CT Maxillofacial Without IV Contrast There is no relevant literature to support the use of CT maxillofacial without IV contrast in the initial staging of suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. 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 sinonasal tumors as well as regional nodal staging. CT provides excellent delineation of the sinonasal skeleton and is superior to MRI in the depiction of osseous anatomy [96]. The presence of skull base foraminal widening, which can be detected on thin-section CT and reconstructions, may alert to perineural tumor spread [96], and the precise determination of bony destruction or remodeling may prove useful in the characterization of slow-growing versus aggressive sinonasal tumors [99]. MRI is considered superior to CT in the delineation of the soft tissue extent of disease, including involvement of neighboring structures, findings that are necessary for the correct T staging of disease. Contrast-enhanced imaging is imperative to correctly identify and outline the primary tumor, distinguishing it from the surrounding normal soft tissues.
Staging and Post Therapy Assessment of Head and Neck Cancer. CT Maxillofacial Without IV Contrast There is no relevant literature to support the use of CT maxillofacial without IV contrast in the initial staging of suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. 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 sinonasal tumors as well as regional nodal staging. CT provides excellent delineation of the sinonasal skeleton and is superior to MRI in the depiction of osseous anatomy [96]. The presence of skull base foraminal widening, which can be detected on thin-section CT and reconstructions, may alert to perineural tumor spread [96], and the precise determination of bony destruction or remodeling may prove useful in the characterization of slow-growing versus aggressive sinonasal tumors [99]. MRI is considered superior to CT in the delineation of the soft tissue extent of disease, including involvement of neighboring structures, findings that are necessary for the correct T staging of disease. Contrast-enhanced imaging is imperative to correctly identify and outline the primary tumor, distinguishing it from the surrounding normal soft tissues.