Radiological assessment of head and neck cancer has largely depended on the demonstration of anatomical changes in the head and neck as an indication of tumor involvement. Computed tomography (CT) and magnetic resonance imaging (MRI) have both been used with similar success in evaluating head and neck cancer in this regard . Distortion of normal anatomic spaces as seen on these images can imply the presence of tumor. Tumor size can be measured accurately. Destruction of bone or cartilage seen on CT can be an indication of tumor involvement.
Nevertheless, CT only has marginal sensitivity to detect such involvement and it cannot be ruled out when tumors are in close proximity to bone , Demonstration of enlarged nodes, indications of possible great vessel involvement, and cartilage or bone destruction can all help assess the overall stage and resectability of a tumor.
Anatomic data as obtained from CT and/or MRI, although extremely helpful, does have some limitations. Identification of small volumes of tumor can be difficult in areas such as the larynx or base of tongue. Also, postoperative scans can be made difficult by the anatomic changes caused by surgery and/or radiation. Assessing head and neck cancer using molecular imaging in conjunction with anatomic imaging has shown to be very helpful in the evaluation of head and neck cancer patients. Molecular imaging capitalizes on the biochemical differences between tumor and normal tissue rather than the anatomic abnormalities that occur. This difference in imaging can be an advantage in many occasions, but also has its own compliment of difficulties. After a short review of CT and MRI imaging techniques, this chapter focuses primarily on the indications for using molecular or functional imaging such a positron emission tomography (PET) in the evaluation of head and neck cancer patients.
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