Nodular fasciitis in the head and neck: CT and MR imaging findings

BACKGROUND AND PURPOSE: The purpose of this study was to describe the CT and MR imaging findings of nodular fasciitis occurring in the head and neck region. METHODS: CT (n = 6) and MR (n = 4) images obtained from 7 patients (3 men and 4 women; mean age, 19.4 years; age range, 1-48 years) with surgically confirmed nodular fasciitis in the head and neck were retrospectively reviewed. All patients presented with a palpable mass in the head and neck that was noticed 1-3 months earlier: 5 in the face, one in the occipital scalp, and the remaining one in the supraclavicular fossa. We investigated the CT and MR imaging characteristics with emphasis on the location, size, internal content, margin, enhancement pattern, and signal intensity of the lesion. RESULTS: All lesions appeared as a discrete mass on imaging, ranging from 1.0 cm to 4.6 cm in diameter (mean, 2.2 cm). Six lesions, all of which appeared benign, were located in the subcutaneous tissue superficial to the deep cervical fascia. The remaining lesion was located deep to the temporalis muscle and showed an aggressive imaging appearance, markedly eroding the bony orbit and skull. Five lesions were solid, and 2 lesions were partly or completely cystic in appearance. Five lesions were well defined, whereas 2 lesions were ill defined. Four of 5 solid lesions showed moderate to marked diffuse enhancement, whereas the remaining lesion demonstrated mild enhancement. Two cystic lesions showed peripheral, nodular, or rim-like enhancement. Compared with muscle, both solid lesions had isointense signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images, whereas the signal intensity of the solid portions of the deep-seated, partly cystic lesion was isointense on both T1-weighted and T2-weighted images. CONCLUSION: Although rare, nodular fasciitis occurs as a discrete solid or cystic mass in the head and neck, depending on the predominant stromal components. When one sees a head and neck mass with a superficial location and moderate to marked enhancement on CT and MR imaging, nodular fasciitis should be included in the differential diagnosis, especially in patients with a recently developed, rapidly growing mass and a history of recent trauma.