CT Neck Without and With IV Contrast There is no relevant literature to support the use of CT neck without and with IV contrast in treated cancer of the nasopharynx or EBV-associated cancer of unknown primary of the head and neck. CT Neck Without IV Contrast There is no relevant literature to support the use of CT neck without IV contrast in treated cancer of the nasopharynx or EBV-associated cancer of unknown primary of the head and neck. Contrast enhancement is imperative in order to correctly identify and delineate recurrence, distinguishing it from treatment changes. CTA Neck With IV Contrast There is no relevant literature to support the use of CTA of the neck with IV contrast 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. In the case of recurrent disease encroaching on the carotid arteries, CTA of the neck can be used to identify patients at high risk of bleeding [41]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT allows for the assessment of treatment response, detection and localization of recurrence, regional nodal disease, and distant metastases in treated NPC [75,90,145-147]. The presence of posttreatment inflammatory changes decreases the specificity of FDG-PET/CT, and, for this reason, imaging ideally occurs at a minimum of 12 weeks from completion of therapy to allow for treatment effects to subside, although imaging as early as 8 weeks after therapy has been suggested [136]. Concurrent infection can similarly give false-positive findings. The high NPV of FDG-PET/CT is very useful in excluding recurrence [147]. FDG-PET/CT has demonstrated similar detection rates of local recurrence as MRI but increased specificity of imaging findings, in particular in patients with treated advanced disease [143,145,146,148].
Staging and Post Therapy Assessment of Head and Neck Cancer. CT Neck Without and With IV Contrast There is no relevant literature to support the use of CT neck without and with IV contrast in treated cancer of the nasopharynx or EBV-associated cancer of unknown primary of the head and neck. CT Neck Without IV Contrast There is no relevant literature to support the use of CT neck without IV contrast in treated cancer of the nasopharynx or EBV-associated cancer of unknown primary of the head and neck. Contrast enhancement is imperative in order to correctly identify and delineate recurrence, distinguishing it from treatment changes. CTA Neck With IV Contrast There is no relevant literature to support the use of CTA of the neck with IV contrast 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. In the case of recurrent disease encroaching on the carotid arteries, CTA of the neck can be used to identify patients at high risk of bleeding [41]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT allows for the assessment of treatment response, detection and localization of recurrence, regional nodal disease, and distant metastases in treated NPC [75,90,145-147]. The presence of posttreatment inflammatory changes decreases the specificity of FDG-PET/CT, and, for this reason, imaging ideally occurs at a minimum of 12 weeks from completion of therapy to allow for treatment effects to subside, although imaging as early as 8 weeks after therapy has been suggested [136]. Concurrent infection can similarly give false-positive findings. The high NPV of FDG-PET/CT is very useful in excluding recurrence [147]. FDG-PET/CT has demonstrated similar detection rates of local recurrence as MRI but increased specificity of imaging findings, in particular in patients with treated advanced disease [143,145,146,148].