T2 Shine-Through Phenomenon in a Plunging Ranula

Aim This case report aims to demonstrate a case of T2 shine-through using MRI and clinical features in a patient with a plunging ranula. Case Report In this report, a 16-year-old male presented with a left submandibular space expansion and a painless intraoral cystic lesion near the caruncula sublingualis. Clinical signs pointed towards a plunging ranula. MRI revealed a hypointense, well-defined lesion in T1 images and a hyperintense lesion extending from the sublingual gland through musculus mylohyoideus to the submandibular space, featuring a characteristic tail sign in T2 images. Notably, diffusion-weighted (DWI) TRACE images and apparent diffusion coefficient (ADC) images both displayed a hyperintense lesion, indicative of T2 shine-through. The combined evaluation of fine-needle aspiration cytology and imaging led to the diagnosis of a plunging ranula, and the patient was referred for surgical intervention by the oral and maxillofacial surgery department. Discussion The differential diagnosis of lesions can be aided by DWI and ADC values. T2 shine-through, as seen in this case, manifests as hyperintensity on both DWI-TRACE and ADC images, distinct from diffusion restriction. This phenomenon arises from prolonged T2 decay time in specific tissues. Similar instances have been noted in epidermoid cysts and, as illustrated here, in a plunging ranula. Conclusion Dentomaxillofacial radiologists should be attuned to the T2 shine-through effect, which can lead to misinterpretation when assessing lesions using DWI-TRACE and ADC sequences. This case underscores the need for accurate differentiation between diffusion restriction and T2 shine-through, enabling informed treatment choices.

Keywords:

Apparent diffusion coefficient, Diffusion weighted imaging, Magnetic resonance imaging Plunging ranula, T2 shine-through,

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Harrison, J.D., The persistently misunderstood plunging ranula. Am J Otolaryngol, 2022. 43(1): p. 103276.
Katabi, N. and J.S. Lewis, Update from the 4th Edition of the World Health Organization Classification of Head and Neck Tumours: What Is New in the 2017 WHO Blue Book for Tumors and Tumor-Like Lesions of the Neck and Lymph Nodes. Head Neck Pathol, 2017. 11(1): p. 48-54.
Carlini, V., et al., Plunging Ranula in Children: Case Report and Literature Review. Pediatr Rep, 2016. 8(4): p. 6576.
Roh, J.L., Transoral Complete vs Partial Excision of the Sublingual Gland for Plunging Ranula. Otolaryngol Head Neck Surg, 2021: p. 1945998211067500.
Syebele, K. and T.I. Munzhelele, The anatomical basis and rational for the transoral approach during the surgical excision of the sublingual salivary gland for the management of plunging ranula. Am J Otolaryngol, 2020. 41(2): p. 102371.
Suresh, K., A.L. Feng, and M.A. Varvares, Plunging ranula with lingual nerve tether: Case report and literature review. Am J Otolaryngol, 2019. 40(4): p. 612-614.
Lyly, A., et al., Plunging ranula - patient characteristics, treatment, and comparison between different populations. Acta Otolaryngol, 2017. 137(12): p. 1271-1274.
Aksoy, S. and K. Orhan, Comparison of T2 Weighted, Fat-Suppressed T2 Weighted, and Three-Dimensional (3D) Fast Imaging Employing Steady-State Acquisition (FIESTA-C) Sequences in the Temporomandibular Joint (TMJ) Evaluation. Biomed Res Int, 2021. 2021: p. 6032559.
Jain, P., Plunging Ranulas and Prevalence of the “Tail Sign” in 126 Consecutive Cases. J Ultrasound Med, 2020. 39(2): p. 273-278.
Li, J. and J. Li, Correct diagnosis for plunging ranula by magnetic resonance imaging. Aust Dent J, 2014. 59(2): p. 264-7.
Han, Y., et al., Diffusion-Weighted MR Imaging of Unicystic Odontogenic Tumors for Differentiation of Unicystic Ameloblastomas from Keratocystic Odontogenic Tumors. Korean J Radiol, 2018. 19(1): p. 79-84.
Srinivasan, K., et al., Diffusion-weighted imaging in the evaluation of odontogenic cysts and tumours. Br J Radiol, 2012. 85(1018): p. e864-70.
Munhoz, L., et al., Application of diffusion-weighted magnetic resonance imaging in the diagnosis of odontogenic lesions: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol, 2020. 130(1): p. 85-100 e1.
Vanagundi, R., et al., Diffusion-weighted magnetic resonance imaging in the characterization of odontogenic cysts and tumors. Oral Surg Oral Med Oral Pathol Oral Radiol, 2020. 130(4): p. 447-454.
Chawla, S., et al., Diffusion-weighted imaging in head and neck cancers. Future Oncol, 2009. 5(7): p. 959-75.
Mukherjee, P., et al., Diffusion tensor MR imaging and fiber tractography: theoretic underpinnings. AJNR Am J Neuroradiol, 2008. 29(4): p. 632-41.
Qayyum, A., Diffusion-weighted Imaging in the Abdomen and Pelvis: Concepts and Applications. RadioGraphics, 2009. 29(6): p. 1797-1810.
Minati, L. and W.P. Węglarz, Physical foundations, models, and methods of diffusion magnetic resonance imaging of the brain: A review. Concepts in Magnetic Resonance Part A, 2007. 30A(5): p. 278-307.
Oshio, K., S. Okuda, and H. Shinmoto, Removing Ambiguity Caused by T2 Shine-through using Weighted Diffusion Subtraction (WDS). Magn Reson Med Sci, 2016. 15(1): p. 146-8.
Geijer, B., et al., The value of b required to avoid T2 shine-through from old lucunar infarcts in diffusion-weighted imaging. Neuroradiology, 2001. 43(7): p. 511-7.
Colagrande, S., et al., The influence of diffusion- and relaxation-related factors on signal intensity: an introductive guide to magnetic resonance diffusion-weighted imaging studies. J Comput Assist Tomogr, 2008. 32(3): p. 463-74.
Hibino, M., et al., Adult Recurrence of Kawasaki Disease Mimicking Retropharyngeal Abscess. Intern Med, 2017. 56(16): p. 2217-2221.

Başlangıç: 2023
Yayıncı: Biruni Üniversitesi

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