Neurologic/Head and Neck Imaging

Abstract

Posttreatment imaging of the patient treated for head and neck cancer is discussed, with a review of imaging findings associated with surgical and irradiation treatment methods, tumor recurrence, and potential treatment complications.

In patients with head and neck cancer, posttreatment imaging can be complicated and difficult to interpret because of the complexity of the surgical procedures performed and the postirradiation changes, but such imaging is critical for the evaluation of (a) the response to therapy and (b) tumor control. Posttreatment changes are affected by the type of surgery performed, reconstruction, neck dissection, and radiation therapy. Three types of flaps are used for reconstruction in the head and neck region: (a) the local flap, with geometric repositioning of adjacent tissue; (b) the pedicle flap, with rotation of donor tissue and preservation of the original vascular system; and (c) the free flap, with transfer of tissue that is revascularized by using microvascular surgical techniques. The posttreatment imaging findings in patients with head and neck cancer can be divided into four groups: altered anatomy secondary to surgical reconstruction, tumor recurrence, potential postsurgical complications, and possible postirradiation changes. Potential postsurgical complications are wound infection, abscess, fistula, flap necrosis, hematoma, chylous fistula, and serous retention. Possible postirradiation changes include mucosal necrosis, osteoradionecrosis, radiation-induced vasculopathy, radiation pneumonitis, radiation lung fibrosis, radiation-induced brain necrosis, and radiation-induced secondary malignancies. A familiarity with the imaging characteristics of posttreatment changes and of the potential complications caused by surgery and irradiation and an ability to differentiate these findings from tumor recurrence are essential for posttreatment surveillance and follow-up management of patients with head and neck cancer.

References

1 Som PM, Lawson W, Genden EM. The posttreatment neck: clinical and imaging considerations. In: Som PM, Curtin HD, eds. Head and neck imaging. 5th ed. St Louis, Mo: Mosby, 2011; 2771–2822. Crossref, Google Scholar
2 Mukherji SK, Wolf GT. Evaluation of head and neck squamous cell carcinoma after treatment. AJNR Am J Neuroradiol 2003;24(9):1743–1746. Medline, Google Scholar
3 Manikantan K, Khode S, Dwivedi RCet al.. Making sense of post-treatment surveillance in head and neck cancer: when and what of follow-up. Cancer Treat Rev 2009;35(8):744–753. Crossref, Medline, Google Scholar
4 de Bree R, van der Putten L, Brouwer J, Castelijns JA, Hoekstra OS, Leemans CR. Detection of locoregional recurrent head and neck cancer after (chemo)radiotherapy using modern imaging. Oral Oncol 2009;45(4-5):386–393. Crossref, Medline, Google Scholar
5 Subramaniam RM, Truong M, Peller P, Sakai O, Mercier G. Fluorodeoxyglucose-positron-emission tomography imaging of head and neck squamous cell cancer. AJNR Am J Neuroradiol 2010; 31(4):598–604. Crossref, Medline, Google Scholar
6 Yao M, Smith RB, Graham MMet al.. The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment. Int J Radiat Oncol Biol Phys 2005; 63(4):991–999. Crossref, Medline, Google Scholar
7 Vandecaveye V, De Keyzer F, Nuyts Set al.. 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 2007;67(4):960–971. Crossref, Medline, Google Scholar
8 Vandecaveye V, De Keyzer F, Dirix P, Lambrecht M, Nuyts S, Hermans R. Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology 2010;52(9):773–784. Crossref, Medline, Google Scholar
9 Bernier J, Cooper JS, Pajak TFet al.. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005; 27(10):843–850. Crossref, Medline, Google Scholar
10 Al-Sarraf M, LeBlanc M, Giri PGet al.. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998;16(4):1310–1317. Crossref, Medline, Google Scholar
11 Baujat B, Audry H, Bourhis Jet al.. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys 2006;64(1):47–56. Crossref, Medline, Google Scholar
12 Forastiere AA, Goepfert H, Maor Met al.. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349(22):2091–2098. Crossref, Medline, Google Scholar
13 Naidich MJ, Weissman JL. Reconstructive myofascial skull-base flaps: normal appearance on CT and MR imaging studies. AJR Am J Roentgenol 1996;167(3):611–614. Crossref, Medline, Google Scholar
14 Chong J, Chan LL, Langstein HN, Ginsberg LE. MR imaging of the muscular component of myocutaneous flaps in the head and neck. AJNR Am J Neuroradiol 2001;22(1):170–174. Medline, Google Scholar
15 Tomura N, Watanabe O, Hirano Y, Kato K, Takahashi S, Watarai J. MR imaging of recurrent head and neck tumours following flap reconstructive surgery. Clin Radiol 2002;57(2):109–113. Crossref, Medline, Google Scholar
16 Hudgins PA. Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease. Eur J Radiol 2002;44(2):130–138. Crossref, Medline, Google Scholar
17 Genden EM, Rinaldo A, Suárez C, Wei WI, Bradley PJ, Ferlito A. Complications of free flap transfers for head and neck reconstruction following cancer resection. Oral Oncol 2004;40(10):979–984. Crossref, Medline, Google Scholar
18 Offiah C, Hall E. Post-treatment imaging appearances in head and neck cancer patients. Clin Radiol 2011;66(1):13–24. Crossref, Medline, Google Scholar
19 Wehage IC, Fansa H. Complex reconstructions in head and neck cancer surgery: decision making. Head Neck Oncol 2011;3:14. http://headandneck oncology.org/content/3/1/14. Published March 8, 2011. Accessed July 21, 2011. Medline, Google Scholar
20 Hermans R. Posttreatment imaging in head and neck cancer. Eur J Radiol 2008;66(3):501–511. Crossref, Medline, Google Scholar
21 Makimoto Y, Yamamoto S, Takano Het al.. Lym-phadenopathy in the mesenteric pedicle of the free jejunal flap: reactive lymphadenopathy, not metastatic. J Comput Assist Tomogr 2006;30(1):65–67. Crossref, Medline, Google Scholar
22 Chong VF. Post treatment imaging in head and neck tumours. Cancer Imaging 2005;5(1):8–10. Crossref, Medline, Google Scholar
23 Lell M, Baum U, Greess Het al.. Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CT and MRI. Eur J Radiol 2000;33(3):239–247. Crossref, Medline, Google Scholar
24 Burri RJ, Kao J, Navada S, Packer S. Nonsurgical treatment of head and neck cancer. In: Som PM, Curtin HD, eds. Head and neck imaging. 5th ed. St Louis, Mo: Mosby, 2011; 2893–2914. Crossref, Google Scholar
25 Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 2003; 4(9):529–536. Crossref, Medline, Google Scholar
26 Fu KK, Pajak TF, Trotti Aet al.. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48(1):7–16. Crossref, Medline, Google Scholar
27 Adelstein DJ, Lavertu P, Saxton JPet al.. Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer 2000;88(4):876–883. Crossref, Medline, Google Scholar
28 Blanchard P, Hill C, Guihenneuc-Jouyaux Cet al.. Mixed treatment comparison meta-analysis of altered fractionated radiotherapy and chemotherapy in head and neck cancer. J Clin Epidemiol 2011; 64(9):985–992. Crossref, Medline, Google Scholar
29 Trotti A. Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys 2000;47(1):1–12. Crossref, Medline, Google Scholar
30 Trotti A, Bellm LA, Epstein JBet al.. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol 2003; 66(3):253–262. Crossref, Medline, Google Scholar
31 Rugg T, Saunders MI, Dische S. Smoking and mucosal reactions to radiotherapy. Br J Radiol 1990; 63(751):554–556. Crossref, Medline, Google Scholar
32 Franzén L, Funegård U, Ericson T, Henriksson R. Parotid gland function during and following radiotherapy of malignancies in the head and neck: a consecutive study of salivary flow and patient discomfort. Eur J Cancer 1992;28(2-3):457–462. Crossref, Medline, Google Scholar
33 Verdi CJ. Cancer therapy and oral mucositis: an appraisal of drug prophylaxis. Drug Saf 1993;9(3): 185–195. Crossref, Medline, Google Scholar
34 Som PM, Brandwein-Gensler MS. Lymph nodes of the neck. In: Som PM, Curtin HD, eds. Head and neck imaging. 5th ed. St Louis, Mo: Mosby, 2011; 2287–2384. Crossref, Google Scholar
35 Parker GD, Harnsberger HR. Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. RadioGraphics 1991;11(3):383–399. Link, Google Scholar
36 Ginsberg LE. Perineural tumor spread associated with head and neck malignancies. In: Som PM, Curtin HD, eds. Head and neck imaging. 5th ed. St Louis, Mo: Mosby, 2011; 2771–2822. Crossref, Google Scholar
37 Sakai A, Okami K, Onuki J, Miyasaka M, Furuya H, Iida M. Statistical analysis of post-operative complications after head and neck surgery. Tokai J Exp Clin Med 2008;33(3):105–109. Medline, Google Scholar
38 Paydarfar JA, Birkmeyer NJ. Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 2006;132(1):67–72. Crossref, Medline, Google Scholar
39 Lavertu P, Bonafede JP, Adelstein DJet al.. Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer. Arch Otolaryngol Head Neck Surg 1998;124(4):401–406. Crossref, Medline, Google Scholar
40 Spear SL, Carter ME, Low M, Ducic I, Schwartz J. Sickle cell trait: a risk factor for flap necrosis. Plast Reconstr Surg 2003;112(2):697–698. Crossref, Medline, Google Scholar
41 Debnam JM, Garden AS, Ginsberg LE. Benign ulceration as a manifestation of soft tissue radiation necrosis: imaging findings. AJNR Am J Neuroradiol 2008;29(3):558–562. Crossref, Medline, Google Scholar
42 Becker M, Schroth G, Zbären Pet al.. Long-term changes induced by high-dose irradiation of the head and neck region: imaging findings. RadioGraphics 1997;17(1):5–26. Link, Google Scholar
43 Chin SC, Jen YM, Chen CY, Som PM. Necrotic nasopharyngeal mucosa: an ominous MR sign of a carotid artery pseudoaneurysm. AJNR Am J Neuroradiol 2005;26(2):414–416. Medline, Google Scholar
44 Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 1983;41(6): 351–357. Crossref, Medline, Google Scholar
45 Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws: a current overview. I. Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 2010;14(1):3–16. Crossref, Medline, Google Scholar
46 Teng MS, Futran ND. Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg 2005;13(4):217–221. Crossref, Medline, Google Scholar
47 Hunter SE, Scher RL. Clinical implications of radionecrosis to the head and neck surgeon. Curr Opin Otolaryngol Head Neck Surg 2003;11(2): 103–106. Crossref, Medline, Google Scholar
48 Rabin BM, Meyer JR, Berlin JW, Marymount MH, Palka PS, Russell EJ. Radiation-induced changes in the central nervous system and head and neck. RadioGraphics 1996;16(5):1055–1072. Link, Google Scholar
49 Chong J, Hinckley LK, Ginsberg LE. Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients. AJNR Am J Neuroradiol 2000;21(1):175–178. Medline, Google Scholar
50 Choi YW, Munden RF, Erasmus JJet al.. Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. RadioGraphics 2004;24(4):985–997. Link, Google Scholar
51 Dassarath M, Yin Z, Chen J, Liu H, Yang K, Wu G. Temporal lobe necrosis: a dwindling entity in a patient with nasopharyngeal cancer after radiation therapy. Head Neck Oncol 2011;3:8. http://head andneckoncology.org/content/3/1/8. Published February 10, 2011. Accessed August 4, 2011. Medline, Google Scholar
52 Chan YL, Leung SF, King AD, Choi PH, Metreweli C. Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging. Radiology 1999;213(3):800–807. Link, Google Scholar
53 Chong VF, Rumpel H, Fan YF, Mukherji SK. Temporal lobe changes following radiation therapy: imaging and proton MR spectroscopic findings. Eur Radiol 2001;11(2):317–324. Crossref, Medline, Google Scholar
54 Chan YL, Yeung DK, Leung SF, Chan PN. Diffusion-weighted magnetic resonance imaging in radiation-induced cerebral necrosis: apparent diffusion coefficient in lesion components. J Comput Assist Tomogr 2003;27(5):674–680. Crossref, Medline, Google Scholar
55 Chong VE, Fan YF. Radiation-induced temporal lobe necrosis. AJNR Am J Neuroradiol 1997;18(4): 784–785. Medline, Google Scholar
56 Wei-wei L, Qiu-liang W, Guo-hao W, Zhi-hua C, Zong-yuan Z. Clinicopathologic features, treatment, and prognosis of postirradiation osteosarcoma in patients with nasopharyngeal cancer. Laryngoscope 2005;115(9):1574–1579. Crossref, Medline, Google Scholar

Article History

Received: Sept 15 2011
Revision requested: Nov 22 2011
Revision received: Mar 1 2012
Accepted: Mar 28 2012
Published online: Aug 31 2012
Published in print: Sept 2012

Vol. 32, No. 5

Abbreviations

Abbreviations:
ADC	apparent diffusion coefficient
FDG	2-(fluorine 18)fluoro-2-deoxy-d-glucose

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