Multiplanar functional imaging of the larynx and hypopharynx with multislice spiral CT

Abstract

The purpose of this study is to evaluate multislice spiral CT (MSCT) in multiplanar functional imaging of the larynx and hypopharynx and to define the optimal image planes for the delineation of the tumor and specific anatomical structures. Forty patients with suspected tumors of the larynx or hypopharynx were examined with MSCT during quiet breathing (QB), E-phonation (EP) and modified Valsalva maneuver (VM). Images were read in the axial, coronal and sagittal planes. Overall image quality, delineation of the tumor and anatomic structures for different conditions and orientations were graded using a three-point scale; the conditional permutation test was applied to detect quality differences. Differences between image types were statistically significant. The axial plane was superior in overall image quality and the delineation of the tumor, pyriform sinus, vocal cords and fat within the parapharyngeal/visceral space. The coronal plane was best for delineating the ventricle and the paraglottic space, the sagittal plane for the retropharyngeal and the preepiglottic space. For tumor detection, sensitivity, specificity and accuracy were 0.92, 1.0 and 0.93 for QB.ax, 0.94, 0.8 and 0.92 for EP.ax and 0.85, 1.0 and 0.87 for VM.ax, respectively. Examination during QB should be the standard procedure; additional scanning with EP improved tumor assessment.

Staging of Laryngeal Cancer Using 64-Channel Multidetector Row CT: Comparison of Standard Neck CT with Dedicated Breath-Maneuver Laryngeal CT

“…Keberle et al 8 found that coronal reformats led to a better visualization of tumor extension in 33% of patients and influenced the treatment decisions in 19% of patients. 8 Lell et al 9 found that CT imaging with the patient phonating correctly identified all of the patients in their study with vocal cord fixation and that E phonation was better than the Valsalva maneuver. Another study by Stadler et al, 10 comparing nonfunctional CT (during quiet breathing) and functional CT (including Valsalva and E-phonation maneuver), reported that functional CT was more accurate than nonfunctional CT for TNM-staging of laryngeal and hypopharyngeal cancers.…”

Multi detector computerized tomography scans aid in the staging of Head and Neck cancers

“…Thick slice thickness reduces resolution and makes multi-planar reformation MPR sub-optimal. When overlapping images are reconstructed from raw data with a nominal slice thickness of 0.5-1.25 mm, (MPR) images of the tumor can be viewed interactively in any arbitrarily chosen imaging plane 12 . Due to better delineation of bony extent and lymph node evaluation by contrast enhanced, CT scan (CECT) has become an essential part of the workup of HNCs patients.…”

Larinks kanserinde bilgisayarlı tomografi ile histopatolojik evrelemenin karşılaştırması: BT evrelemede başarısızlık nedenleri

“…Valsalva, modifiye Valsalva manevrası, fonasyon veya inspirasyon sırasında sırasında yapılan ek çekimler mukozal yüzeylerin ve derin yayılımların (paraglottik alandan tiroid kıkırdağa fiksasyon gibi) veya vokal kordun mobilitesinin değerlendirilmesi mümkün olmaktadır (17,18).…”