MRI has demonstrated a mildly lower sensitivity than FDG-PET/CT in detecting cervical nodal disease [82] but is considered superior in detecting retropharyngeal lymph node metastases [74,82]. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate the primary site, distinguishing it from the surrounding soft tissues. This includes the evaluation of tumor size and local extent of disease, including the invasion of surrounding structures. MRI Orbits, Face, and Neck Without IV Contrast There is no relevant literature to support the use of MRI of the orbits, face, and neck without IV contrast in the initial staging of suspected or diagnosed NPC or EBV-associated 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. However, noncontrast MR sequences are routinely used to identify the primary tumor and define tumor extent, in particular marrow involvement, and are used in nodal staging. Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the sinuses in the initial staging of suspected or diagnosed NPC or EBV-associated unknown primary of the head and neck. US Neck US can be a useful adjunct to cross-sectional imaging, in particular for nodal staging in NPC or EBV-associated unknown primary of the head and neck. Coupled with fine-needle aspiration and/or core-needle biopsy, nodal evaluation with US is a reliable tool and correlates well with staging following neck dissection [62].
Staging and Post Therapy Assessment of Head and Neck Cancer. MRI has demonstrated a mildly lower sensitivity than FDG-PET/CT in detecting cervical nodal disease [82] but is considered superior in detecting retropharyngeal lymph node metastases [74,82]. Combined pre- and postcontrast imaging provides the best opportunity to correctly identify and delineate the primary site, distinguishing it from the surrounding soft tissues. This includes the evaluation of tumor size and local extent of disease, including the invasion of surrounding structures. MRI Orbits, Face, and Neck Without IV Contrast There is no relevant literature to support the use of MRI of the orbits, face, and neck without IV contrast in the initial staging of suspected or diagnosed NPC or EBV-associated 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. However, noncontrast MR sequences are routinely used to identify the primary tumor and define tumor extent, in particular marrow involvement, and are used in nodal staging. Radiography Paranasal Sinuses There is no relevant literature to support the use of radiography of the sinuses in the initial staging of suspected or diagnosed NPC or EBV-associated unknown primary of the head and neck. US Neck US can be a useful adjunct to cross-sectional imaging, in particular for nodal staging in NPC or EBV-associated unknown primary of the head and neck. Coupled with fine-needle aspiration and/or core-needle biopsy, nodal evaluation with US is a reliable tool and correlates well with staging following neck dissection [62].