Tongue cancer CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [3]

Overview

Head and neck CT scan may be helpful in the diagnosis of tongue cancer. Findings on CT scan suggestive of tongue cancer include soft tissue attenuation of lesions, bony erosions, and increased attenuation of involved nodes.

CT

• CT is the most commonly used modality for assessment of tongue squamous cell carcinoma
• able to both locally stage the tumor and assess for nodal metastases.
• Lesions typically appear of soft tissue attenuation, usually a little more attenuating than normal tongue musculature (on account of the keratin) and enhance following contrast administration.
• Both algorhythm thin section CT is the most sensitive modality for assessing early bony erosion.
• Non-contrast scans of the neck may demonstrate increased attenuation of involved nodes due to keratin production by tumor deposits.
• CT is the modality of choice to evaluate the patient's nodal status. The evaluation of nodal size, number, location, contour, and necrosis is helpful in staging. Tongue cancer may be difficult to pick up on CT due to its imaging characteristics, unless the tumor leads to deformity of the extrinsic tongue musculature or the anatomy of the floor of mouth or tongue base.
• CT scan  Tumors enhance more than normal head and neck structures except for mucosa, extraocular muscles, and blood vessels [24]. Compared with MRI, CT provides greater spatial resolution, and can be performed with faster acquisition times, thereby virtually eliminating motion artifact, and it is better for the evaluation of bone destruction. Modern multidetector CT technology allows scanning to be performed with slice thickness less than 1 mm. Contrast-enhanced CT can help determine the extent of tumor infiltration into deep tongue musculature and whether or not the mandible is involved.   The "puffed cheek" technique improves evaluation of lesions of the oral cavity. This technique requires patients to self-insufflate their oral cavity with air by puffing out their cheek [25].   For other head and neck cancers, CT is particularly useful in upstaging cancers that have deeper local invasion or infiltration into adjacent structures that is difficult to detect on physical examination.   CT can provide information on invasion of the preepiglottic space, laryngeal cartilage, paraglottic space and subglottic extension, and can evaluate retropharyngeal, parapharyngeal, upper mediastinal, and paratracheal nodes. In addition, bone and cartilage invasion, a criterion for stage T4 disease, can be more readily detected. Distinction of cartilage invasion from non-ossified cartilage can be a difficult task for conventional CT. The new technology of dual energy and multispectral CT has demonstrated improved accuracy for assessing cartilage invasion compared with conventional CT [26].   CT evaluation of regional lymph nodes primarily relies upon size criteria as well as the appearance of lymph nodes to differentiate involved from uninvolved lymph nodes.   The use of size criteria alone results in frequent false positive and false negative assessment of regional nodes.   CT is also highly sensitive for detection of extracapsular spread of tumor.  Pathologic lymphadenopathy is usually defined radiologically as a node greater than 10 to 11 mm in minimal axial diameter or one that contains central necrosis [30,31].   size criteria based on measurement of minimal axial diameter are considered the most accurate and effective [32,33]  pathological lymph nodes include rounded shape, loss of normal fatty hilum, increased or heterogeneous contrast enhancement, lymph node clustering, and sentinel lymph node location [35].   CT was superior to physical examination in terms of sensitivity (83 versus 74 percent), specificity (83 versus 81 percent), accuracy (83 versus 77 percent), and detection of pathologic cervical adenopathy (91 versus 75 percent). [36]  nodes were 10 mm or smaller.  malignant nodes had extracapsular spread; almost one-third of these nodes were 10 mm or smaller and some were less than 5 mm.  Central necrosis was found primarily in nodes larger than 20 mm, suggesting that it is a late event in metastatic adenopathy.  Extracapsular spread of nodal metastasis

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  CT of squamous cell carcinoma of the tongue showing axial bone window

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  CT of squamous cell carcinoma of the tongue showing coronal bone window