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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
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.
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.
RESULTS AND DISCUSSION
Value of MRI:
Evaluate treatment response.
Detect early recurrence.
Look for complications of treatment.
Guide biopsies.
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.
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.
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
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 differentiate
between
radionecrosis and brain metastasis).
Fig 2: Coronal T2 SE MRI : Radionecrosis in left
temporal lobe (a)
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.
Fig 3: T2 sagittal SE spinal
MRI: Spinal cord enlargement
with intramedullary high-signal
T2 . Radiation myelopathy.
Reference 2
RESULTS AND DISCUSSION
Radiation-induced tumors: exceptional,
occurring 5-10 years after treatment.
Especially sarcomas.
Choanal stenosis post radiation.
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.
Fig 4: Coronal SE T1 MRI after Gadolinium
injection: Recurrent nasopharyngeal cancer in the
left cavernous sinus
CONCLUSION
MRI is currently the first-line examination
to detect local and intracranial recurrence
after treatment of nasopharyngeal cancer.
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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