Nasopharyngeal carcinoma CT: Difference between revisions

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{{Nasopharyngeal carcinoma}}
{{Nasopharyngeal carcinoma}}
{{CMG}} {{AE}}{{Homa}}{{Faizan}}
CT scan may be helpful in the diagnosis of nasopharyngeal carcinoma and it's metastasis to the lymph nodes, intracranial space, bone, chest, and liver. Findings on CT scan suggestive of nasopharyngeal carcinoma include [[soft tissue]] [[mass]]<nowiki/>es which most commonly centred at the lateral [[nasopharyngeal]] recess (fossa of Rosenmüller) and heterogeneous enhancement of the [[tumor]] in the [[Computed tomography|CT scan]] with [[contrast]].  
 
==Overview==
 
There are no CT scan findings associated with [disease name].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
==CT scan==
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include:
*[Finding 1]
*[Finding 2]
*[Finding 3]
 
CT and MR can be complementary in this regard: CT is superior for the study of bony structures and for the presence of cervical lymph nodes, while the MR provides a better assessment of the primary tumor location and of intracranial structures and retropharyngeal spaces. PET scan may assist in the accurate planning of radiotherapy treatment (RT). PET-CT scan can replace the traditional work-up for detection of distant metastatic disease Invasion of bone of the skull base can be imperceptible on computed tomography (CT) but denotes T3 stage. It is, thus, preferable that MR imaging be used for NPC staging.3,19,20 In the authors’ experience, the T1-weighted images in 3 planes, but particularly the coronal and sagittal plane, are excellent for evaluation of the normally hyperintense (fat signal) skull base marrow. When tumor abuts the skull base, loss of the fat signal indicates bone infiltration. Once this is determined, it is important to consider more extensive intracranial disease spread through the skull base foramina along cranial nerves or along the internal carotid artery. This disease spread is also best seen with MR imaging and designates T4 tumor. NPC may also spread laterally from the nasopharynx through the pharyngobasilar fascia or through the foramen of Morgagni to the parapharyngeal  fat with or without skull base invasion. Parapharyngeal fat involvement, which is well seen on either CT or MR imaging owing to the fat’s low CT density and high T1 signal intensity on MR imaging, denotes T2 tumor. Further lateral spread through the superficial layer of the deep cervical fascia into the masticator space, however, upstages the tumor to T4 and is an independent prognostic factor for overall survival and local relapse-free survival.21 Because the masticator muscles are supplied by the mandibular division  of the trigeminal nerve and are located inferior to the greater sphenoid wing, it is important to look for involvement of the foramen ovale for intracranial spread once masticator space involvement is determined. This involvement will not change tumor staging because intracranial spread is also T4, but it is important for radiation planning.
 
All patients should be evaluated by a multidisciplinary team (consisting of surgeons, medical oncologists, and radiation oncologists). A chest x-ray and a CT scan of the chest (including the liver) should be performed to identify metastases. A CT/MRI examination should be done to assess local and locoregional disease. Extension into the parapharyngeal space, bone erosion, or intracranial involvement is seen only by CT/ MRI examination. Yu et al. [5] reported a 55% upstaging of T2 and a 56% upstaging of T3 patients when comparing staging done by CT scans versus plain x-rays. MRI is superior to CT in detecting infiltration along the pharyngobasilar fascia and retropharyngeal lymph nodes. CT scans are better to detect early bony invasion. CT and MRI have a low sensitivity (45% and 56% respectively) in evaluating residual disease after treatment; either could be used [6].
 
CT has long been used for staging NPC,especially for the detection of skull base tumor involvement with lytic or sclerotic lesions [6, 7], but it has now largely been replaced by MRI for primary and nodal staging. However, CT is still used for radiotherapy planning and, in some centers, is used together with PET using 18F-FDG. PET/CT has been shown to be of value in NPC staging, where the main advantage is for the detection of distant metastasis [8]. It is also used for monitoring patients after therapy and detecting NPC recurrence.
 
NPC has a strong tendency for systemic metastases to the bone, chest, and/or liver, with up to 5% of patients having distant metastasis at presentation. M1 tumor staging determines stage IVC disease.7,27 Up to 30% of patients will have distant recurrence after radiation therapy.15,28 National Comprehensive Cancer Network (NCCN) practice guidelines recommend positron emission tomography– computed tomography (PET-CT) to evaluate for distant metastases when N2 or N3 disease is present.
 
==Overview==
 
On the head and neck CT scan, [[nasopharyngeal carcinoma]] is characterized by presence of soft tissue masses most commonly centered at the lateral [[nasopharyngeal]] recess (fossa of Rosenmüller).


==CT scan==
==CT scan==


On the head and neck CT scan, [[nasopharyngeal carcinoma]] is characterized by soft tissue masses most commonly centred at the lateral [[nasopharyngeal]] recess (fossa of Rosenmüller). Larger tumours may be seen extending into any direction, eroding:
[[CT scan]] may be helpful in the [[diagnosis]] of nasopharyngeal carcinoma and it's invasion. [[CT scan]] can be useful in:<ref>{{Cite journal
 
| author = [[V. F. Chong]], [[Y. F. Fan]] & [[J. B. Khoo]]
*[[Eustachian tube]]
| title = Nasopharyngeal carcinoma with intracranial spread: CT and MR characteristics
 
| journal = [[Journal of computer assisted tomography]]
*Base of skull
| volume = 20
 
| issue = 4
*[[Foramen lacerum]]
| pages = 563–569
| year = 1996
| month = July-August
| pmid = 8708057
}}</ref><ref>{{Cite journal
| author = [[Alfred L. Weber]], [[Sharif al-Arayedh]] & [[Asma Rashid]]
| title = Nasopharynx: clinical, pathologic, and radiologic assessment
| journal = [[Neuroimaging clinics of North America]]
| volume = 13
| issue = 3
| pages = 465–483
| year = 2003
| month = August
| pmid = 14631685
}}</ref><ref>{{Cite journal
| author = [[Julian Goh]] & [[Keith Lim]]
| title = Imaging of nasopharyngeal carcinoma
| journal = [[Annals of the Academy of Medicine, Singapore]]
| volume = 38
| issue = 9
| pages = 809–816
| year = 2009
| month = September
| pmid = 19816641
}}</ref><ref name="CurranHackney1986">{{cite journal|last1=Curran|first1=Walter J.|last2=Hackney|first2=David B.|last3=Blitzer|first3=Peter H.|last4=Bilaniuk|first4=Larissa|title=The value of magnetic resonance imaging in treatment planning of nasopharyngeal carcinoma|journal=International Journal of Radiation Oncology*Biology*Physics|volume=12|issue=12|year=1986|pages=2189–2196|issn=03603016|doi=10.1016/0360-3016(86)90019-2}}</ref><ref name="ChongFan1997">{{cite journal|last1=Chong|first1=V F|last2=Fan|first2=Y F|title=Detection of recurrent nasopharyngeal carcinoma: MR imaging versus CT.|journal=Radiology|volume=202|issue=2|year=1997|pages=463–470|issn=0033-8419|doi=10.1148/radiology.202.2.9015075}}</ref><ref>{{cite book | last = Hermans | first = Robert | title = Head and Neck Cancer Imaging | publisher = Springer Berlin Heidelberg | location = Berlin, Heidelberg | year = 2006 | isbn = 3540684395 }}</ref><ref>{{cite book | last = Som | first = Peter | title = Head and neck imaging | publisher = Mosby | location = St. Louis | year = 2011 | isbn = 9780323053556 }}</ref>
*[[Diagnosis]] of nasopharyngeal carcinoma in [[Computed tomography|CT scan]] (with and without [[Contrast|contras]]<nowiki/>t), the characteristics are:
**[[Soft tissue]] [[mass]]<nowiki/>es which most commonly centred at the lateral [[nasopharyngeal]] recess (fossa of Rosenmüller)  
**Heterogenous enhancement of the [[tumor]] in the [[Computed tomography|CT scan]] with [[contrast]]
*Detection of [[cervical lymph nodes]] involvement
*Detection of intracranial involvement
*Diagnosis of [[bone metastasis]], by detection of [[lytic]] or [[Sclerotic metastasis|sclerotic]] lesions,the most common [[metastatic]] regions are:
**[[Eustachian tube]]


*[[Foramen ovale]]
**Base of skull


*[[Cavernous sinus]]
**[[Foramen lacerum]]


*[[Temporal bone]]
**[[Foramen ovale]]


On CT scan, assessment of cervical lymph nodes is essential due to the high rate of nodal involvement at the time of diagnosis.<ref>http://radiopaedia.org/articles/nasopharyngeal-carcinoma</ref>
**[[Cavernous sinus]]


CT has long been used for staging NPC,especially for the detection of skull base tumor involvement with lytic or sclerotic lesions [6, 7], but it has now largely been replaced by MRI for primary and nodal staging. However, CT is still used for radiotherapy planning and, in some centers, is used together with PET using 18F-FDG. PET/CT has been shown to be of value in NPC staging, where the main advantage is for the detection of distant metastasis [8]. It is also used for monitoring patients after therapy and detecting NPC recurrence.
**[[Temporal bone]]
*Detection of the [[metastasis]] to [[chest]] and [[liver]]


==References==
==References==

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CT scan may be helpful in the diagnosis of nasopharyngeal carcinoma and it's metastasis to the lymph nodes, intracranial space, bone, chest, and liver. Findings on CT scan suggestive of nasopharyngeal carcinoma include soft tissue masses which most commonly centred at the lateral nasopharyngeal recess (fossa of Rosenmüller) and heterogeneous enhancement of the tumor in the CT scan with contrast.

CT scan

CT scan may be helpful in the diagnosis of nasopharyngeal carcinoma and it's invasion. CT scan can be useful in:[1][2][3][4][5][6][7]

    • Base of skull

References

  1. ↑ V. F. Chong, Y. F. Fan & J. B. Khoo (1996). "Nasopharyngeal carcinoma with intracranial spread: CT and MR characteristics". Journal of computer assisted tomography. 20 (4): 563–569. PMID 8708057. Unknown parameter |month= ignored (help)
  2. ↑ Alfred L. Weber, Sharif al-Arayedh & Asma Rashid (2003). "Nasopharynx: clinical, pathologic, and radiologic assessment". Neuroimaging clinics of North America. 13 (3): 465–483. PMID 14631685. Unknown parameter |month= ignored (help)
  3. ↑ Julian Goh & Keith Lim (2009). "Imaging of nasopharyngeal carcinoma". Annals of the Academy of Medicine, Singapore. 38 (9): 809–816. PMID 19816641. Unknown parameter |month= ignored (help)
  4. ↑ Curran, Walter J.; Hackney, David B.; Blitzer, Peter H.; Bilaniuk, Larissa (1986). "The value of magnetic resonance imaging in treatment planning of nasopharyngeal carcinoma". International Journal of Radiation Oncology*Biology*Physics. 12 (12): 2189–2196. doi:10.1016/0360-3016(86)90019-2. ISSN 0360-3016.
  5. ↑ Chong, V F; Fan, Y F (1997). "Detection of recurrent nasopharyngeal carcinoma: MR imaging versus CT". Radiology. 202 (2): 463–470. doi:10.1148/radiology.202.2.9015075. ISSN 0033-8419.
  6. ↑ Hermans, Robert (2006). Head and Neck Cancer Imaging. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 3540684395.
  7. ↑ Som, Peter (2011). Head and neck imaging. St. Louis: Mosby. ISBN 9780323053556.

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