Role of Cross-Sectional Imaging in Tongue Lesions

Abstract

Background: The purpose of this study was to determine the role of CT and MR imaging in demonstrating lesions of the tongue. Imaging can help to decide the further management of the patient, and when resection is considered, the precise extent of the lesion can be delineated, and also if organ conservation therapy can be suggested. Hence, knowing the differentiating characteristics of these lesions is essential for a Radiologist to narrow the differential diagnosis. The aim of the study is to describe the imaging findings of various tongue lesions, give radio-pathological correlation, and discuss the role of CT and MRI in planning further appropriate treatment, the extent of involvement of adjacent structures, resectability, postoperative reconstruction & prognosis. Subjects and Methods: Twenty patients with tongue masses were prospectively evaluated with CT & MRI for eighteen months from June 2018 - Nov 2019. Contrast-enhanced CT axial images with reconstruction were acquired. MRI plain & contrast study done. Imaging findings & diagnoses were later correlated with surgical and histopathological results in all possible cases. Results: Among twenty patients, three patients revealed no abnormality; seventeen patients with findings on imaging include twelve squamous cell carcinoma, two venous malformations, two thyroglossal cysts, one hemangioma & one fatty lipoma. Conclusion: Few specific lesion characteristics can aid in narrowing the differential diagnosis. Solid high-density lesions in the midline mostly represent lingual thyroids. Calcifications likely indicate goitrous transformation. Phleboliths are highly suggestive of venous malformations. Multinodular, thin-rim enhancing cystic lesions are indicative of lymphatic malformations, primarily when fluid-fluid levels are found. Fat/calcium content within a complex cystic lesion is specific for a dermoid cyst, whereas diffusion restriction within a pure cystic lesion is suggestive of an epidermoid cyst. Finally, when an injury is Trans spatial, three differentials to be considered are highly aggressive malignancies, congenital masses & aggressive infections.