Imaging

Nasopharyngeal carcinoma

Preliminary Diagnosis: Nasopharyngeal carcinoma

I. What imaging technique is first-line for this diagnosis?

  • CT soft tissue neck with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of nasopharyngeal carcinoma.

Advantages

  • Relatively inexpensive, fast imaging modality

  • Able to detail the abnormal soft tissue neoplasm from surrounding osseous structures, vasculature, and lymph nodes with great sensitivity and specificity

Disadvantages

  • Exposes the patients to large amounts of ionizing radiation

  • May not detail potential perineural spread of tumor

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • Fat-saturated contrasted MR of the neck

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of nasopharyngeal carcinoma.

Fat-saturated contrasted MR of the neck

Advantages

  • Better able to identify and characterize subtle tumor than CT

  • Better evaluates perineural spread of tumor than CT

Disadvantages

  • Less specific and sensitive in evaluating the surrounding osseous structures than CT

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

Fat-saturated contrasted MR of the neck

  • MR imaging may be contraindicated in patients with non–MR-compatible hardware.

  • Gadolinium contrast is relatively contraindicated in patients with renal failure

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