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HEAD AND NECK : HN19

HEAD AND NECK : HN19. POST TREATMENT FOLLOW-UP OF NASOPHARYNGEAL CANCER IN MRI. L. EL ASSASSE, S. BOUTACHALI, F. AMRAOUI, R. LATIB, I . CHAMI, N. BOUJIDA, L . JROUNDI Radiology Service. National Institute of Oncology. Rabat. Morocco. INTRODUCTION.

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HEAD AND NECK : HN19

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  1. HEAD AND NECK: HN19

  2. POST TREATMENT FOLLOW-UP OF NASOPHARYNGEAL CANCER IN MRI L. EL ASSASSE, S. BOUTACHALI, F. AMRAOUI, R. LATIB, I. CHAMI, N. BOUJIDA, L. JROUNDI Radiology Service. National Institute of Oncology. Rabat. Morocco

  3. INTRODUCTION • Nasopharyngeal cancer is frequent worldwide. Morocco is part of the zone of intermediate frequency. • Imaging plays a role both in diagnosis, staging, and follow-up post treatment. • MRI represents the main means of monitoring imaging.

  4. MATERIALS AND METHODS: • These are cases collected in the radiology service of the national institute of oncology for patients treated for nasopharyngeal cancer and followed by MRI.

  5. RESULTS AND DISCUSSION • Value of MRI: • Evaluate treatment response. • Detect early recurrence. • Look for complications of treatment. • Guide biopsies.

  6. RESULTS AND DISCUSSION • MRI PROTOCOL: • 1 time / year for 5 years, then every 5 years. • Thickness of slices 3-5 mm . • T1 T2 sequences, Gadolinium with FATSAT. • Functional sequences: diffusion and perfusion.

  7. RESULTS AND DISCUSSION • NORMAL POST THERAPEUTIC ASPECTS: • Almost normal cavum. • Atrophy with irregularities of the mucosa. • Mucosal thickening. • Asymmetric cavum with loss of substance in case of large initial tumor. • Bone remodeling especially the sphenoid, sometimes cervical spine.

  8. Fig. 1: Axial T1 SE cavum MRI after gadolinium injection: control of a nasopharyngeal carcinoma treated by radiotherapy. Loss of substance without enhanced residual tumor .Reference 1

  9. RESULTS AND DISCUSSION • COMPLICATIONS OF RADIOTHERAPY: • Neurological complications: late-onset • Cerebral radionecrosis: especially at the lower part of the temporal lobes, T1 hypointense lesion and T2 hyperintense with inconstant contrast enhancement and parenchymal atrophy in the chronic phase (spectroscopy is used to differentiatebetween radionecrosis and brain metastasis).

  10. Fig 2: Coronal T2 SE MRI : Radionecrosis in left temporal lobe (a)

  11. RESULTS AND DISCUSSION • Radiation myelopathy: spinal cord enlargement with abnormal signal of irradiated tissue, and later spinal cord atrophy . • Vascular complications: rare • Radiation stenosis: circumferential regular noncalcified. vascular thickening. • Thrombosis and pseudoaneurysm: exceptional.

  12. Fig 3: T2 sagittal SE spinal MRI: Spinal cord enlargement with intramedullary high-signal T2 . Radiation myelopathy. Reference 2

  13. RESULTS AND DISCUSSION • Radiation-induced tumors: exceptional, occurring 5-10 years after treatment. Especially sarcomas. • Choanal stenosis post radiation.

  14. RESULTS AND DISCUSSION • TUMOR RECURRENCE: • Parietal thickening with enhanced after injection. • Diffusion: decreased ADC and high-signal on b1000. • Perfusion: a decreased perfusion  low probability of recurrence.

  15. Fig 4: Coronal SE T1 MRI after Gadolinium injection: Recurrent nasopharyngeal cancer in the left cavernous sinus

  16. CONCLUSION • MRI is currently the first-line examination to detect local and intracranial recurrence after treatment of nasopharyngeal cancer.

  17. REFERENCES 1-J.N. Bruneton, J. Stines, B. Padovani, C. Roy. Imagerie et surveillance post thérapeutique en oncologie. Masson 2000. 118-120. 2- Y. Hsaini, J. Mounach, M. El Marjany, A. Zerhouni, A. Satte, A. Karouache, A. Semlali, T. Boulahri, A. Bourazza, R. Mosseddaq. Les complications neurologiques de la radiothérapie: Apport de l’imagerie. JFR 2008. 3-F. Cohen, O. Monnet, F. Casalonga, A. Jacquier, V. Vidal, J.M. Bartoli, G. Moulin. Cancer du nasopharynx. J Radiol 2008; 89: 956-67. 4- Z. Jamaleddine, S. El Haddad, R. Latib, I. Chami, M. Boujida, L. Jroundi. Atlas d’imagerie dans le cancer du cavum. JFR 2010. 5-F. Orlandini. Aspects post thérapeutiques en cancérologie ORL. SFR 2009.

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