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<meta name="DC.Title" content="MRI Findings in Acute Tonsillar Infections" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7368" />
<meta name="DC.Date" content="2021-12-16" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections.

MATERIALS AND METHODS: We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards.

RESULTS: The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness.

CONCLUSIONS: Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.

CRP
:   C-reactive protein
Gd
:   gadolinium
ITA
:   intratonsillar abscess
LOS
:   length of the hospital stay
PPV
:   positive predictive value
PTA
:   peritonsillar abscess
SLS
:   sublingual space
SMS
:   submandibular space
T2SI
:   T2-signal intensity
VS
:   visceral space" />
<meta name="DC.Contributor" content="J. Heikkinen" />
<meta name="DC.Contributor" content="J. Nurminen" />
<meta name="DC.Contributor" content="J. Velhonoja" />
<meta name="DC.Contributor" content="H. Irjala" />
<meta name="DC.Contributor" content="T. Soukka" />
<meta name="DC.Contributor" content="T. Happonen" />
<meta name="DC.Contributor" content="M. Nyman" />
<meta name="DC.Contributor" content="K. Mattila" />
<meta name="DC.Contributor" content="J. Hirvonen" />
<meta name="article:published_time" content="2021-12-16" />
<meta name="article:section" content="HEAD &amp;amp; NECK" />
<meta name="citation_title" content="MRI Findings in Acute Tonsillar Infections" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.&lt;/p&gt;" />
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<meta name="twitter:title" content="MRI Findings in Acute Tonsillar Infections" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections.

MATERIALS AND METHODS: We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards.

RESULTS: The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness.

CONCLUSIONS: Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.

CRP
:   C-reactive protein
Gd
:   gadolinium
ITA
:   intratonsillar abscess
LOS
:   length of the hospital stay
PPV
:   positive predictive value
PTA
:   peritonsillar abscess
SLS
:   sublingual space
SMS
:   submandibular space
T2SI
:   T2-signal intensity
VS
:   visceral space" />
<meta name="og-title" property="og:title" content="MRI Findings in Acute Tonsillar Infections" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2021/12/16/ajnr.A7368" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Previous literature is vague on the prevalence and exact nature of abscesses in tonsillar infections, ranging from intratonsillar and peritonsillar collections to deep extension involving the parapharyngeal and retropharyngeal spaces. MR imaging has excellent diagnostic accuracy in detecting neck infections and can potentially clarify this issue. We sought to characterize the spectrum of MR imaging findings regarding tonsillar infections.

MATERIALS AND METHODS: We conducted a retrospective cohort study of emergency neck MR imaging scans of patients with tonsillar infections. Imaging data were assessed in terms of signs of infection and the location of abscesses and were compared with clinical findings, final diagnoses, and surgical findings as reference standards.

RESULTS: The study included 132 patients with tonsillar infection. Of these, 110 patients (83%) had ≥1 abscess (99 unilateral, 11 bilateral; average volume, 3.2 mL). Most abscesses were peritonsillar, and we found no evidence of intratonsillar abscess. Imaging showed evidence of parapharyngeal and retropharyngeal extension in 36% and 10% of patients, respectively. MR imaging had a high positive predictive value for both abscesses (0.98) and deep extension (0.86). Patients with large abscesses and widespread edema patterns had a more severe course of illness.

CONCLUSIONS: Emergency neck MR imaging can accurately describe the extent and nature of abscess formation in tonsillar infections.

CRP
:   C-reactive protein
Gd
:   gadolinium
ITA
:   intratonsillar abscess
LOS
:   length of the hospital stay
PPV
:   positive predictive value
PTA
:   peritonsillar abscess
SLS
:   sublingual space
SMS
:   submandibular space
T2SI
:   T2-signal intensity
VS
:   visceral space" />
<meta name="og-type" property="og:type" content="article" />
<meta name="og-image" property="og:image" content="" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">HEAD &amp; NECK</span></span></div>
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J. Heikkinen</span>, <span class="highwire-citation-author" data-delta="1">J. Nurminen</span>, <span class="highwire-citation-author" data-delta="2">J. Velhonoja</span>, <span class="highwire-citation-author" data-delta="3">H. Irjala</span>, <span class="highwire-citation-author" data-delta="4">T. Soukka</span>, <span class="highwire-citation-author" data-delta="5">T. Happonen</span>, <span class="highwire-citation-author" data-delta="6">M. Nyman</span>, <span class="highwire-citation-author" data-delta="7">K. Mattila</span> and <span class="highwire-citation-author" data-delta="8">J. Hirvonen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2021,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7368 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-94700--81099219411" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J. Heikkinen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J. Heikkinen, J.N., T.H., M.N., K.M., J. Hirvonen)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BHeikkinen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Heikkinen%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BHeikkinen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8007-5090" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Heikkinen</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Nurminen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J. Heikkinen, J.N., T.H., M.N., K.M., J. Hirvonen)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BNurminen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nurminen%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BNurminen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2482-9051" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Nurminen</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">J. Velhonoja </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Otorhinolaryngology-Head and Neck Surgery (J.V., H.I.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BVelhonoja%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Velhonoja%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BVelhonoja%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-1988-9770" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Velhonoja</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">H. Irjala </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Otorhinolaryngology-Head and Neck Surgery (J.V., H.I.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BIrjala%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Irjala%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.%2BIrjala%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3054-4677" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Irjala</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">T. Soukka </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Oral and Maxillofacial Surgery (T.S.), University of Turku, Turku, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BSoukka%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Soukka%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BSoukka%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5558-3416" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Soukka</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">T. Happonen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (J. Heikkinen, J.N., T.H., M.N., K.M., J. 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