Nasopharyngeal carcinoma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

MRI is more sensitive to perineural spread and for demonstrating early the bone marrow changes of infiltration (see normal bone marrow signal of the clivus), although not all bone marrow changes represent tumor extension. Similarly dural thickening may be both evidence of tumour infiltration or reactive hyperplasia.

MRI

MRI is more sensitive to perineural spread and for demonstrating early the bone marrow changes of infiltration (see normal bone marrow signal of the clivus), although not all bone marrow changes represent tumor extension. Similarly dural thickening may be both evidence of tumour infiltration or reactive hyperplasia.

  • T1: typically isointense to muscle
  • T2
    • isointense to somewhat hyperintense to muscle
    • fat saturation is helpful 5
    • fluid in the middle ear is a helpful marker
  • T1 C+ (Gd)
    • post contrast sequences should be fat saturated
    • prominent heterogeneous enhancement is typical
    • perineural extension should be sought

Post radiotherapy fibrosis can be distinguished from recurrent / residual tumour on MR if the fibrosis is mature. In such cases fibrotic scarring is of low signal intensity on T2 and does not demonstrate enhancement. Early fibrotic change cannot be distinguished from residual/recurrent tumour as both may be hyperintense on T2 and demonstrate enhancement.[1]

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