The role of gadolinium-DTPA in the evaluation of extracranial head and neck mass lesions.

Based on our experience with 28 patients, there is good evidence that gadolinium-enhanced MR will be useful in evaluation of skull base involvement, sinus involvement, or intracranial extension by neoplasms that involve the neck above the hard palate. This region has historically been a difficult area to image with any modality, because of the detailed anatomy and numerous important structures that traverse it. Gadolinium-enhanced MR should provide a valuable tool in the evaluation and management of these patients. The evidence that gadolinium is useful in staging of primary and nodal squamous cell carcinoma of the extracranial head and neck is less apparent. Areas where gadolinium may be helpful include size and extent of primary tumor and internal architecture of nodes that do not meet size criteria for malignant adenopathy. This is an area in which more experience is necessary, employing careful correlation with enhanced CT, unenhanced MR, and surgical specimens. Posttreatment follow-up of head and neck squamous cell lesions is a potential use for gadolinium, but this too is yet to be adequately studied. We have found that gadolinium enhancement provides no additional information important to the management of benign head and neck lesions over enhanced CT or unenhanced MR.