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Head and Neck

Imaging

Dr Jagrit Shah

Consultant Neuroradiologist & Head

and Neck Radiologist - NUH

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What I will talk about

Why and How to Image?

Imaging characteristics of typical

Head and Neck tumours Resectability issues

PET- CT covered superficially

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Question

How do you best delineate the

mucosal extent of the tumour?

(a) MRI(b) CT

(c) PET

(d) Ultrasound(e) Get on the phone

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How and when to Image?

Depends !!!!

What and where is the problem?

What is the question and does itchange what you do?

Pre-op imaging ? When? Chest

Imaging?

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Modalities

Plain film OPG, CXR

CT good all rounder. Bone. Chest.

MR

good soft tissue delineation.Problem solving tool. Oral Cavity,

Salivary glands, Skull base. Paranasal

sinuses.

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Resectability Issues

Balance between complete resection

and the impact of resection on patient

AJCC cancer staging manual

2010. T4a - extensive surgery, resectable

T4b Unresectable, medical therapy.

Unresectability does not implyincurable e.g. nasopharyngeal

carcinoma

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T4b

AJCC - Three repetitive criteria

(1) Vascular encasement > 270 degree,

unresectable(2) Prevertebral Fascia involvement

no good imaging test

(3) Mediastinal invasion

fat infiltration,vascular invasion. Tracheal and

oesophageal involvement

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Criteria for surgical planning

Laryngeal cartilage invasion

Pre-epiglottic fat invasion

Dural infiltration

Bone infiltration -Mandibular

invasaion, Skull base invasion

Perineural Tumour spread Brachial plexus infiltration

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Laryngeal Cartilage Invasion

Inner cortex involved T3

Invades through the thyroid cartilage

T4

surgical resection No single criteria has sensitivity and

specificity over 70% e.g.

extralaryngeal tumour, sclerosis,erosion, bowing, marrow obliteration

CT more specific, MR more sensitive

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Mandibular invasion

MR more sensitive (90-95%), CT

(Dentascan) more specific (80-90%).

PET/CT - Sensitivity 100% andspecificity 83%.

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Parotid space

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Sinonasal carcinoma

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Sinonasal carcinoma

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Sinonasal Carcinoma

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Odontogenic Keratocyst

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Tongue base tumour

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Tonsillar SCC

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Hypopharyngeal Tumour

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Hypopharyngeal tumours

Hypopharynx - plane of the hyoid boneabove to the plane of the lower border ofthe cricoid cartilage below.

Has 3 parts: the pyriform sinus, thepostcricoid area, and the posteriorpharyngeal wall.

Cervical node metastasis is frequent,

occurring in 70% of pyriform sinus lesions,40% of postcricoid carcinomas, and 50% ofposterior hypopharyngeal wall lesions.

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Parotid Acinic cell carcinoma

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Salivary cancers

Association between radiation and

salivary cancers

Prognosis Parotid > SMG >Sublingual >minor salivary glands

Look for perineural spread e.g.

adenoid cystic carcinoma and treat it.

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Papillary Thyroid Carcinoma

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Lymphoma

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Post treatment patients

Many diagnostic and therapeutic challenges

distinguishing treatment related changes

from disease

Early detection is recurrence is the key to

improving disease control rates

Need previous studies

Baseline post treatment scans helpful at 2-3months.

PET/CT

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Recurrentsquamous cell Ca of the

tonsil

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Conclusion:

The modality of choice depends on

the lesion you are trying to image. CT is adequate in most cases, MR

better for oral cavity

PET very useful in some cases. PETneeds to be authorised by MDT.