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8/13/2019 Head and Neck Imaging for Max Fac Trainees 15.11.13
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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.
Recommended