Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
Semin Nucl Med. 2021 Jan;51(1):3-12. doi: 10.1053/j.semnuclmed.2020.07.005. Epub 2020 Aug 6.
Imaging of head and neck (HN) cancer is a challenge for many radiologists and largely due to the challenging anatomy in a small volume of the body. Additionally, multiple pathologies and the absence of an agreed-upon standard imaging protocol for staging and surveillance add complexity in choosing the most appropriate imaging study. Computed tomography (CT) is often the first-line imaging tool used as it is readily available, relatively cheaper than magnetic resonance (MR) and is rapidly acquired. In comparison, MR is hampered not just by its greater expense and time involved with an imaging study, but the optimization of MR techniques is difficult in this complex part of the body. Over the last decade, additional advanced techniques have been developed for both CT and MR such as dual-energy CT, and perfusion imaging with CT or MR, which may aid in making a more accurate diagnosis and predication of tumor behavior. Ultrasound (US) plays an important role in HN imaging, particularly in the pediatric age group for new neck masses, and in adult patients with known or suspected thyroid pathology. US is also useful for the evaluation of other superficial masses in the neck and for guiding fine needle aspiration. This article will focus on each imaging modality, reviewing the benefits and drawbacks of CT, MR, and US as well as additional or advanced techniques within each. It will highlight disease processes where a specific modality is strongly favored as the most appropriate imaging study, and specific HN tumor behaviors that require dedicated imaging protocols or techniques. This review will also discuss the entity of carcinoma of unknown primary, which is often imaged with PET/CT, but for which specific guidelines were introduced in the 8th edition of the American Joint Committee of Cancer/Union for International Cancer Control Staging Manuals.
头颈部（HN）癌症的影像学诊断对许多放射科医生来说是一个挑战，主要是由于该部位体积小，解剖结构复杂。此外，多种病理学以及缺乏用于分期和监测的公认标准成像协议，使得选择最合适的影像学研究更加复杂。计算机断层扫描（CT）通常是首选的影像学工具，因为它易于获得，比磁共振（MR）便宜，并且可以快速采集。相比之下，MR 不仅受到其更高的成本和成像研究所需时间的限制，而且在身体这个复杂部位优化 MR 技术也很困难。在过去的十年中，为 CT 和 MR 开发了许多其他先进技术，例如双能 CT 和 CT 或 MR 灌注成像，这可能有助于更准确地诊断和预测肿瘤行为。超声（US）在 HN 影像学中起着重要作用，特别是在儿科新颈部肿块和已知或疑似甲状腺疾病的成年患者中。US 还可用于评估颈部其他浅表肿块，并指导细针抽吸。本文将重点介绍每种影像学方式，回顾 CT、MR 和 US 的优缺点，以及每种方式的其他或先进技术。它将突出显示强烈倾向于使用特定方式作为最合适的影像学研究的疾病过程，以及需要专门的影像学方案或技术的特定 HN 肿瘤行为。本文还将讨论未知原发灶癌的实体，这通常使用 PET/CT 进行成像，但在第 8 版美国癌症联合委员会/国际癌症控制联合会分期手册中引入了特定指南。
