Cervical MRI and Tumor: Diagnostic Tool

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La cervical region is a very rich part of the body from an anatomical point of view (numerous anatomical structures) and histological (different tissues: bone, nervous, muscular, glandular, connective...). It is therefore likely to be affected by a wide variety of tumor pathologies.

The diagnosis of neck tumors is largely based on questioning and physical examination, but confirmation almost always requires additional examinations such as CT scan, MRI and histological study (biopsy).

THECervical MRI is one of the most advanced examinations for diagnosing many pathologies, in particular those affecting the soft tissues.

In this article we will talk about tumors in the cervical region and the interest of cervical MRI as a diagnostic tool for them.

Cervical region: reminder anatomical

La cervical region, part linking the head to the trunk, is very rich in anatomical elements:

  • Bone : the bone framework of the neck is represented essentially by the cervical spine, the upper part of the spine consisting of 7 vertebrae numbered from C1 to C7. Each of these is articulated with the vertebrae adjacent via a intervertebral disc, a fibrocartilaginous structure acting as a shock absorber.
  • Spinal cord : it is contained in the vertebral canal, a sort of bony tunnel formed by the superposition of vertebral foramina (holes dug in the center of the jerky vertebrate).
  • Muscles and tendons : they allow to give stability and mobility to the neck. Mention may in particular be made of the trapezius, the sterno-cleido-mastoid, the scalenes and the splenus.
  • Organs: the neck contains many organs such as the thyroid gland, parathyroid glands, larynx, trachea and the cervical part of the esophagus.
  • Ships: the neck is crossed by large-caliber vessels, in particular those intended for the vascularization of the brain such as the carotid arteries, the vertebral arteries and the jugular veins.

Tumor involving the cervical region

The great anatomical and histological richness of the cervical region exposes it to a wide variety of tumours:

  • Bone tumors: tumors affecting the spine can be primary (primary location, benign or malignant) or secondary (spinal metastases from another cancer, always malignant).
  • Tumors of the spinal cord : these so-called “intramedullary” central nervous system tumors can be benign or malignant. They manifest with a wide variety of neurological symptoms that are primarily the result of spinal cord compression.
  • Muscle tumors: benign (myomas) or malignant (myosarcomas) tumors that can affect any striated muscle in the body. In children, the neck is a predilection area for rhabdomyosarcomas (the most common malignant muscle tumors in children and adolescents).
  • Thyroid tumors : the thyroid gland can be the seat of nodules (nodular or multinodular goiter), functional or not (depending on whether or not they secrete an excess of thyroid hormones), benign or malignant. These nodules are usually palpable and easily detectable on cervical ultrasound.
  • Tumors of the larynx and trachea: cancers of the larynx or trachea particularly affect heavy smokers and alcohol drinkers.
  • Esophageal tumours: Esophageal cancer is most often diagnosed on the occasion of symptoms such as dysphagia (discomfort with swallowing) and the occurrence of regurgitation. Fibroscopy represents the examination of choice to highlight this pathology, but the final and precise diagnosis is only possible with the histological study of a biopsy of the tumor.

Symptoms (When to worry?)

Cancerous pathologies affecting the cervical region are extremely numerous and can manifest as very different symptoms depending on the seat of the tumour, its type, its evolutionary stage, the patient's condition, etc.

Here is a list of symptoms that may indicate the presence of a cancerous pathology in the cervical region:

  • Neurological symptoms

Neurological symptoms such as motor disorders upper or lower limbs (decreased muscle strength, partial or total paralysis, etc.), pain (localized, diffuse or giving irradiation), a loss of sensitivity to tingling in the limbs and/or trunk may indicate the presence of a spinal compression in the cervical region.

This compression could be due either to a nerve tumor growing in the spinal cord (intramedullary tumour), or a bone tumor affecting the spine cervical (compression of the spinal cord by narrowing the spinal canal).

Other pathologies can also lead to medullary compression at the cervical level (in particular the herniated disc). It is therefore essential to consult a doctor as soon as possible before any neurological symptoms.

  • Symptoms related to a muscle tumor

Cancers affecting the neck muscles can manifest themselves with different symptoms depending on the muscle affected, the type of tumor and its stage of development. In general, it is localized pain and the appearance of abnormal muscle masses (visible on inspection or perceptible on palpation).

  • Certain digestive symptoms

A dysphagia (discomfort with swallowing) persistent and gradually onset, regurgitation, foul breath, hiccough… These symptoms are suggestive of a tumor pathology affecting the esophagus, especially when they evolve in a general context of asthenia (chronic fatigue) and are accompanied by emaciation.

  • Certain respiratory symptoms

Symptoms such as a dysphonia (change of voice), difficulty swallowing or breathing progressive onset may be a sign of laryngeal cancer. Particularly when they occur in a person with risk factors such as tobacco use and alcohol.

Cervical MRI: Diagnostic tool?

MRI (Magnetic Resonance Imaging) is an examination ofmedical imaging using a magnetic field to obtain very detailed images of the internal structures of our organism. In addition to being non-invasive and harmless, MRI is extremely performances to diagnose many pathologies.

THECervical MRI is widely used in the diagnosis of pathologies affecting the neck region, especially those affecting soft tissues such as herniated discs and many types of you die cervical.

This examination is mainly of interest in the morphological study of cervical tumors. That is to say, it is effective in highlighting a mass (diagnosing its presence) and makes it possible to study some of its characteristics as :

  • The exact seat of the mass,
  • Its contours (regular or irregular),
  • Its dimensions (diameters),
  • Its shape (round, oval, etc.),
  • Its consistency (depending on the intensity of the signal on the MRI),
  • Its local extension (compared to neighboring structures),
  • Its vascularization (interest of a Cervical MRI with injection of contrast product to study the blood vessels feeding the tumour).

Thus, at the end of this magnetic resonance examination, the doctor will not only be able to make the diagnosis of a cervical tumor, But also have an idea of ​​whether it is benign or malignant.

Indeed, thanks to the morphological characteristics of a tumor obtained by imaging, it is possible to move towards a particular tumor type.

Nevertheless, the definitive and precise diagnosis will only be made with a biopsy mass. Only the latter makes it possible to study the microscopic structure of the tumor to determine:

  • His character benign ou malin.
  • Le cell type affected by malignant transformation (neurons, fibroblasts, osteoblasts, etc.).
  • Le degree of differentiation cancer cells (undifferentiated, poorly or highly differentiated, etc.).
  • The presence or not inflammatory infiltrates.
  • La vessel proliferation blood (angiogenesis)…

THECervical MRI is therefore a very powerful tool for diagnosing many types of tumors affecting the neck region.

There is another, even newer and more advanced imaging test for diagnosing different types of tumors called "positron emission tomography" ou “PET scanner” (“PET scan” among the Anglo-Saxons).

The PET scan is able to detect tumors by highlighting a increase de metabolic activity in certain areas of the body through the injection of radioactive glucose (tumors have a high metabolic activity and consume more glucose than healthy tissues, which makes it possible to distinguish them on the PET scan). Tumors therefore light up like blisters on imaging, even those that are undetectable on MRI.

Other exams may be used in the diagnosis of cervical tumors according to their locationns:

  • La fibroscopy for tumors of the esophagus.
  • La laryngoscopy for tumors of the larynx.
  • THEcervical ultrasound for thyroid tumors.
  • The blood tests to detect tumor biomarkers.
  • Etc

References

[1] MN Razafindranaivo, “MALIGNANT TUMORS OF THE ANTERIOR CERVICAL REGION IN THE HOSPITAL CENTER OF SOAVINANDRIANA”.

[2] S. Lezar, S. Hassen, W. Zamiati, and R. Kadiri, “NR31 Medullary tumors (about 24 cases)”, Journal of Radiology, flight. 87, no 10, p. 1492, 2006.

[3] J. Paris, M. Zanaret, and MA Chrestian, "Cervical tumors and adenopathies: what are the clinician's questions", Journal of Radiology, flight. 86, no 10, p. 1323, 2005.

[4] E. du C. de Neurochirurgie, “Tumours du rachis”.

[5] E. Saïji and L. Guillou, “Fibroblastic and myofibroblastic tumors of the head and neck”, in Annals of Pathology, 2009, vol. 29o 4, p. 335-346.

[6] J.-L. Lefebvre and D. Chevalier, “Cancers of the larynx”, EMC-Otolaryngology, flight. 2, no 4, p. 432-457, 2005.

[7] G. Jerusalem, R. Hustinx, Y. Beguin, and G. Fillet, “PET scan imaging in oncology”, European Journal of Cancer, flight. 39, no 11, p. 1525‑1534, July. 2003, doi: 10.1016/S0959-8049(03)00374-5.

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