Computed Tomography Versus Magnetic Resonance in Head and Neck Cancer: When to Use What and Image Optimization Strategies

Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Squamous cell carcinoma, the most common cancer of the head and neck, is often used synonymously with the phrase head and neck cancer. Head and neck squamous cell carcinoma is associated with a multitude of risk factors. The head and neck region are characterized by complex anatomy, and imaging plays a vital role in the evaluation of head and neck malignancies, including detecting the primary tumor in patients presenting with metastatic cervical lymphadenopathy, assessing treatment response, and differentiating posttreatment changes from recurrences. Studies have shown that PET/MRI, with few exceptions, is noninferior to PET/CT in evaluating head and neck cancer, and is often advantageous, due to its superior soft tissue contrast and less patient exposure to ionizing radiation.

Head and neck cancers are the sixth most common group of malignancies worldwide. In the United States, the estimated incidence is 65,000 new cases per year. Head and neck cancers can arise in the oral cavity, nasopharynx, hypopharynx, oropharynx, nasal cavity and paranasal sinuses, larynx, and salivary glands. Multiple histologies can be found in these sites, but more than 90% are squamous cell carcinomas (SCC). SCC is associated with aggressive behavior and high incidence of locoregional recurrence. This chapter summarizes the initial management of patients with head and neck malignancies. The first part of the chapter focuses on the assessment of the disease and highlights changes in the latest edition of the staging system. The last part of the chapter discusses the importance of neck disease and the treatment of the metastatic neck.

This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management of oral cavity squamous cell carcinoma (OSCC). Early OSCC can be treated with either surgery alone while advanced cancers are treated with a combination of surgery, radiotherapy and/or chemotherapy. Considering the complex anatomy of the oral cavity and its surrounding structures, imaging plays an indispensable role not only in locoregional staging but also in the distant metastatic work-up and post treatment follow-up. Knowledge of the anatomy with understanding of common routes of spread of cancer, allows the radiologist to accurately determine disease extent and augment clinical findings to plan appropriate therapy. This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management.

The aim of our study was to assess CT angiography findings of head and neck tumours in predicting carotid blow out syndrome (CBS).

We retrospectively reviewed the records of patients with head and neck cancer who underwent invasive angiography for CBS at our Institution from July 2013–2019. All routine CT angiography scans were assessed for the following findings with a univariate logistic regression analysis: 1) 360 ° involvement of the suspect artery by the tumour; 2) tissue or tumour necrosis, which was defined as an hypodense area with lack of contrast enhancement in the soft tissues of the neck or tumour mass, adjacent to the suspected vessel; 3) calibre reduction of the culprit artery; 5) jugular vein infiltration. T stage was also included in the analysis.

A total of 24 patients who underwent routine CT angiogram neck and embolization for CBS were included in this study. Univariate logistic regression showed as 360 ° involvement of target vessel may significantly increase the risk of bleeding (OR 11.6, CI: 1.4–91.5; p = 0.01), along with T stage (OR 14.0, p = 0.03). Tumour necrosis and calibre vessel reduction were quite influential, but not significantly (i.e. tumour necrosis OR 5.0 95 % CI: 0.8–31.0, p = 0.08). Contingency table analysis found 360 ° vessel involvement with the highest sensitivity and PPV in predicting bleeding (87.5 % and 82.35 %, respectively).

CT angiography imaging findings have the potential to identify patients with head and neck cancer at higher risk of bleeding.