Radiography Chest CXR is not considered the imaging modality of choice for the evaluation of pulmonary metastatic disease in treated cancer of the paranasal sinuses or nasal cavity. Chest CT is far more sensitive in detecting pulmonary metastatic disease compared to radiography [15], with the sensitivity of CXR to detect pulmonary metastatic disease reported as low as 28% compared to chest CT [11]. The low sensitivity may in part be due to the small size of pulmonary nodules at presentation or peripheral location, in which CXR tends to be less reliable [11]. The use of CXR for detection of metastases has not been shown to improve prognosis because pulmonary metastatic disease detected on CXR tends to be diagnosed at a late stage when it is not as amenable to treatment [18]. CT Chest With IV Contrast CT chest with IV contrast can accurately identify pulmonary metastasis and be used to detect thoracic nodal and skeletal metastases to the ribs or vertebrae. Patients with recurrent head and neck squamous cell carcinoma are significantly more likely to have pulmonary metastatic disease [21,120]. Development of lung metastases is also increased in advanced stage disease [15]. CT chest confers superior spatial localization and contrast resolution when compared to radiography, allowing for the improved detection of small pulmonary nodules [15]. The use of screening CT chest in patients treated with definitive therapy have been shown to detect metastatic disease that was successfully treated with salvage therapy [121]. The rates of detection of pulmonary metastatic disease in the setting of recurrent disease for chest CT is similar to that of FDG-PET/CT [122]. The use of IV contrast allows for improved detection of mediastinal and hilar adenopathy, distinguishing nodes from mediastinal vessels and aiding in the delineation of the soft tissue extension of skeletal metastatic disease.
Staging and Post Therapy Assessment of Head and Neck Cancer. Radiography Chest CXR is not considered the imaging modality of choice for the evaluation of pulmonary metastatic disease in treated cancer of the paranasal sinuses or nasal cavity. Chest CT is far more sensitive in detecting pulmonary metastatic disease compared to radiography [15], with the sensitivity of CXR to detect pulmonary metastatic disease reported as low as 28% compared to chest CT [11]. The low sensitivity may in part be due to the small size of pulmonary nodules at presentation or peripheral location, in which CXR tends to be less reliable [11]. The use of CXR for detection of metastases has not been shown to improve prognosis because pulmonary metastatic disease detected on CXR tends to be diagnosed at a late stage when it is not as amenable to treatment [18]. CT Chest With IV Contrast CT chest with IV contrast can accurately identify pulmonary metastasis and be used to detect thoracic nodal and skeletal metastases to the ribs or vertebrae. Patients with recurrent head and neck squamous cell carcinoma are significantly more likely to have pulmonary metastatic disease [21,120]. Development of lung metastases is also increased in advanced stage disease [15]. CT chest confers superior spatial localization and contrast resolution when compared to radiography, allowing for the improved detection of small pulmonary nodules [15]. The use of screening CT chest in patients treated with definitive therapy have been shown to detect metastatic disease that was successfully treated with salvage therapy [121]. The rates of detection of pulmonary metastatic disease in the setting of recurrent disease for chest CT is similar to that of FDG-PET/CT [122]. The use of IV contrast allows for improved detection of mediastinal and hilar adenopathy, distinguishing nodes from mediastinal vessels and aiding in the delineation of the soft tissue extension of skeletal metastatic disease.