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==CT==
==CT==
*CT is the most commonly used modality for assessment of tongue [[squamous cell carcinoma]]
*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 more attenuating than normal tongue musculature (on account of the [[keratin]]) and enhance following contrast administration.
*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.<ref name="radio">Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015</ref>
*Non-contrast scans of the neck may demonstrate increased attenuation of involved nodes due to keratin production by tumor deposits.<ref name="radio">Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015</ref>
*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 is better for the evaluation of bone destruction.  
*Central necrosis was found primarily in nodes larger than 20 mm, suggesting that it is a late event in metastatic adenopathy.  
*Assessment of cartilage invasion.<ref name="pmid22984188">{{cite journal| author=Kuno H, Onaya H, Iwata R, Kobayashi T, Fujii S, Hayashi R et al.| title=Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. | journal=Radiology | year= 2012 | volume= 265 | issue= 2 | pages= 488-96 | pmid=22984188 | doi=10.1148/radiol.12111719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22984188  }}</ref>  
*Extracapsular spread of nodal metastasis  
*Detection of extracapsular spread of tumor.    
*CT can be performed with faster acquisition times, thereby virtually eliminating motion artifact, and it is better for the evaluation of bone destruction.  
*Pathologic lymph nodes are 10 to 11 mm and contains central necrosis. Size criteria based on measurement of minimal axial diameter are considered the most accurate and effective.<ref name="pmid2217772">{{cite journal| author=van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J et al.| title=Cervical lymph node metastasis: assessment of radiologic criteria. | journal=Radiology | year= 1990 | volume= 177 | issue= 2 | pages= 379-84 | pmid=2217772 | doi=10.1148/radiology.177.2.2217772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2217772 }}</ref>   
*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.   
*Pathological lymph nodes show: loss of normal fatty hilum, increased or heterogeneous contrast enhancement, lymph node clustering.<ref name="pmid9530307">{{cite journal| author=Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ| title=Comparison of CT and MR imaging in staging of neck metastases. | journal=Radiology | year= 1998 | volume= 207 | issue= 1 | pages= 123-30 | pmid=9530307 | doi=10.1148/radiology.207.1.9530307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9530307 }}</ref>   
*Modern multidetector CT technology allows scanning to be performed with slice thickness less than 1 mm.
*Sensitivity is 83% and specificity is 83%.<ref name="pmid9046281">{{cite journal| author=Merritt RM, Williams MF, James TH, Porubsky ES| title=Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination. | journal=Arch Otolaryngol Head Neck Surg | year= 1997 | volume= 123 | issue= 2 | pages= 149-52 | pmid=9046281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9046281  }}</ref>    
*Contrast-enhanced CT can help determine the extent of tumor infiltration into deep tongue musculature and whether or not the mandible is involved.
 
*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.<ref name="pmid22984188">{{cite journal| author=Kuno H, Onaya H, Iwata R, Kobayashi T, Fujii S, Hayashi R et al.| title=Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. | journal=Radiology | year= 2012 | volume= 265 | issue= 2 | pages= 488-96 | pmid=22984188 | doi=10.1148/radiol.12111719 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22984188  }}</ref>  
== PET-CT scan ==
*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.   
Injection of  positron-emitting radionuclides, such as fluorine-18, are taken up by metabolically or functionally active tissues. PET images are created by detecting these emissions by an array of detectors and then using reconstruction techniques to create a three dimensional image. The most commonly used agent is fluorodeoxyglucose (FDG), which is taken up into cells in different concentrations depending on the relative metabolism of different tissues. It is fairly specific for tumors because metabolic rates are very high in many tumors.
*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.    
Imaging of the primary tumor site and regional lymph nodes with PET is limited by its poor spatial resolution, which can make it difficult to localize the anatomic location of the FDG uptake. These issues can be at least partially addressed with integrated PET/CT imaging, in which PET and CT are performed sequentially during a single visit on a hybrid PET/CT scanner. The images are then coregistered using fusion software, enabling the physiologic data obtained on PET to be localized according to the anatomic CT images.
*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.<ref name="pmid9530307">{{cite journal| author=Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ| title=Comparison of CT and MR imaging in staging of neck metastases. | journal=Radiology | year= 1998 | volume= 207 | issue= 1 | pages= 123-30 | pmid=9530307 | doi=10.1148/radiology.207.1.9530307 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9530307 }}</ref>   
 
*size criteria based on measurement of minimal axial diameter are considered the most accurate and effective.<ref name="pmid2217772">{{cite journal| author=van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J et al.| title=Cervical lymph node metastasis: assessment of radiologic criteria. | journal=Radiology | year= 1990 | volume= 177 | issue= 2 | pages= 379-84 | pmid=2217772 | doi=10.1148/radiology.177.2.2217772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2217772 }}</ref>   
Historically, CT images obtained from integrated PET/CT scanners had lower spatial resolution compared with dedicated CT scanners. This problem is now being overcome by new generation of PET/CT scanners that offer volumetric CT capability
*pathological lymph nodes include rounded shape, loss of normal fatty hilum, increased or heterogeneous contrast enhancement, lymph node clustering, and sentinel lymph node location. 
 
*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).<ref name="pmid9046281">{{cite journal| author=Merritt RM, Williams MF, James TH, Porubsky ES| title=Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination. | journal=Arch Otolaryngol Head Neck Surg | year= 1997 | volume= 123 | issue= 2 | pages= 149-52 | pmid=9046281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9046281  }}</ref>    
PET appears to be at least as sensitive and specific as CT and MRI in detecting primary head and neck tumors [41-44]. More importantly, PET is superior to both CT and MRI for detecting regional nodal metastases, as well as distant metastases and second primary tumors [45-47].
<gallery>
 
Despite these data, the value of PET is uncertain for patients with a clinically negative (N0) neck, a reflection of its limitations in detecting occult nodal metastases less than 5 mm. The sensitivity of PET is lower in this setting (25 to 51 percent in four separate studies [48-51]), although at least one series reports better results [52]. Some of this disparity may be due to the detail with which resected lymph nodes are examined pathologically [53].<gallery>
Axial bone window (2).jpeg|CT of squamous cell carcinoma of the tongue showing axial bone window <ref name="radio1">Image courtesy of Dr. Bruno Di Muzio [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/squamous-cell-carcinoma-of-the-tongue-1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>
Axial bone window (2).jpeg|CT of squamous cell carcinoma of the tongue showing axial bone window <ref name="radio1">Image courtesy of Dr. Bruno Di Muzio [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/squamous-cell-carcinoma-of-the-tongue-1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>
Coronal bone window.jpeg|CT of squamous cell carcinoma of the tongue showing coronal bone window<ref name="radio1">Image courtesy of Dr. Bruno Di Muzio [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/squamous-cell-carcinoma-of-the-tongue-1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>
Coronal bone window.jpeg|CT of squamous cell carcinoma of the tongue showing coronal bone window<ref name="radio1">Image courtesy of Dr. Bruno Di Muzio [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/squamous-cell-carcinoma-of-the-tongue-1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>

Revision as of 17:48, 29 November 2017

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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.[1]

CT

  • CT is the most commonly used modality for assessment of tongue squamous cell carcinoma
  • Lesions typically appear more attenuating than normal tongue musculature (on account of the keratin) and enhance following contrast administration.
  • Non-contrast scans of the neck may demonstrate increased attenuation of involved nodes due to keratin production by tumor deposits.[1]
  • CT is better for the evaluation of bone destruction.
  • Assessment of cartilage invasion.[2]
  • Detection of extracapsular spread of tumor. 
  • Pathologic lymph nodes are 10 to 11 mm and contains central necrosis. Size criteria based on measurement of minimal axial diameter are considered the most accurate and effective.[3]
  • Pathological lymph nodes show: loss of normal fatty hilum, increased or heterogeneous contrast enhancement, lymph node clustering.[4]
  • Sensitivity is 83% and specificity is 83%.[5] 

PET-CT scan

Injection of positron-emitting radionuclides, such as fluorine-18, are taken up by metabolically or functionally active tissues. PET images are created by detecting these emissions by an array of detectors and then using reconstruction techniques to create a three dimensional image. The most commonly used agent is fluorodeoxyglucose (FDG), which is taken up into cells in different concentrations depending on the relative metabolism of different tissues. It is fairly specific for tumors because metabolic rates are very high in many tumors.

Imaging of the primary tumor site and regional lymph nodes with PET is limited by its poor spatial resolution, which can make it difficult to localize the anatomic location of the FDG uptake. These issues can be at least partially addressed with integrated PET/CT imaging, in which PET and CT are performed sequentially during a single visit on a hybrid PET/CT scanner. The images are then coregistered using fusion software, enabling the physiologic data obtained on PET to be localized according to the anatomic CT images.

Historically, CT images obtained from integrated PET/CT scanners had lower spatial resolution compared with dedicated CT scanners. This problem is now being overcome by new generation of PET/CT scanners that offer volumetric CT capability

PET appears to be at least as sensitive and specific as CT and MRI in detecting primary head and neck tumors [41-44]. More importantly, PET is superior to both CT and MRI for detecting regional nodal metastases, as well as distant metastases and second primary tumors [45-47].

Despite these data, the value of PET is uncertain for patients with a clinically negative (N0) neck, a reflection of its limitations in detecting occult nodal metastases less than 5 mm. The sensitivity of PET is lower in this setting (25 to 51 percent in four separate studies [48-51]), although at least one series reports better results [52]. Some of this disparity may be due to the detail with which resected lymph nodes are examined pathologically [53].

  • CT of squamous cell carcinoma of the tongue showing axial bone window [6]

    CT of squamous cell carcinoma of the tongue showing axial bone window [6]

  • CT of squamous cell carcinoma of the tongue showing coronal bone window[6]

    CT of squamous cell carcinoma of the tongue showing coronal bone window[6]

References

  1. ↑ 1.0 1.1 Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015
  2. ↑ Kuno H, Onaya H, Iwata R, Kobayashi T, Fujii S, Hayashi R; et al. (2012). "Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT". Radiology. 265 (2): 488–96. doi:10.1148/radiol.12111719. PMID 22984188.
  3. ↑ van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J; et al. (1990). "Cervical lymph node metastasis: assessment of radiologic criteria". Radiology. 177 (2): 379–84. doi:10.1148/radiology.177.2.2217772. PMID 2217772.
  4. ↑ Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ (1998). "Comparison of CT and MR imaging in staging of neck metastases". Radiology. 207 (1): 123–30. doi:10.1148/radiology.207.1.9530307. PMID 9530307.
  5. ↑ Merritt RM, Williams MF, James TH, Porubsky ES (1997). "Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination". Arch Otolaryngol Head Neck Surg. 123 (2): 149–52. PMID 9046281.
  6. ↑ 6.0 6.1 Image courtesy of Dr. Bruno Di Muzio Radiopaedia (original file [1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC

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