Use of three-dimensional spiral computed tomography imaging for staging and surgical planning of head and neck cancer

Abstract

We compare four different three-dimensional (3D) reconstruction methods of spiral computed tomography (CT) data for head and neck cancer to establish the method best suited for specific uses, eg, staging of lymph nodes and viewing of spatial relationships between the tumor, fascial spaces, adjacent soft tissues, and others structures. We evaluated a series of 10 patients (six men and four women), aged 32 to 60 years. Of these, five were histologically diagnosed with squamous cell carcinoma, two with lymphoma, one with thyroid cancer, one with Kikuchi's disease or necrotizing lymphadenitis, and one with esthesioneuroblastoma. All scans were obtained using high-resolution spiral CT (General Electric Medical Systems, Milwaukee, WI). The collimations used were 3 mm and 5 mm, matrix 512 x 512, and reconstruction interval not more than 3 mm. Scanning was performed from the skull base to the aortic arch. Iodinated contrast medium was injected so that the blood vessels were clearly differentiated from nodes. Different techniques of three-dimensional reconstruction were employed, including shaded surface display (SSD), multiplanar reconstructions (MPR), maximum intensity projection (MIP), 3D volume rendering (VR), and combined techniques. The reconstructions were performed in a variety of planes, including sagittal, coronal, and oblique views. In our series of selected patients, the technique of 3D VR showed potential advantages over other techniques. The MIP technique was useful in analyzing the patency of vessels and to exclude thrombus, compression, or displacement by tumor. The use of combined techniques such as SSD and MPR, accurately demonstrated the levels of lymph nodes and the relationship between the tumor projection of interest and various anatomic structures. In conclusion, 3D reconstruction of CT data is useful in the localization and staging of neck tumors and assists in surgical planning and radiation treatment.