Introduction to imaging: The head and neck
BMJ 2003; 327 doi: https://doi.org/10.1136/sbmj.0312446 (Published 01 December 2003) Cite this as: BMJ 2003;327:0312446
- John Frank, consultant in nuclear medicine and radiology1
- 1Charing Cross Hospital, London W6 8RF
Radiologists can image the head and neck in a variety of ways to show different pathologies. Radiologically, the head is made up of two separate parts--the cranium and the face. They grow at different rates, as can easily be seen in babies, who have a relatively large cranium that grows slowly, and a smaller face, which grows more quickly. Imaging the head usually relates to the cranium and contents. Always consult an imaging department for the best advice so that radiologists can tailor the correct investigation to the question you need answering.
When to request a plain x ray
Doctors often request plain x rays of the skull for vague symptoms such as headache. The only real indication for plain x rays of the skull in an adult, however, is trauma.1 Other intracranial problems do not show up in plain x ray images. Rare conditions, such as chronic raised intracranial pressure, will be diagnosed by computed tomography (CT) long before they cause any changes to the inner table of the skull vault. The only time plain x rays are of use is in imaging facial bones to look for fractures or infections such as sinusitis (figs 1 and 2).
X ray image showing opaque left maxillary antrumdue to sinusitis. Sinuses are usually filled with air, which is black in x rayimages; opacity is caused by the air space being filled with pus and fluid
X ray image of a fracture of the floor of theleft orbit with an opaque left maxillary antrum filled with blood
Magnetic resonance imaging or computed tomography?
You should investigate any suspected intracranial lesion with either CT or magnetic resonance imaging (MRI) (figs 3 and 4). The commonest suspected lesions are strokes or tumours. Intracranial lesions such as …
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