5. Imaging diagnostics of major tumor groups

Question 1

Diagnostic imaging of head and neck tumors

Answer 1

• skull bone and petrous temporal bone tumors: MRI (CT if bone structure needs more precision)
• viscerocranium tumors: CE-CT
• differentiation b/w tumor and inflammation: MRI
• differention b/w intracranial or perineural invasion: MRI
• palpable neck swelling: US
• mucosa of upper resp. tract or GI tract: physical exam with diresctoscope or endoscope
• primary neck, pharynx, or oral cavity tumors: MRI (or CE-CT)
• salivary, thyroid, and parathyroid gland tumors: US, FNAB, MRI
• cervical lymph node imaging: US, CT, MRI, PET/CT

Question 2

Diagnostic imaging of gastrointestinal tumors

Answer 2

• endoscopy with biopsy!
• for esophageal, stomach and rectum tumors:
  
  • intramural and local Ln invasion: EUS
  • transmural invasion and regional/distant metastasis: CT and MRI
  • risk of distant metastasis: FDG-PET/CT
• tumors of small intestine: CT and MR enterography
• tumors of large intestine: colonoscopy
• rectal cancer: endoscopy with surface coil MRI
• checking for recurrence: CT/MRI
• tumors of the liver: US
  
  • staging/grading: MDCT and MRI
• bile duct and pancreatic duct: MR cholangiopancreatography
• cystic pancreatic lesion: MRI, MRCP, EUS
• operability of pancreatic tumor: MRI
• endocrine tumor differentiation: CT or MRI

Question 3

Diagnostic imaging of gyenocological tumors

Answer 3

• lesser pelvis: complex US (abdominal and endovaginal US)
• intrapelvic lesions: MRI
• advanced tumor: CT or MRI

Question 4

Diagnostic imaging of urogenital tumors

Answer 4

• renal parenchyma, pelvis, calyces, ureter tumors: US
  
  • thoraci and abdominal CT for staging
  • MRI to check for the vascular or surrounding invasion
• differentiate b/w malignant and benign adrenal gland tumor: CT or MRI
• bladder cancer:
  
  • intra-/transmural invasion: CT or mpMRI
  • invasion of mucosa: cytoscopy
• prostate cancer: transrectal US and MRI

Question 5

Diagnostic imaging of thoracic tumors

Answer 5

• tumor suspicion: chest X-ray
• in case of positive chest X-ray: CT or MRI
• treatment planning and tumor staging: PET/CT
• in heavy smokers: low-dose CT

Question 6

Diagnostic imaging of breast tumors

Answer 6

• primary imaging and screening: mammography
• differentiate b/w cyst and tumor: US
• risk of breast cancer or identifying whether tumor is bilateral or multifocal tumor: MRI

Question 8

Diagnostic imaging of nervous system tumors

Answer 8

• first choice: CT
• second choice: MRI
• occasionally: PET/CT
• metastasis or tumors of skull base, inner ear, hypophysis: MRI
• metastatic nodules, meninx infiltration, leptomeninx tumor, perineural invasion: CE-CT
• for accurate surgery and radiation therapy: funcional MRI
• spine tumors: MRI

Question 8

Diagnostic imaging of bone and soft tissue tumors

Answer 8

• primarily X-ray
• bone metastases: scintigraphy
• soft tissue invasion: CT
• bone marrow invasion: MRI
• soft tissue tumors: MRI and US

Question 8

Diagnostic imaging of lymphatic system tumors

Answer 8

• misdiagnosis of tumorous lymph node w/o apparent growth and difficulty differentiating b/w tumorous growth of LN or reactive hyperplasia, when using CT and MRI
• US is adequate in regions that can be examined
• LN metastasis: PET/CT
• malignant lymphoma above/below diaphragm: MDCT
• treatment, screening, detecting intracranial, intraspinal lymphoma or bone marrow involvement: MRI
• lymphoma: US, CT or MRI-guided core needle biopsy, or intracranial biopsy for histological examination
  
  • biopsy must be taken for acurate diagnosis!!