dual-energy CT applications for the evaluation of the soft tissues of the neck. Clin Radiol 73:70–80. https://doi.org/10.1016/j.crad.2017.04.002CrossRef

51.

Scholtz J-E, Hüsers K, Kaup M et al (2015) Evaluation of image quality and dose reduction of 80 kVp neck computed tomography in patients with suspected peritonsillar abscess. Clin Radiol 70:e67–e73. https://doi.org/10.1016/j.crad.2015.04.009CrossRef

52.

Hattori Y, Azuma M, Nakada H et al (2021) Usefulness of virtual monochromatic images and iodine maps derived from dual-energy computed tomography for diagnosing deep neck abscesses. J Comput Assist Tomogr 45:625–628. https://doi.org/10.1097/RCT.0000000000001188CrossRef

Title: MRI of acute neck infections: evidence summary and pictorial review
Authors: Jussi Hirvonen
Jaakko Heikkinen
Mikko Nyman
Tatu Happonen
Jarno Velhonoja
Heikki Irjala
Tero Soukka
Kimmo Mattila
Janne Nurminen
Publication date: 01-12-2023
Publisher: Springer Vienna
Keywords: Peritonsillar Abscess
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Edema
Peritonsillar Abscess
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-022-01347-9

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MRI of acute neck infections: evidence summary and pictorial review

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