Imaging Evaluation of the Head and Neck Oncology Patient

  • Ravi Prasad
  • Beth Chen
Part of the Cancer Treatment and Research book series (CTAR, volume 174)


Imaging plays a multifaceted role in the diagnosis and characterization of head and neck oncological patients and is integral to their care. Given the complexity of treatment, a multimodality approach is often necessary. With the advent of new technologies, imaging can also be used to predict tumor behavior and treatment response. In this chapter, with selected case examples, we describe the various imaging modalities available and offer suggestions on their utilization.


Oncologic imaging PET-MRI 4D CT Surveillance imaging Image-guided biopsies 


  1. 1.
    Chaturvedi AK, Anderson WF, Lortet-Tieulent J et al (2013) Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol 31:4550CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7CrossRefPubMedGoogle Scholar
  3. 3.
    Maroldi R, Farina D, Borghesi A et al (2008) Perineural tumor spread. Neuroimaging Clin N Am 18:413–429CrossRefPubMedGoogle Scholar
  4. 4.
    Wild D, Eyrich GK, Ciernik IF et al (2006) In-line 18F-fluorodeoxyglucose positron emission tomography with computed tomography (PET/CT) in patients with carcinoma of the sinus/nasal area and orbit. J Cranio-Maxillofacial Surg 34:9–16CrossRefGoogle Scholar
  5. 5.
    Bui CD, Ching AS, Carlos PD et al (2003) Diagnostic accuracy of 2-[fluorine-18] fluoro-2-deoxy-D-glucose positron emission tomography imaging in nonsquamous tumors of the head and neck. Invest Radiol 38:593–601CrossRefPubMedGoogle Scholar
  6. 6.
    Villar R, Ramos B, Acosta M et al (2013) Recurrent adenocarcinoma of the sinonasal tract. Oral Maxillofac Surg 17:155–158CrossRefPubMedGoogle Scholar
  7. 7.
    Char DH, Miller T, Kroll S (1997) Orbital metastases: diagnosis and course. Br J Ophthalmol 81:386–390CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Loevner LA et al (2002) Imaging of neoplasms of the paranasal sinuses. Magn Reson Imaging Clin N Am 10:467–493CrossRefPubMedGoogle Scholar
  9. 9.
    Howlett DC, Kesse KW, Hughes DV et al (2002) The role of imaging in the evaluation of parotid disease. Clin Radiol 57:692–701CrossRefPubMedGoogle Scholar
  10. 10.
    Som PM, Brandwein MS (2003) Salivary glands: anatomy and pathology. In: Som PM, Curtin HD (eds) Head and neck imaging, 4th edn. Mosby, St Louis (MO), pp 2005–2134Google Scholar
  11. 11.
    Koischwitz D, Gritzmann N (2000) Ultrasound of the neck. Radiol Clin North Am 38:1029–1045CrossRefPubMedGoogle Scholar
  12. 12.
    Bryan R, Miller R, Ferreyro R et al (1982) Computed tomography of the major salivary glands. AJR Am J Roentgenol 139:547–554CrossRefPubMedGoogle Scholar
  13. 13.
    Prasad RS (2016) Parotid gland imaging. Otolaryngol Clin N Am 49:285–312CrossRefGoogle Scholar
  14. 14.
    Yousem DM, Kraut MA, Chalian AA (2000) Major salivary gland imaging. Radiology 216:19–29CrossRefPubMedGoogle Scholar
  15. 15.
    Stern JS, Ginat DT, Nicholas JL et al (2015) Imaging of pediatric head and neck masses. Otolaryngol Clin North Am 48(1):225–246CrossRefPubMedGoogle Scholar
  16. 16.
    Roh JL, Ryu CH, Choi SH et al (2007) Clinical utility of 18F-FDG PET for patients with salivary gland malignancies. J Nucl Med 48(2):240–246PubMedGoogle Scholar
  17. 17.
    Yabuuchi H, Matsuo Y, Kamitani T et al (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249:909–916CrossRefPubMedGoogle Scholar
  18. 18.
    Aiken AH, Glastonbury C (2008) Imaging Hodgkin and non-Hodgkin lymphoma in the head and neck. Radiol Clin North Am 46(2):363–378CrossRefPubMedGoogle Scholar
  19. 19.
    Hisa Y, Tatemoto K (1998) Bilateral parotid gland metastases as the initial manifestation of a small cell carcinoma of the lung. Am J Otolaryngol 19:140–143CrossRefPubMedGoogle Scholar
  20. 20.
    King AD (2008) Imaging for staging and management of thyroid cancer. Cancer Imaging 8:57–69CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Iannuccilli JD, Cronan JJ, Monchik JM (2004) Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med 23:1455–1464CrossRefPubMedGoogle Scholar
  22. 22.
    King AD, Ahuja AT, To EWH et al (2000) Staging of papillary carcinoma of the thyroid: MR imaging vs ultrasound of the neck. Clin Radiol 55:222–226CrossRefPubMedGoogle Scholar
  23. 23.
    Loevner LA et al (2008) Cross-sectional imaging of the thyroid gland. Neuroimaging Clin N Am 18:445–461CrossRefPubMedGoogle Scholar
  24. 24.
    Gotway MB, Higgins CB (2000) MR imaging of the thyroid and parathyroid glands. Magn Reson Imaging 8:163–182Google Scholar
  25. 25.
    Grünwald F, Kalicke T, Feine U et al (1999) Fluorine-18 fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study. Eur J Nucl Med 26:1547–1552CrossRefPubMedGoogle Scholar
  26. 26.
    Dietlein M, Scheidhauer K, Voth E et al (1997) Flourine-18 fluorodeoxyglucose positron emission tomography and iodine-131 whole body scintigraphy in the follow-up of differentiated thyroid cancer. Eur J Nucl Med 24:1342–1348CrossRefPubMedGoogle Scholar
  27. 27.
    Wang W, Larson SM, Fazzari M et al (2000) Prognostic value of [18F] fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab 85:1107–1113PubMedGoogle Scholar
  28. 28.
    Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: Technique and role in the preoperative evaluation of primary hyperparathyroidism. Am J Roent 188:1706–1715CrossRefGoogle Scholar
  29. 29.
    Civelek AC, Ozalp E, Donovan P et al (2002) Prospective evaluation of delayed technetium-99 m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 131:149–157CrossRefPubMedGoogle Scholar
  30. 30.
    Hoang JK, Sung W, Bahl M et al (2014) How to perform parathyroid 4D CT: tips and traps for technique and interpretation. Radiology 270:15–24CrossRefPubMedGoogle Scholar
  31. 31.
    Hunter GJ, Schellingerhout D, Vu TH et al (2012) Accuracy of four dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Radiology 264:789–795CrossRefPubMedGoogle Scholar
  32. 32.
    Hinson AM, Lee DR, Hobbs BA et al (2015) Preoperative 4D CT nonlocalizing parathyroid adenomas by Ultrasound and SPECT-CT. Otolaryngol Head Neck Surg 153:775–778CrossRefPubMedGoogle Scholar
  33. 33.
    Gilbert K, Dalley RW, Maronian N et al (2010) Staging of laryngeal cancer using 64-channel multidetector row CT: comparison of standard neck CT with dedicated breath-maneuver laryngeal CT. Am J Neuroradiol 31:251–256CrossRefPubMedGoogle Scholar
  34. 34.
    Som PM, Lawson W, Genden EM (2011) The posttreatment neck: clinical and imaging considerations. In: Som PM, Curtin HD (eds) Head and Neck Imaging, 5th edn. Mosby, St Louis, Mo, pp 2771–2822CrossRefGoogle Scholar
  35. 35.
    Wong RJ, Lin DT, Schoder H et al (2002) Diagnostic and prognostic value of [(18)F] fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 20:4199–4208CrossRefPubMedGoogle Scholar
  36. 36.
    Fukui MD, Blodgett TM, Snyderman CH et al (2005) Combined PET-CT in the head and neck. Radiographics 25:913–930CrossRefPubMedGoogle Scholar
  37. 37.
    Glastonbury CM (2007) Nasopharyngeal carcinoma: the role of magnetic resonance imaging in diagnosis, staging, treatment, and follow-up. Top Magn Reson Imaging 18:225–235CrossRefPubMedGoogle Scholar
  38. 38.
    Hermans R (2008) Posttreatment imaging in head and neck cancer. Eur J Radiol 66:501–511CrossRefPubMedGoogle Scholar
  39. 39.
    Manikantan K, Khode S, Dwivedi RC et al (2009) Making sense of post-treatment surveillance in head and neck cancer: when and what of follow-up. Cancer Treat Rev 35:744–753CrossRefPubMedGoogle Scholar
  40. 40.
    Naidich MJ, Weissman JL (1996) Reconstructive myofascial skull-base flaps: normal appearance on CT and MR imaging studies. Am J Roentgenol 167:611–614CrossRefGoogle Scholar
  41. 41.
    Offiah C, Hall E (2011) Post-treatment imaging appearances in head and neck cancer patients. Clin Radiol 66:13–24CrossRefPubMedGoogle Scholar
  42. 42.
    Lell M, Baum U, Greess H et al (2000) Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CT and MRI. Eur J Radiol 33:239–247CrossRefPubMedGoogle Scholar
  43. 43.
    Stone HB, Coleman CN, Anscher MS et al (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536CrossRefPubMedGoogle Scholar
  44. 44.
    Saito N, Nadgir RN, Nakahira M et al (2012) Postreatment CT and MR Imaging in head and neck cancer: what the radiologists need to know. Radiographics 32:1261–1282CrossRefPubMedGoogle Scholar
  45. 45.
    Chong VF (2005) Post treatment imaging in head and neck tumors. Cancer Imaging 5:8–10CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Vandecaveye V, De Keyzer F, Nuyts S et al (2007) Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo) radiotherapy: correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 67:960–971CrossRefPubMedGoogle Scholar
  47. 47.
    Vandecaveye V, De Keyzer F, Dirix P et al (2010) Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology 52:773–784CrossRefPubMedGoogle Scholar
  48. 48.
    Ginsberg LE (2011) Perineural tumor spread associated with head and neck malignancies. In: Som PM, Curtin HD (eds) Head and neck imaging, 5th edn. Mosby, St Louis, Mo, pp 2771–2822Google Scholar
  49. 49.
    Paydarfar JA, Birkmeyer NJ (2006) Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 132:67–72CrossRefPubMedGoogle Scholar
  50. 50.
    Genden EM, Rinaldo A, Suárez C et al (2004) Complications of free flap transfers for head and neck reconstruction following cancer resection. Oral Oncol 40:979–984CrossRefPubMedGoogle Scholar
  51. 51.
    Chrcanovic BR, Reher P, Sousa AA et al (2010) Osteoradionecrosis of the jaws: a current overview. I. Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 14(1):3–16CrossRefPubMedGoogle Scholar
  52. 52.
    Chong J, Hinckley LK, Ginsberg LE (2000) Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients. Am J Neuroradiol 21(1):175–178PubMedGoogle Scholar
  53. 53.
    Wei-wei L, Qiu-liang W, Guo-hao W et al (2005) Clinicopathologic features, treatment, and prognosis of postirradiation osteosarcoma in patients with nasopharyngeal cancer. Laryngoscope 115(9):1574–1579CrossRefPubMedGoogle Scholar
  54. 54.
    Varoquaux A, Rager O, Poncet A et al (2014) Detection and quantification of focal uptake in head and neck tumours: 18F-FDG PET/MR versus PET/CT. Eur J Nucl Med Mol Imaging 41(3):462–475CrossRefPubMedGoogle Scholar
  55. 55.
    Varoquaux A, Rager O, Dulguerov P et al (2015) Diffusion-weighted and PET/MR imaging after radiation therapy for malignant head and neck tumors. Radiographics 35:1502–1527CrossRefPubMedGoogle Scholar
  56. 56.
    Gaddikeri S, Gaddikeri RS, Tailor T et al (2016) Dynamic contrast-enhanced MR imaging in head and neck cancer: techniques and clinical applications. Am J Neuroradiol 37:588–595CrossRefPubMedGoogle Scholar
  57. 57.
    Lee FK, King AD, Ma BB et al (2012) Dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) for differential diagnosis in head and neck cancer. Eur J Radiol 81:784–788CrossRefPubMedGoogle Scholar
  58. 58.
    Chawla S, Kim S, Loevner LA et al (2011) Prediction of disease-free survival in patients with squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging. Am J Neuroradiol 32:778–784CrossRefPubMedGoogle Scholar
  59. 59.
    Fischbein NJ, Noworolski SM, Henry RG et al (2003) Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. Am J Neuroradiol 24:301–311PubMedGoogle Scholar
  60. 60.
    Abemayor E, Ljung B, Ward P et al (1985) CT-directed aspiration biopsies of masses in the head and neck. Laryngoscope 95:1382–1386CrossRefPubMedGoogle Scholar
  61. 61.
    Lufkin R, Teresi L, Hanafee W (1987) New needle for MR-guided aspiration cytology of the head and neck. Am J Roentgenol 149:380–382CrossRefGoogle Scholar
  62. 62.
    Learned KO, Lev-Toaff AS, Brake BJ et al (2016) US-guided biopsy of neck lesions: the head and neck neuroradiologist’s persepective. Radiographics 36:226–243CrossRefPubMedGoogle Scholar
  63. 63.
    Lorenzo G, Saindane AM (2013) Pitfalls in image guided tissue sampling in the head and neck. Neuroimaging Clin N Am 23(1):167–178CrossRefPubMedGoogle Scholar
  64. 64.
    Sherman PM, Yousem DM, Loevner LA (2004) CT-guided aspirations in the head and neck: assessment of the first 216 cases. Am J Neuroradiol 25:1603–1607PubMedGoogle Scholar
  65. 65.
    Gupta S, Henningsen JA, Wallace MJ et al (2007) Percutaneous biopsies of head and neck lesions with CT guidance: various approaches and relevant anatomic and technical considerations. Radiographics 27:371–390CrossRefPubMedGoogle Scholar
  66. 66.
    DeMarcantonio M, Choo DI (2015) Radiographic evaluation of children with hearing loss. Otolaryngol Clin N Am 48:913–932CrossRefGoogle Scholar
  67. 67.
    Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukemia and brain tumors: a retrospective cohort study. Lancet 380:499–505CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.City of Hope National Medical CenterDuarteUSA

Personalised recommendations