Reinterpretation of Cross-Sectional Images in Patients with Head and Neck Cancer in the Setting of a Multidisciplinary Cancer Center
Laurie A. Loevnera,b,
Adina I. Sonnersa,d,
Brian J. Schulmane,
Kerstin Slaweka,
Randal S. Weberb,
David I. Rosenthalc,
Gul Moonisa and
Ara A. Chalianb
a Department of Radiology, Philadelphia
b Department of Otorhinolaryngology: Head and Neck Surgery, Philadelphia
c Department of Radiation Therapy, Philadelphia
d University of Pennsylvania School of Medicine, University of Pennsylvania Medical Center, Philadelphia
e University of Pennsylvania College of Arts and Sciences, Philadelphia
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FIG 1. 57-year-old woman with a history of squamous cell carcinoma of the left side of the tongue. Enhanced CT image shows a necrotic regional nodal metastasis (arrows) in the contralateral neck that was detected on reinterpretation in the cancer center, but missed on the initial read. This was pathologically proved following neck dissection.
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FIG 2. 49-year-old woman with known cancer of the right side of the tongue and a second primary cancer of the nasopharynx detected at the time of image reinterpretation.
A, Nonenhanced axial CT image shows asymmetry of the nasopharynx, with increased tissue on the left (arrow) and obliteration of the fat along the deep musculature (levator and tensor veli palatini muscles).
B, Nonenhanced coronal CT image again shows increased tissue at the left nasopharynx (arrows). Subsequent biopsy revealed carcinoma.
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FIG 3. 80-year-old woman with primary pharyngeal cancer. A normal-sized, fat-replaced left jugulogastric lymph node was interpreted as abnormal because of inhomogeneous signal intensity.
A, Axial nonenhanced T1-weighted (600/17/1 [repetition time/echo time/excitations]) MR image shows intrinsic high signal intensity in the lymph node (arrows) consistent with fat.
B, Axial fat-suppressed T2-weighted (4000/80/1) MR image obtained at the same level as that in A shows hypointensity in the hilum of this node (arrow) consistent with suppressed fat.
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