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Extra info for Essentials of Neuroimaging, An Issue of Radiologic Clinics

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Contrast-enhanced axial CT scan of the neck shows a large cystic lesion (arrowhead) medial to the right sternocleidomastoid muscle. Imaging features may suggest a branchial cleft cyst; however, the location is atypical for it. Pathologic examination revealed metastasis from papillary thyroid cancer. cinous adenocarcinoma, treated lymphoma, and granulomatous disease. Imaging characteristics: sonography Sonography of the neck offers an inexpensive and readily available means to evaluate for cervical adenopathy; however, operator experience is important because some of the sonographic findings of malignant disease may be subtle.

AJR Am J Roentgenol 1998;171:73–84. Keir SL, Wardlaw JM. Systematic review of diffusion and perfusion imaging in acute ischemic stroke. Stroke 2000;31:2723–31. Arenillas JF, Rovira A, Molina CA, et al. Prediction of early neurological deterioration using diffusion- and perfusion-weighted imaging in hyperacute middle cerebral artery ischemic stroke. Stroke 2002;33:2197–203. Tomandl BF, Klotz E, Handschu R, et al. Comprehensive imaging of ischemic stroke with multisection CT. Radiographics 2003;23:565–92.

Metastatic nodes are usually hypoechoic relative to muscle, with the exception of metastatic papillary carcinoma of the thyroid, which may appear hyperechoic, resembling the echogenicity of the thyroid gland [Fig. 9]. Identification of a hyperechoic node should prompt the operator to evaluate the thyroid gland for a possible thyroid carcinoma. Metastatic lymph nodes tend to have a distinct margin; an indistinct margin raises the possibility of extracapsular spread of disease [Fig. 10]. Necrosis and cystic change are frequently seen in metastatic disease, but may also be seen in granulomatous diseases.

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