Preliminary Diagnosis: Nasopharyngeal carcinoma
I. What imaging technique is first-line for this diagnosis?
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CT soft tissue neck with contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of nasopharyngeal carcinoma.
Advantages
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Relatively inexpensive, fast imaging modality
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Able to detail the abnormal soft tissue neoplasm from surrounding osseous structures, vasculature, and lymph nodes with great sensitivity and specificity
Disadvantages
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Exposes the patients to large amounts of ionizing radiation
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May not detail potential perineural spread of tumor
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients
IV. What alternative imaging techniques are available?
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Fat-saturated contrasted MR of the neck
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of nasopharyngeal carcinoma.
Fat-saturated contrasted MR of the neck
Advantages
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Better able to identify and characterize subtle tumor than CT
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Better evaluates perineural spread of tumor than CT
Disadvantages
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Less specific and sensitive in evaluating the surrounding osseous structures than CT
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Expensive
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Time consuming
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Requires significant patient cooperation to minimize motion artifact
VI. What are the contraindications for the alternative imaging techniques?
Fat-saturated contrasted MR of the neck
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MR imaging may be contraindicated in patients with non–MR-compatible hardware.
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Gadolinium contrast is relatively contraindicated in patients with renal failure
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