Srinivasan A, ed. Mukherji SK, consulting ed. Neuroimaging Clinics of North America: State of the Art Evaluation of the Head and Neck. Elsevier; 2020;30(3):261–392; $397.00

Coming nearly in a coordinated fashion with the just-ended virtual American Society of Head and Neck Radiology Annual Meeting, the current issue of Neuroimaging Clinics develops a number of themes that are pertinent to the practice of head and neck radiology or will soon become incorporated into interpretation and reporting of head and neck cases.

Edited by Dr. Ashok Srinivasan from the University of Michigan and authored/co-authored by 33 contributors, there are 9 chapters, which delve into some of the major areas of imaging of the head and neck. After a review of the general principles of DWI, the chapter on diffusion MR imaging shows, with good examples, how DWI can be useful in differential diagnosis, and more importantly, how separation of some malignant versus benign lesions can be suggested by findings on DWI. Shown are examples where the DWI/ADC findings are typical for malignancy but also where relying on those criteria alone could be misleading (as in the example of chondrosarcoma). Beyond the conventional DWI, this chapter explores diffusion tensor imaging and diffusion kurtosis imaging while showing classic examples of how these and routine DWI can be helpful in diagnosis. The illustrations illuminate the points made in the text.

Whether MR spectroscopy ever becomes more than a rarely used technique is a matter of conjecture, but the chapter entitled “MR Spectroscopy of the Head and Neck” could serve as a platform for those attempting to utilize spectroscopy in their practice.

The need to continually improve image quality in the head and neck by applying new or modified sequences is the theme of the chapter “Technical Improvements in Head and Neck Imaging: At the Cutting Edge.” Covered in adequate background detail are 3D techniques, black bone imaging, variations in fat suppression, and vascular MR imaging (which includes angiography, permeability, ASL, and perfusion). Faster image acquisition often means the difference between a nondiagnostic and a diagnostic study, so a review of accelerated acquisition fits well in this chapter.

While most practices do not utilize dual-energy CT, the chapter entitled “Dual-Energy Computed Tomography in Head and Neck Imaging: Pushing the Envelope” points out the principles behind the effectiveness of dual-energy CT and how it can be applied. Where it is useful, as in thyroid cartilage evaluation or in generating iodine maps, is shown in proper illustrative material. In the latter instance, suspected tumor boundaries are more clearly defined in SCC.

Following the lead of other standardized reporting systems such as BI-RADS or TI-RADS, the chapter “Neck Imaging Reporting and Data System: Principles and Implementation” sets forth parameters/templates to be used in the reporting of posttreatment evaluation of head and neck cancer, here called NI-RADS, in which a well-developed point system is used. The included table shows exactly how this information is determined and reported. The level of suspicion for tumor recurrence or residual lends itself to clarifying the imaging/clinical status of each patient. The trick, of course, is getting this integrated into individual practices in a manner similar to that universally used in breast imaging.

For those even more deeply involved in head and neck imaging as a subspecialty area, additional chapters on PET imaging in tumor hypoxia, the role of advanced imaging in radiation therapy, artificial intelligence in head and neck imaging, and common data elements in head and neck radiology reporting will be of interest. This last chapter defines the specific elements that should be in a report for a given examination or clinical question. This chapter points out the advantage of these common elements, but also indicates differences in attitude and advantages/disadvantages toward structured reports versus narrative reports. Some examples are shown, but the font size on some of the reports makes it difficult to impossible to read.

This is a valuable volume and Drs. Suresh Mukherji and Ashok Srinivasan are to be congratulated for having put together material that will be important in the hands of all those who interpret head and neck imaging.



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