When compared to CECT, MRI neck performs similarly in correctly identifying osseous involvement, with MRI better delineating marrow involvement and CT better depicting erosive cortical change [29,31]. MRI and CT achieve similar capability in the detection of extranodal extension of tumor [59] and depth of invasion in oral tongue cancer [26]. Conversely, when compared to CT, MRI has been reported to have a higher sensitivity but a similar specificity in detecting cartilage invasion, an upstaging feature of larynx and hypopharyngeal malignancies [33,34]. Accuracy of local staging of larynx cancer has been reported to be higher with MRI than CECT (80% versus 70%) [60]. MRI performs similarly to CECT in the detection of nodal metastatic disease with sensitivity ranging from 64% to 92% and specificity from 40% to 81% [61]. Most studies show superiority of FDG-PET/CT compared to MRI for detection of nodal disease [61]. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate the primary tumor, distinguishing it from surrounding normal soft tissues. MRI Orbits, Face, and Neck Without IV Contrast There is no relevant literature to specifically support the use of MRI orbits, face, and neck without IV contrast in the initial staging of suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate the primary site, distinguishing it from the surrounding normal soft tissues. The absence of IV contrast limits the ability to accurately delineate margin and the soft tissue extent of the tumor, which is a key component in the T staging of disease and essential for treatment planning.
Staging and Post Therapy Assessment of Head and Neck Cancer. When compared to CECT, MRI neck performs similarly in correctly identifying osseous involvement, with MRI better delineating marrow involvement and CT better depicting erosive cortical change [29,31]. MRI and CT achieve similar capability in the detection of extranodal extension of tumor [59] and depth of invasion in oral tongue cancer [26]. Conversely, when compared to CT, MRI has been reported to have a higher sensitivity but a similar specificity in detecting cartilage invasion, an upstaging feature of larynx and hypopharyngeal malignancies [33,34]. Accuracy of local staging of larynx cancer has been reported to be higher with MRI than CECT (80% versus 70%) [60]. MRI performs similarly to CECT in the detection of nodal metastatic disease with sensitivity ranging from 64% to 92% and specificity from 40% to 81% [61]. Most studies show superiority of FDG-PET/CT compared to MRI for detection of nodal disease [61]. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate the primary tumor, distinguishing it from surrounding normal soft tissues. MRI Orbits, Face, and Neck Without IV Contrast There is no relevant literature to specifically support the use of MRI orbits, face, and neck without IV contrast in the initial staging of suspected or diagnosed cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate the primary site, distinguishing it from the surrounding normal soft tissues. The absence of IV contrast limits the ability to accurately delineate margin and the soft tissue extent of the tumor, which is a key component in the T staging of disease and essential for treatment planning.