Laryngeal imaging

Functional organ preservation in laryngeal and hypopharyngeal cancer

The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.

[Pretherapeutic and posttherapeutic laryngeal imaging]

Cross-sectional imaging with CT, MRI and more recently PET CT plays an indispensable complementary role to endoscopy in the pretherapeutic diagnostic and staging of laryngeal neoplasms and in the evaluation of the operated or irradiated larynx. Adequate interpretation of the CT, PET CT and MR images requires a thorough knowledge of the patterns of submucosal spread and familiarity with the diagnostic signs of neoplastic invasion as seen with each modality. In addition, one should be aware of the implications of imaging for staging and treatment. Both CT and MR imaging are highly sensitive for the detection of neoplastic invasion of the preepiglottic and paraglottic spaces, subglottic region and cartilage. The high negative predictive value of both CT and MRI allows a relatively reliable exclusion of neoplasm cartilage invasion. The specificity of both CT and MRI is, however, moderately high and both methods may, therefore, overestimate the extent of tumor spread. However, recent investigations have shown that the specificity of MRI may be significantly improved by using new diagnostic criteria which allow differentiation of tumor from peritumoral inflammation in many instances. Both cross-sectional imaging methods also significantly improve the pretherapeutic staging accuracy of laryngeal tumors if used in addition to clinical examination and endoscopic biopsy. In the presence of a submucosal mass, CT and MRI play a key role for the diagnosis, as they may characterize the lesion, reliably depict its submucosal extent and guide the endoscopist to perform deep biopsies which allow the definitive histological diagnosis. Cross-sectional imaging also plays a key role in the evaluation of laryngoceles, recurrent laryngeal nerve paralysis and fractures.

[MR diagnostic value in assessing laryngeal tumor]

AIMS

To evaluate diagnostic accuracy of pretreatment surgical magnetic resonance images (MRI) in assessment of patients with tumors of the larynx.

MATERIALS AND METHODS

The study included 12 patients, 11 men and 1 women, age 61,4 years. All patients underwent laryngeal endoscopy and biopsy followed by MRI. The biopsy confirmed that all patient had squamous-cell carcinoma. The MRI images were evaluated for presence in supraglottic, glottic or subglottic region, invasion of submucosal space, cartilage, extension to extralaryngeal tissue, presence of regional lymph nodes in regions I to VII. Imaging data were compared to surgical findings.

RESULTS

In 11 patients (92%) the tumor was supraglottic and glotic region and in 1 (8%) subglottic. None of them had tumor only in one region. Paraglottic ivasion was seen in 9 (75%) and preepiglottic in 2 (50%) patients. Paraglottic and preepiglotic invasion in the same time was seen in 3 (25%) patients. 7 (58%) patients had normal vocal cord mobility, 3 (25%) mobility was unilateral and 2 (17%) had no vocal cord mobility. Cartilage invasion has not been seen in present study. All patients had billateral limphadenopathy region II-IV. Extension to extralaryngeal tissue was absent. These findings were confirmed on surgery with high diagnostic accuracy.

CONCLUSION

MRI has been shown to be a reliable method for presurgical assessment of patients with tumor of the larynx.

Primary and salvage total laryngectomy

Treatment of laryngeal cancer has evolved, and newer methods of laryngeal conservation, both surgical and nonsurgical, are the primary treatment of choice. Nevertheless, total laryngectomy is not extinct and still plays an important role in primary therapy for advanced stage laryngeal cancers and as salvage therapy for failures of organ preservation strategies.

Imaging of the larynx and hypopharynx

The purpose of this article is to review currently used imaging protocols for the evaluation of pathologic conditions of the larynx and hypopharynx, to describe key anatomic structures in the larynx and hypopharynx that are relevant to tumor spread and to discuss the clinical role of Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and PET CT in the pretherapeutic workup and posttherapeutic follow-up of patients with squamous cell carcinoma of this region. A detailed discussion of the characteristic neoplastic submucosal invasion patterns, including extension to the preepiglottic space, paraglottic space and laryngeal cartilages and the implications of imaging for tumor staging and treatment planning is provided. The present article also reviews less common tumors of this region, such as chondrosarcoma, lymphoma, minor salivary gland tumors and lipoma. As the majority of non-neoplastic conditions do not require imaging the role of CT and MRI is discussed in some particular situations, such as to delineate cysts and laryngoceles, abscess formation in inflammatory conditions, to evaluate laryngeal and hypopharyngeal involvement in granulomatous and autoimmune diseases, and to evaluate the extent of laryngeal fractures due to severe blunt trauma.

CT versus MR: still a tough decision

CT and MRI are the two most widely used imaging modalities for evaluating head and neck pathology. There is continued controversy in the literature about which modality is superior for imaging different areas of the head and neck. This article summarizes the literature supporting the use of CT, MRI, or both for specific clinical scenarios in otolaryngology. Familiarity with the benefits and potential pitfalls of each modality allows referring physicians and radiologists to tailor imaging regimens to the needs of individual patients.

Multimodality imaging of head and neck cancer

Imaging has an important role in staging, planning treatment and post-treatment follow up of patients with head and neck cancer. The most commonly utilized imaging modalities are discussed in relation to their relative indications, strengths and weaknesses. This is followed by a brief update on the advances in functional magnetic resonance imaging.