MRI or FDG PET-CT for recurrent nasopharyngeal carcinomas –what do you choose? : A pictorial review

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2016

Poster Number:

C-0674

Type:

Educational Exhibit

Keywords:

Head and neck, Oncology, Ear / Nose / Throat, MR, PET-CT, Radiation therapy / Oncology, Chemotherapy, Treatment effects, Cancer, Neoplasia, Radiation oncology in Developing Nations

Authors:

A. S. KAWTHALKAR¹, A. Mahajan², S. Arya²; ¹MUMBAI, MA/IN, ²MUMBAI, MAHARASHTRA/IN

DOI:

10.1594/ecr2016/C-0674

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-0674

Fig. 2: (a) and (b) FDG PET-CT fusion image and bone window image respectively showing...

Fig. 6: (a) Axial T1W fat suppressed post-contrast MR image shows a centimeter sized...

Fig. 1: Nasopharyngeal carcinoma post CT-RT; first follow up scan (a) T1W...

Fig. 3: (a) Axial T1W post-contrast fat suppressed image. In this treated patient of...

Learning objectives

To identify characteristic imaging features of recurrent nasopharyngeal carcinoma (rNPC) on contrast-enhanced MRI (CE-MRI) and FDG PET-CT Awareness of the advantages and limitations of these modalities for detecting rNPC

Background

Nasopharyngeal carcinoma is a malignancy with significant morbidity and mortality unless diagnosed at an early stage.[1] Recurrence rates range from 6 to 16%.[2] Recurrent nasopharyngeal carcinoma has its own set of challenges and clinico-pathological characteristics. rNPC was previously viewed as an incurable disease with patients receiving palliative treatment. However with the development of comprehensive diagnostic tests and newer efficient therapies it is possible to cure a certain selected segment of the sNPC patient population.[3] Early detection of recurrence and accurate response assessment is vital to...

Findings and procedure details

Material and Methods In patients treated for nasopharyngeal carcinoma with precision external beam radiotherapy techniques alone or with precision external beam radiotherapy and concurrent chemotherapy, CE-MRI and FDG PET-CT were first performed at least 10 -12 weeks post-therapy. Subsequent imaging was performed every 6 months. CE-MRI was performed on 1.5 Tesla GE or Philips scanners and PETCTs were performed on a GE Discovery scanner. Image Analysis Features assessed were 1.Recurrent mass at the primary site and spread to the oro and hypopharynx. 2. Lateral extension...

Conclusion

Early detection of rNPC improves survival rates. Awareness of the imaging appearances of rNPCand post –treatment changes on CE-MRI and PET-CTalong with their strengths and limitations helps optimal management. MRI is superior for evaluating local extent and its indirect sequelae at the primary site , while FDGPETCT is invaluable for detecting equivocal nodes on MRI, mapping the extent of nodal burden and identifying distant metastases. MRI is superior in demonstrating adverse effects of therapy while PETCT is a problem solving tool for equivocal post treatment...

Personal information

Dr. Ameya S. Kawthalkar Second Year Junior Resident Dept of Radiodiagnosis & Imaging Tata Memorial Hospital Dr E Borges Road, Parel Mumbai, Maharashtra, 400 012 INDIA Dr. Abhishek Mahajan Assistant Professor Dept of Radiodiagnosis & Imaging Tata Memorial Hospital Dr E Borges Road, Parel Mumbai, Maharashtra, 400 012 INDIA Dr. Supreeta Arya Professor Dept of Radiodiagnosis & Imaging Tata Memorial Hospital Dr E Borges Road,Parel Mumbai, Maharashtra, 400 012 INDIA

References

1. Goh J, Lim K. Imaging of nasopharyngeal carcinoma. Ann Acad Med Singapore. 2009 Sep;38(9):809-16. 2. Teo P, Tan N, Khoo J. Imaging appearances for recurrent nasopharyngeal carcinoma and post-salvage nasopharyngectomy. Clin Radiol. 2013 Nov;68(11):e629-38. 3. Tao X, Tang J, Gu M et al. Recurrent nasopharyngeal carcinoma: a clinical dilemma and challenge. Curr Oncol. 2013 Oct; 20(5): e406–e419. 4. Suarez C, Rodrigo J, Rinaldo A et al. Current treatment options for recurrent nasopharyngeal cancer. Eur Arch Otorhinolaryngol. 2010 Dec; 267(12): 1811–1824. 5. Mohandas A, Marcus...