CT maxillofacial without IV contrast would not provide sufficient evaluation of the soft tissue extent of disease but may be complementary in the anatomic evaluation of the primary site, in particular for the evaluation of osseous erosion. CT maxillofacial will typically not include evaluation of the neck and would therefore be inadequate for the staging of regional lymphadenopathy when performed alone and may best be used in combination with MRI or FDG- PET/CT. CT Neck With IV Contrast Although protocols vary across institutions, for the purposes of this document, CT of the neck includes coverage from the top of the frontal sinuses down to the level of the aortic arch, with thin slices, multiplanar reformats, and both soft tissue and bony algorithms. CECT of the neck allows for the detection and localization of nasopharyngeal tumors as well as regional nodal staging. CT imaging is excellent for the delineation of osseous anatomy and in the detection of subtle cortical erosion. However, because of improved soft tissue contrast resolution, MRI is considered superior to CT in outlining the extent of soft tissue disease, including involvement of neighboring structures, findings that are necessary for the correct T staging of disease. Although MRI has largely surpassed the use of CECT for NPC staging with high sensitivity and specificity for correctly identifying the primary site [81,82], CT Assessment of Head and Neck Cancer has a complementary role in staging and is often used for radiation planning purposes. FDG-PET/CT is considered the imaging modality of choice for detecting cervical and distant metastases in patients with NPC [83] and demonstrates high sensitivity and specificity, when compared to CECT, in detecting nodal metastasis [82,84,85]. When CT is performed, IV contrast is recommended to better outline the soft tissue extent of the primary tumor.
Staging and Post Therapy Assessment of Head and Neck Cancer. CT maxillofacial without IV contrast would not provide sufficient evaluation of the soft tissue extent of disease but may be complementary in the anatomic evaluation of the primary site, in particular for the evaluation of osseous erosion. CT maxillofacial will typically not include evaluation of the neck and would therefore be inadequate for the staging of regional lymphadenopathy when performed alone and may best be used in combination with MRI or FDG- PET/CT. CT Neck With IV Contrast Although protocols vary across institutions, for the purposes of this document, CT of the neck includes coverage from the top of the frontal sinuses down to the level of the aortic arch, with thin slices, multiplanar reformats, and both soft tissue and bony algorithms. CECT of the neck allows for the detection and localization of nasopharyngeal tumors as well as regional nodal staging. CT imaging is excellent for the delineation of osseous anatomy and in the detection of subtle cortical erosion. However, because of improved soft tissue contrast resolution, MRI is considered superior to CT in outlining the extent of soft tissue disease, including involvement of neighboring structures, findings that are necessary for the correct T staging of disease. Although MRI has largely surpassed the use of CECT for NPC staging with high sensitivity and specificity for correctly identifying the primary site [81,82], CT Assessment of Head and Neck Cancer has a complementary role in staging and is often used for radiation planning purposes. FDG-PET/CT is considered the imaging modality of choice for detecting cervical and distant metastases in patients with NPC [83] and demonstrates high sensitivity and specificity, when compared to CECT, in detecting nodal metastasis [82,84,85]. When CT is performed, IV contrast is recommended to better outline the soft tissue extent of the primary tumor.