Diagnostic Imaging in Head and Neck Cancer

Preface
Contents
1: Perspectives and Trends in Diagnostic Imaging of Head and Neck Cancer
	1.1	 The Central Task: A Competent Report/Consultation
	1.2	 Knowledge Base for Progress Toward Becoming an Expert Head and Neck Cancer Imaging Consultant
		1.2.1	 The Beginnings: Becoming a “Student of the Disease”
	1.3	 The Fundamentals of Local and Regional Spread: The Basis of Eventual Expert Interpretive Skills and Appropriate Report Content
	1.4	 Perspectives on Current Appropriate Use of Diagnostic Imaging in Head and Neck Cancers
		1.4.1	 Evaluation of the Primary Site and Perineural Spread
		1.4.2	 Regional Adenopathy
		1.4.3	 Distant Metastases
		1.4.4	 Surveillance
	1.5	 Perspectives on Pitfalls, Distractions, and Ongoing Controversies in Head and Neck Cancer Imaging
		1.5.1	 Pitfall: Forgetting the Fundamentals
		1.5.2	 Potential Distraction: Tissue Specificity from Imaging Studies
		1.5.3	 Ongoing Controversy: What Is the Best Imaging Study to Detect Regional Adenopathy?
		1.5.4	 New Controversy: Is Routine Post-treatment Surveillance Justified?
	References
2: Diagnostic Imaging of Nasopharyngeal Carcinoma
	2.1	 Introduction
	2.2	 Anatomy
	2.3	 Pathology
	2.4	 AJCC/UICC TNM Classification
	2.5	 MRI Staging of the Primary Tumour (T-Classification)
		2.5.1	 T0 and T1
		2.5.2	 T2
		2.5.3	 T3
		2.5.4	 T4
	2.6	 MRI Staging of Nodal Disease (N Classification) (Table 2.2)
		2.6.1	 N1, N2
		2.6.2	 N3
	2.7	 MRI Staging of Distant Metastates (M Classification)
	2.8	 Radiotherapy for the Radiologist
	2.9	 Tumour Recurrence
		2.9.1	 Local Failure
		2.9.2	 Regional Failure
		2.9.3	 Distant Metastases
	2.10	 Imaging Tumour Recurrence
		2.10.1	 Nuclear Medicine
		2.10.2	 MRI
	2.11	 Complications of Radiotherapy
		2.11.1	 Radiation-Induced Central Nervous System (CNS) Injury
			2.11.1.1	 Injury to the Brain
			2.11.1.2	 Injury to the Cranial Nerves
		2.11.2	 Radiation-Induced Bone and Cartilage Injury
		2.11.3	 Radiation-Induced Vascular Injury
		2.11.4	 Radiation-Induced Mucosal Injury
		2.11.5	 Radiation-Induced Glandular (Exocrine and Endocrine) Injury
		2.11.6	 Radiation-Induced Neoplasms
	2.12	 Future Imaging Techniques
	References
3: Diagnostic Imaging of Oropharyngeal Cancer
	3.1	 Introduction
	3.2	 Oropharyngeal Squamous Cell Carcinoma
		3.2.1	 Demographics and Epidemiologic Features (Table 3.1)
		3.2.2	 Anatomical Considerations
		3.2.3	 Staging of Oropharyngeal Cancer
		3.2.4	 Imaging Features
	3.3	 Differential Diagnosis
		3.3.1	 Malignant Lymphoma
	3.4	 Summary
	References
4: Diagnostic Imaging of Oral Cavity Cancer
	4.1	 Epidemiology and Etiology
	4.2	 Anatomy of Oral Cavity: An Overview
	4.3	 TNM Classification
		4.3.1	 T Classification
		4.3.2	 N classification
	4.4	 Imaging Techniques
		4.4.1	 CT
		4.4.2	 MRI
	4.5	 Imaging of Oral Cancer
		4.5.1	 Mucosal Lip
		4.5.2	 Tongue
		4.5.3	 Lower Alveolar Ridge (Lower Gingival Cancer)
		4.5.4	 Upper Alveolar Ridge (Upper Gingival Cancer)
		4.5.5	 Retromolar Trigone
		4.5.6	 Floor of the Mouth
		4.5.7	 Buccal Mucosa
		4.5.8	 Hard Palate
		4.5.9	 Lymph Node Metastasis
	4.6	 Imaging of Post-treatment Change, Complication, and Recurrence
		4.6.1	 Post-treatment Change
		4.6.2	 Complications
		4.6.3	 Recurrence
	References
5: Diagnostic Imaging of Laryngeal and Hypopharyngeal Cancers
	5.1	 Introduction
	5.2	 Epidemiology
	5.3	 Anatomy
		5.3.1	 Anatomy of the Larynx
		5.3.2	 Anatomy of Hypopharynx
		5.3.3	 Deep Space of Larynx
			5.3.3.1	 Preepiglottic Space (PES)
			5.3.3.2	 Paraglottic Space (PGS)
			5.3.3.3	 Cricoid Area/Subglottic Space
		5.3.4	 Laryngeal Cartilage
	5.4	 Imaging Techniques
		5.4.1	 CT
		5.4.2	 MR Images
		5.4.3	 FDG-Pet
	5.5	 TNM Classification
		5.5.1	 Laryngeal Cancer
		5.5.2	 Hypopharyngeal Cancer
		5.5.3	 Nodal Category (N)
	5.6	 Spread Pattern and Site-Specific Imaging Evaluation
		5.6.1	 Laryngeal Cancer
			5.6.1.1	 Supraglottic Cancer
			5.6.1.2	 Glottic Cancer
			5.6.1.3	 Subglottic Cancer
			5.6.1.4	 Spread Pattern of Laryngeal Cancer (Deep Space)
			5.6.1.5	 Extralaryngeal Spread of the Laryngeal Cancer
		5.6.2	 Hypopharyngeal Cancer
			5.6.2.1	 Pyriform Sinus (PS)
			5.6.2.2	 Postcricoid (PC)
			5.6.2.3	 Posterior Wall (PW)
			5.6.2.4	 Spread Pattern of Hypopharyngeal Cancer into the Deep Space and Tissues
			5.6.2.5	 Extralaryngeal Spread of Hypopharyngeal Cancer
	5.7	 Cartilage Invasion
	5.8	 Lymph Node Metastasis
	5.9	 Distant Metastasis
	5.10	 Treatment Strategy
	5.11	 Posttreatment Imaging
		5.11.1	 Postoperative Imaging
		5.11.2	 Postradiation Imaging
		5.11.3	 Posttreatment Surveillance Imaging
	References
6: Diagnostic Imaging of Metastatic Nodal Disease
	6.1	 Introduction
	6.2	 Anatomy of Normal Lymph Node
	6.3	 Lymph Node Classification
		6.3.1	 Imaging-Based Classification
		6.3.2	 Basic Anatomic Classification
	6.4	 Common Lymphatic Drainage of HNSCC
		6.4.1	 Drainage Patterns to Lymph Nodes
		6.4.2	 Drainage Patterns from the Primary Site
	6.5	 Imaging Techniques
		6.5.1	 Contrast-Enhanced CT and MRI
		6.5.2	 US
		6.5.3	 FDG-PET/CT
	6.6	 Imaging Features of Metastatic Nodes
		6.6.1	 Size
		6.6.2	 Shape
		6.6.3	 Grouping
		6.6.4	 Focal Nodal Inhomogeneity or Central Necrosis
			6.6.4.1	 Cystic Nodal Metastasis
		6.6.5	 Extranodal Extension (ENE)
			6.6.5.1	 Carotid Arterial Invasion
			6.6.5.2	 Prevertebral Fascia Invasion
		6.6.6	 Vascular Patterns on US
	6.7	 Nodal Staging of HNSCC
		6.7.1	 Unknown Primary Tumor
	6.8	 Treatment Assessment
		6.8.1	 Prediction of Treatment Response to (Chemo)Radiotherapy
		6.8.2	 Assessment for Post (Chemo)Radiotherapy
		6.8.3	 Posttreatment Surveillance
	References
7: Diagnostic Imaging of Sinonasal Tumors
	7.1	 Introduction
	7.2	 Sinonasal SCC
		7.2.1	 General Knowledge
		7.2.2	 Maxillary Sinus
		7.2.3	 Nasal Cavity
		7.2.4	 Ethmoid Sinus and Frontal Sinus
		7.2.5	 Symptoms
		7.2.6	 Extension
		7.2.7	 Diagnostic Imaging
		7.2.8	 Perineural Spread
		7.2.9	 Treatment
	7.3	 Other Tumors: Non-SCCs and Nonepithelial Tumors
		7.3.1	 Adenoid Cystic Carcinoma
			7.3.1.1	 Imaging Features
		7.3.2	 Sinonasal Undifferentiated Carcinoma
			7.3.2.1	 Imaging Features
		7.3.3	 Olfactory Neuroblastoma
			7.3.3.1	 Imaging Features
		7.3.4	 Mucosal Malignant Melanoma
			7.3.4.1	 Diagnostic Imaging
		7.3.5	 Non-Hodgkin’s Lymphomas of the Sinonasal Cavity
			7.3.5.1	 Diffuse Large B-Cell Lymphoma
				Diagnostic Imaging
			7.3.5.2	 Extranodal Natural Killer/T-Cell Lymphoma
				Diagnostic Imaging
		7.3.6	 Inverted Papilloma
			7.3.6.1	 Diagnostic Imaging
	References
8: Diagnostic Imaging of Salivary Gland Tumors
	8.1	 Introduction
	8.2	 Clinical Features
	8.3	 Histopathology
	8.4	 Staging
	8.5	 Radiological Imaging
	8.6	 Mucoepidermoid Carcinoma
	8.7	 Adenoid Cystic Carcinoma
	8.8	 Acinic Cell Carcinoma
	8.9	 Secretory Carcinoma
	8.10	 Polymorphous Adenocarcinoma
	8.11	 Adenocarcinoma NOS
	8.12	 Salivary Duct Carcinoma
	8.13	 Epithelial-Myoepithelial Carcinoma
	8.14	 Carcinoma ex Pleomorphic Adenoma
	8.15	 Poorly Differentiated Carcinoma
	8.16	 Summary
	References
9: Diagnostic Imaging of Perineural Spread
	9.1	 The Basics: Growth Along Nerves and Vessels (Perineural and Perivascular Spread)
	9.2	 Imaging Structural Manifestations
	9.3	 Two General Clinical Scenarios
		9.3.1	 Skin Cancer
		9.3.2	 Mucosal Origin Cancers and/or Those with Known Neurotrophic Tendencies
	9.4	 Imaging Modalities
	9.5	 General Treatment Implications
10: PET in the Diagnosis of Head and Neck Cancer
	10.1	 FDG-PET Image Acquisition
		10.1.1	 Patient Preparation
		10.1.2	 Scanning Protocols
		10.1.3	 PET/MR
	10.2	 FDG-PET Image Evaluation
		10.2.1	 Quantification and Visual Inspection of FDG Uptake
		10.2.2	 Tumor Heterogeneity
	10.3	 TNM Staging by PET
		10.3.1	 Initial Treatment Strategy
		10.3.2	 T Staging
		10.3.3	 N Staging
		10.3.4	 M Staging
		10.3.5	 Unknown Primary Tumor
	10.4	 Patients with HPV Positive Oropharyngeal Cancer
	10.5	 Implication for Patient Management
		10.5.1	 Scan Timing for Therapy Assessment
		10.5.2	 Prognostic Value of Baseline FDG-PET
		10.5.3	 Prognostic Value of Intratreatment or Posttreatment FDG-PET
		10.5.4	 PET/CT Evaluation for Residual Nodal Disease After CRT
		10.5.5	 Surveillance Following Definitive Treatment of HNC
	10.6	 Summary
	References