Imaging manifestations of head and neck lymphatic malformations: A single‐center experience of 170 surgical cases

Abstract Objectives To discuss the imaging manifestations and the utility of preoperative ultrasonography (US), contrast‐enhanced computed tomography (CE‐CT) and contrast enhanced magnetic resonance imaging (CE‐MRI) in diagnosing the pediatric head and neck lymphatic malformations (HNLMs). Methods We performed a retrospective review of 170 children who were referred to our hospital in the past 9 years for the treatment of HNLMs. Results The diagnostic rates of US, CE‐CT and CE‐MRI were 93.0% (146/157), 94.7% (143/151) and 100% (45/45), respectively. As in multilocular cases, intracystic septa detection rate was 91.5% (130/142), 50.4% (68/135) and 88.1% (37/42), and which had a statistical difference ( χ 2 = 25.8131, p < 0.05). US showed capsule contents anechoic in 51.0% (80/157) cases, hypoechoic or mixed echoic in 49.0% (77/157) cases, and flocculent or dotted echo floating in 36.9% (58/157) cases. CT showed low density of the capsule contents without enhancement in 69.5% (105/151) cases and mixed density with enhancement in 30.4% (46/151) cases. Liquid–liquid levers were seen in 8.6% (13/151) cases. MRI showed T1WI high signal and T2WI low signal of the capsule contents without enhancement in 28.9% (13/45) cases and mixed density in 71.1% (32/45) cases. Liquid–liquid levers were seen in 46.7% (21/45) cases. There were statistically significant differences between pure HNLMs and intracystic hemorrhage in capsule content (echo, density, signal), enhancement, and liquid–liquid lever (all p < 0.05). Among US, CE‐CT and CE‐MRI, intracystic hemorrhage diagnostic accuracy had a statistical difference ( χ 2 = 25.4152, p < 0.05). Conclusions For clinical diagnosis and evaluation of HNLMs, we suggest that US combined with CE‐CT for acute cases, and for stable cases, US combined with CE‐MRI.