Considering PET/MR imaging as a whole-body staging tool, scan time restrictions in a single body area are mandatory for the costeffective clinical operation of an integrated multimodality scanner setting. It has to be considered that 18 F-FDG already acts as a contrast agent and that under certain circumstances MR contrast may not yield additional clinically relevant information. The concept of the present study was to understand which portions of the imaging information enhance the sensitivity and specificity of the hybrid examination and which portions are redundant. Methods: One hundred fifty consecutive patients referred for primary staging or restaging of head and neck cancer underwent sequential wholebody 18 F-FDG PET with CT-based attenuation correction, contrast-enhanced (ce) CT, and conventional diagnostic MR imaging of the head and neck in a trimodality PET/CT-MR system. Assessed were image quality, lesion conspicuity, diagnostic confidence, and the benefit of additional coronal and sagittal imaging planes in cePET/CT, PET/MR imaging with only T2-weighted fat-suppressed images (T2w PET/MR imaging), and cePET/MR imaging. Results: In 85 patients with at least 1 PET-positive lesion, 162 lesions were evaluated. Similar robustness was found for CT and MR image quality. T2w PET/MR imaging performed similarly to (metastatic lymph nodes) or better than (primary tumors) cePET/CT in the morphologic characterization of PET-positive lesions and permitted the diagnosis of necrotic or cystic lymph node metastasis without application of intravenous contrast medium. CePET/MR imaging yielded a higher diagnostic confidence for accurate lesion conspicuity (especially in the nasopharynx and in the larynx), infiltration of adjacent structures, and perineural spread. Conclusion: The results of the present study provide evidence that PET/MR imaging can serve as a legitimate alternative to PET/CT in the clinical workup of patients with head and neck cancers. Intravenous MR contrast medium may be applied only if the exact tumor extent or infiltration of crucial structures is of concern (i.e., preoperatively) or if perineural spread is anticipated. In early assessment of the response to therapy, in follow-up examinations, or in a whole-body protocol for non-head and neck tumors, T2w PET/MR imaging may be sufficient for coverage of the head and neck. The additional MR scanning time may instead be used for advanced MR techniques to increase the specificity of the hybrid imaging examination. Int egrated PET/CT has been established as an important diagnostic technique for staging and therapy assessment in advanced head and neck cancers. 18 F-FDG PET/CT has a higher sensitivity than CT or MR imaging for the detection of small lymph nodes (1). Also, in therapy assessment PET/CT has been shown to differentiate early responders from nonresponders (2). However, 18 F-FDG is known not to be specific to cancer cells, and inflammatory or physiologic uptake has to be considered as a differential diagnosis. Furthermore, cystic lymph node alte...

Although actinomycosis of the tonsil is well known and has even been described as mimicking tonsillar cancer, this is, to our knowledge, the first report of a carotid blowout secondary to actinomycosis.

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Zusammenfassung. In dieser Übersicht werden die Krankheitsbilder aus der Hals-/Nasen- und Ohrenheilkunde und deren Symptome, die gehäuft oder aber auch speziell nur in der Schwangerschaft auftreten, vorgestellt. Zusätzlich werden die jeweiligen Therapieoptionen in dieser teilweise vulnerablen Phase der Mutter und des Kindes diskutiert. Primär gilt der Grundsatz «so viel wie nötig, aber so wenig wie möglich». Auch wenn die Beschwerden häufig mit der Geburt des Kindes verschwinden, kann ein erheblicher Leidensdruck für die Betroffenen bestehen und eine Therapie nötig sein. Bei sämtlichen HNO-Erkrankungen, auch den nicht speziell mit der Schwangerschaft assoziierten, sollte eine adäquate Therapie durchgeführt werden.