The most common site of metastatic involvement beyond the head and neck in up to 90% of cases is the lungs. A distant second are the bones followed by the liver, brain, and other sites [108]. Radiography Chest CXR is not considered the imaging modality of choice for the evaluation of pulmonary metastatic disease in treated cancer of a major salivary gland. 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. Pulmonary metastatic disease is the single most common site of metastatic disease beyond the head and neck in suspected or confirmed metastatic disease at follow-up. CT chest confers superior spatial localization and contrast resolution compared to radiography, allowing for the detection of small pulmonary nodules [15]. The use of IV contrast may improve detection of mediastinal and hilar adenopathy by distinguishing the nodes from mediastinal vessels. There is a paucity of relevant supportive literature specifically comparing the diagnostic performance of CT chest with IV contrast and CT chest without IV contrast. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast in the evaluation of treated cancer of a major salivary gland.
Staging and Post Therapy Assessment of Head and Neck Cancer. The most common site of metastatic involvement beyond the head and neck in up to 90% of cases is the lungs. A distant second are the bones followed by the liver, brain, and other sites [108]. Radiography Chest CXR is not considered the imaging modality of choice for the evaluation of pulmonary metastatic disease in treated cancer of a major salivary gland. 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. Pulmonary metastatic disease is the single most common site of metastatic disease beyond the head and neck in suspected or confirmed metastatic disease at follow-up. CT chest confers superior spatial localization and contrast resolution compared to radiography, allowing for the detection of small pulmonary nodules [15]. The use of IV contrast may improve detection of mediastinal and hilar adenopathy by distinguishing the nodes from mediastinal vessels. There is a paucity of relevant supportive literature specifically comparing the diagnostic performance of CT chest with IV contrast and CT chest without IV contrast. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast in the evaluation of treated cancer of a major salivary gland.