However, posttreatment inflammatory changes, reactive mucosal change, postradiation scarring, or osteoradionecrosis may complicate MRI interpretation, and FDG-PET/CT has been shown to have increased specificity in detecting local recurrence, in particular in treated advanced disease [143,145,146,148]. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate recurrence site, distinguishing it from the surrounding soft tissues and treatment changes. MRI Orbits, Face, and Neck Without IV Contrast There is no relevant literature to support the use of MRI orbits, face, and neck without IV contrast in follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the nasopharynx or EBV-associated unknown primary of the head and neck. Combined pre- and postcontrast imaging provides the best opportunity to identify and delineate local tumor recurrence, distinguishing it from treatment-related change and in evaluating local tumor response. The absence of IV contrast limits the ability to accurately delineate the margin and the soft tissue extent of the tumor. However, noncontrast MR sequences are routinely used to identify tumor recurrence and can define tumor extent, in particular marrow involvement, and are used in nodal assessment. Assessment of Head and Neck Cancer Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the paranasal sinuses in the follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the nasopharynx or EBV-associated cancer of unknown primary of the head and neck. US Neck US coupled with fine-needle aspiration and/or core-needle biopsy can be a useful tool in regional nodal evaluation following treatment of NPC [140]. A range of sensitivities and specificities for detection of nodal disease are found in the literature, likely reflecting the highly operator-dependent nature of this technique.
Staging and Post Therapy Assessment of Head and Neck Cancer. However, posttreatment inflammatory changes, reactive mucosal change, postradiation scarring, or osteoradionecrosis may complicate MRI interpretation, and FDG-PET/CT has been shown to have increased specificity in detecting local recurrence, in particular in treated advanced disease [143,145,146,148]. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate recurrence site, distinguishing it from the surrounding soft tissues and treatment changes. MRI Orbits, Face, and Neck Without IV Contrast There is no relevant literature to support the use of MRI orbits, face, and neck without IV contrast in follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the nasopharynx or EBV-associated unknown primary of the head and neck. Combined pre- and postcontrast imaging provides the best opportunity to identify and delineate local tumor recurrence, distinguishing it from treatment-related change and in evaluating local tumor response. The absence of IV contrast limits the ability to accurately delineate the margin and the soft tissue extent of the tumor. However, noncontrast MR sequences are routinely used to identify tumor recurrence and can define tumor extent, in particular marrow involvement, and are used in nodal assessment. Assessment of Head and Neck Cancer Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the paranasal sinuses in the follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the nasopharynx or EBV-associated cancer of unknown primary of the head and neck. US Neck US coupled with fine-needle aspiration and/or core-needle biopsy can be a useful tool in regional nodal evaluation following treatment of NPC [140]. A range of sensitivities and specificities for detection of nodal disease are found in the literature, likely reflecting the highly operator-dependent nature of this technique.