**10. References**


Imaging of Nasopharyngeal Carcinoma 119

Goh J & Lim K (2009). Imaging of Nasopharyngeal Carcinoma. *Ann Acad Med Singapore*.

Henderson BE, Louie E, SooHoo Jing J, Buell P, Gardner MB. Risk factors associated with nasopharyngeal carcinoma. *N. Engl. J. Med.* 295(20), 1101–1106 (1976). Ho HC, Lee MS, Hsiao SH *et al* (2008). Prognostic influence of parapharyngeal extension in

Ho JHC (1978). An epidemiologic and clinical study of nasopharyngeal carcinoma. *Int J* 

Johnston CR, Thames HD, Huang DT (1995). The tumour volume and clonogens

Khor TH, Tan BC, Chua EJ, Chia KB (1978). Distant metastases in nasopharyngeal

King AD, Ahuja AT, Leung SF *et al* (2000). Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease. *Head Neck.* 22(3), 275–281. King AD, Bhatia KSS (2010). Magnetic resonance imaging staging of nasopharyngeal

King AD, Lam WW, Leung SF, Chan YL, Teo P, Metreweli C (1999). MRI of local disease in

King AD, Ma BB, Yau YY, Zee B, Leung SF, Wong JKT, Kam MKM, Ahuja T, & Chan ATC

King AD, Teo P, Lam WW, Leung SF, Metreweli C (2000). Paranasopharyngeal space

King AD, Vlantis AC, Tsang RK *et al.* (2006). Magnetic resonance imaging for the detection

King AD, Tse GM, Ahuja AT *et al* (2004). Necrosis in metastatic neck nodes: diagnostic

Kumar MB, Lu JJ, Loh KS *et al.* (2004). Tailoring distant metastatic imaging for patients with

Lartigau E, Le Ridant AM, Lambin P, Weeger P, Martin L, Sigal R, Lusinchi A, Luboinski

Lau KY, Kan WK, Sze WM *e t al (*2004). Magnetic resonance for T-staging of nasopharyngeal

Lee AW, Poon YF, Foo W, Law SC, Cheung FK, Chan DK, Tung SY, Thaw M, Ho JH (1992).

Lee AW, Au JS, Teo PM *et al.* (Eds) (2004). *Clin. Oncol. (R. Coll. Radiol.)* 16(4), 269–276.

of nasopharyngeal carcinoma. *Am. J. Neuroradiol.* 27(6), 1288–1291.

accuracy of CT, MR imaging, and US. *Radiology.* 230(3), 720–726.

nasopharyngeal carcinoma: tumour extent vs tumour stage. *Br. J. Radiol.* 72(860),

(2008). The impact of 18FDG PET/CT on assessment of nasopharyngeal carcinoma

involvement in nasopharyngeal cancer: detection by CT and MRI. *Clin. Oncol. (R.* 

clinically localized undifferentiated nasopharyngeal carcinoma. *Int. J. Radiat. Oncol.* 

B,Eschwege F, Guichard M. (1993). Oxygenation of head and neck tumors. *Cancer.*

carcinoma – the most informative pair of sequences. *Jpn J. Clin. Oncol.* 34(4), 171–

Retrospective analysis of 5037 patients with nasopharyngeal carcinoma treated

number relationship: tumor control predictions based upon tumor volume estimates derived from computer tomography. *Int J Radiat Oncol Biol Phys.*

nasopharyngeal carcinoma. *Acta Otolaryngol.* 128(7), 790–798.

carcinoma in the head and neck. *World J Radiol*. 2(5):159-165.

at diagnosis. *The British Journal of Radiology*. 81:291-298.

38:809-816.

332:281-337.

734–741.

*Radiat Oncol Bio Phys*. 4:183-205.

carcinoma. *Clin Radiol*. 29:27-30.

*Coll. Radiol.)* 12(6), 397–402.

*Biol. Phys.* 58(3), 688–693.

717:2319-2325.

175.


Chang ET & Adami HO (2006). The Enigmatic Epidemiology of Nasopharyngeal

Chang JT, Lin CY, Chen TM *et al.* (2005). Nasopharyngeal carcinoma with cranial nerve

Chen YK, Su CT, Ding HJ *et al.* (2006). Clinical usefulness of fused PET/CT compared with

Cheng SH, Tsai SY, Yen KL, Jian JJ, Feng AC, Chan KY, Hong CF, Chu NM, Lin YC, Lin CY,

Chiesa F, De Paoli F (2001). Distant metastases from nasopharyngeal cancer. *ORL J* 

Chin SC, Fatterpekar G, Chen CY, Som PM. (2003). MR imaging of diverse manifestations of

Chong VFH (2006). Neoplasms of the nasopharynx. In: *Head and Neck Cancer Imaging*. Baert

Chong VFH, Fan YF (2000). Facial lymphadenopathy in nasopharyngeal carcinoma. *Clin* 

Chong VFH, Fan YF (1993). MRI and CT assessment of paranasal sinus involvement in

Chong VF, Fan YF, Khoo JB (1996). Nasopharyngeal carcinoma with intracranial spread: CT

Chua ML, Ong SC, Wee JT *et al.* (2009). Comparison of 4 modalities for distant metastasis staging in endemic nasopharyngeal carcinoma. *Head Neck* 31(3), 346–354. Chua DT, Sham JS, Kwong DL, Choy DT, Au GK, Wu PM (1996). Prognostic value of

Chung NN, Ting LL, Hsu WC, Lui LT, Wang PM (2004). Impact of magnetic resonance

Comoretto M, Balestreri L, Borsatti E, Cimitan M, Franchin G, Lise M (2008). Detection and

Dillon WP, Mills CM, Kjos B, et al (1984) Magnetic Resonance imaging of the nasopharynx.

Dubrulle F, Souillard R, Hermans R (2007). Extension patterns of nasopharyngeal

Glastonbury CM (2007). Nasopharyngeal Carcinoma The Role of Magnetic Resonance

paranasopharyngeal extension of nasopharyngeal carcinoma. A significant factor in

imaging versus CT on nasopharyngeal carcinoma: primary tumor target

restaging of residual and/or recurrent nasopharyngeal carcinoma after chemotherapy and radiation therapy: comparison of MR imaging and FDG

Imaging in Diagnosis, Staging, Treatment, and Follow-up. *Top Magn Reson Imaging*.

nasopharyngeal carcinomas. *Am. J. Roentgenol.* 180(6), 1715–1722.

and MR characteristics. *J. Comput. Assist. Tomogr.* 20(4), 563–569.

local control and distant metastasis. *Cancer.* 78(2), 202–210.

delineation for radiotherapy. *Head Neck.* 26(3), 241–246.

PET/CT. *Radiology.* 249(1), 203–211.

carcinoma. *Eur Radiol*. 17:2622-2630

*Radiology.* 152:731-738.

18:225-235.

AL, Sartor K (Eds). Springer, Berlin, Germany, 143–162.

nasopharyngeal carcinoma. *Clin Radiol.* 48:345.

palsy: the importance of MRI for radiotherapy. *Int. J. Radiat. Oncol. Biol. Phys.* 63(5),

PET alone or CT alone in nasopharyngeal carcinoma patients. *Anticancer Res.* 

Tan TD, Hsieh CY, Chong V, Huang AT (2005). Prognostic significance of parapharyngeal space venous plexus and marrow involvement: potential landmarks of dissemination for stage I-III nasopharyngeal carcinoma. *Int J Radiat* 

Carcinoma. *Cancer Epidemiol Biomarkers Prev.* 15:1765-1777.

1354–1360.

26(2B), 1471–1477.

*Radiol*. 55:363-7.

*Oncol Biol Phys.* 61: 456-465.

*Otorhinolaryngol Relat Spec*. 63(4):214.


during 1976-1985: overall survival and patterns of failure. *Int J Radiat Oncol Biol Phys*. 23(2):261.

Imaging of Nasopharyngeal Carcinoma 121

Olmi P, Fallai C, Colagrande S, Giannardi G (1995). Staging and follow-up of

Parkin DM, Bray F, Ferlay J, Pisani P (2005). Global cancer statistics. *CA Cancer J Clin.* 55:74–

Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB, editors (2002). Cancer incidence in five continents, vol. VIII. IARC scientific publications No. 155. Lyon: IARC. Ren EC & Chan SH (1996). Human leucocyte antigens and nasopharyngeal carcinoma. *Clin.* 

Roh JL, Sung MW, Kim KH, Choi BY, Oh SH, Rhee CS, Ha JW (2004). Nasopharyngeal

Sakata K, Hareyama M, Tamakawa M, Oouchi A, Sido M, Nagakura H, Akiba H, Koito K,

Som PM, Brandwein MS. Lymph nodes. In: Som PM, Curtin HD,editors (2003). Head and

Som PM, Curtin HD, Mancuso AA (1999). An imaging-based classification for the cervical

Su Y, Zhao C, Xie CM, Lu LX, Sun Y, Han F, Wu HB, Cui NJ, Zeng ZY, Lu TX (2006).

Teo PM, Kwan WH, Lee WY, Leung SF, Johnson PJ (1996). Prognosticators determining

Teo P, Lee WY, Yu P (1996). The prognostic significance of parapharyngeal tumour involvement in nasopharyngeal carcinoma. *Radiother. Oncol.* 39(3), 209–221. Wang XS, Hu CS, Ying HM, Zhou ZR, Ding JH, Feng Y (2009). Patterns

Wang GH, Lau EW, Shakher R, Binns DS, Hogg A, Drummond E, Hicks RJ (2007). Clinical

Yoshizaki T, Ito M, Murono S, Wakisaka N, Kondo S, & Endo K (2011). Current

monitoring of nasopharyngeal carcinoma. *Ai Zheng.*26(6):638-42. Wei WI & Sham JST (2005). Nasopharyngeal carcinoma. *Lancet.* 365:2041-2054.

metastasis in nasopharyngeal carcinoma. *Ai Zheng*. 25(5):521-525. Sze WM, Lee AW, Yau TK, Yeung RM, Lau KY, Leung SK, Hung AW, Lee MC,

carcinoma with skull base invasion: a necessity of staging subdivision. *Am J* 

Himi T, & Asakura K (1999). Prognostic factors of nasopharynx tumors investigated by MR imaging and the value of MR imaging in the newly published

nodes designed as an adjunct to recent clinically based nodal classifications. *Arch* 

Evaluation of CT, MRI and PET/CT in detecting retropharyngeal lymph node

Chappell R, Chan K. (2004) Primary tumor volume of nasopharyngeal carcinoma prognostic significance for local control. *Int J Radiat Oncol Biol Phys.*

survival subsequent to distant metastasis from nasopharyngeal carcinoma. *Cancer.* 

of retropharyngeal node metastasis in nasopharyngeal carcinoma. *Int J Radiat Oncol* 

application of (18)F-FDG PET/CT to staging and treatment effectiveness

understanding and management of nasopharyngeal carcinoma. *Auris Nasus Larynx*.

tomography. *Int. J. Radiat. Oncol. Biol. Phys.* 32(3), 795–800.

TNM staging. *Int J Radiat Oncol Biol Phys*. 43(2):273. Som PM (1987). Lymph nodes of the neck. *Radiology*. 165:593-600.

Neck Imaging. 4th ed. Vol 2. Mosby Inc. 1910-1911.

*Otolaryngol Head Neck Surg.* 125:388–396.

108.

59:21-27.

77(12), 2423–2431.

*Biol Phys.*73(1):194-201.

Article in press.

*Sci. (Lond.)* 91(3), 256–258.

*Otolaryngol.* 25(1):26-32.

nasopharyngeal carcinoma: magnetic resonance imaging versus computerized


Liang SB, Sun Y, Liu LZ *et al.* (2009). Extension of local disease in nasopharyngeal carcinoma

Liao XB, Mao YP, Liu LZ, Tang LL, Sun Y, Wang Y, Lin AH, Cui CY, Li L, Ma J (2008). How

Lin XP, Zhao C, Chen MY, Fan W, Zhang X, Zhi SF, Liang PY (2008). Role of 18F-FDG

Liu FY, Lin CY, Chang JT *et al* (2007). 18F-FDG PET can replace conventional work-up in

Liu MZ, Tang LL, Zong JF *et al.* (2008). Evaluation of sixth edition of AJCC staging system

Liu T, Xu W, Yan WL, Ye M, Bai YR, Huang G (2007). FDG-PET, CT, MRI for diagnosis of

Liu LZ, Zhang GY, Xie CM, Liu XW, Cui CY, Li L (2006). Magnetic resonance imaging of

Lu JC, Wei Q, Zhang YQ, Li F (2004). Influence of MRI abnormality in skull base bone on prognosis of nasopharyngeal carcinoma. *Cancer Radiother.* 8: 230-233. Mao YP, Liang SB, Liu LZ, Chen Y, Sun Y, Tang LL, Tian L, Lin AH, Liu MZ, Li L, Ma J

Mao YP, Xie FY, Liu LZ *et al (2009)*. Re-evaluation of 6th edition of AJCC staging system for

Ng S, Chan S, Yen T, Chang JT, Ko S, Wang H, Lin C, Chang K, Lin Y (2010).

Ng SH, Chang JT, Chan SC, Ko SF, Wang HM, Liao CT, Chang YC, Yen TC (2004). Nodal

Ng SH, Chang TC, Ko SF *et al.* (1997). Nasopharyngeal carcinoma: MRI and CT assessment.

resonance imaging. *Int. J. Radiat. Oncol. Biol. Phys.* 73(5), 1326–1334.

imaging work-up. *Eur J Nucl Med Mol Imaging*. 36:12-22.

*Eur J Nucl Med Mol Imaging.* 31: 1073-1080.

*Neuroradiology.* 39(10), 741–746.

delineation. *Int. J. Radiat. Oncol. Biol. Phys.* 75(3), 742–750.

systematic review. *Radiotherapy and Oncology*. 85:327-335.

spread. *Int J Radiat Oncol Biol Phys.* 66: 721-730.

imaging. *Clin Cancer Res.* 14: 7497-7503

*Radiat Oncol Biol Phys*. 72(5):1368-1377.

*Phys*. 23(2):261.

27(9):974-978.

48(10), 1614–1619.

*Biol. Phys.* 70(4), 1115–1123.

during 1976-1985: overall survival and patterns of failure. *Int J Radiat Oncol Biol* 

detected by magnetic resonance imaging: improvement of clinical target volume

does magnetic resonance imaging influence staging according to AJCC staging system for nasopharyngeal carcinoma compared with computed tomography? *Int J* 

PET/CT in diagnosis and staging of nasopharyngeal carcinoma. *Ai Zheng*.

primary M staging of nonkeratinizing nasopharyngeal carcinoma. *J. Nucl. Med*.

for nasopharyngeal carcinoma and proposed improvement. *Int. J. Radiat. Oncol.* 

local residual or recurrent nasopharyngeal carcinoma, which one is best? A

retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: patterns of

(2008). The N staging system in nasopharyngeal carcinoma with radiation therapy oncology group guidelines for lymph node levels based on magnetic resonance

nasopharyngeal carcinoma and proposed improvement based on magnetic

Comprehensive imaging of residual/recurrent nasopharyngeal carcinoma using whole-body MRI at 3 T compared with FDG-PET-CT. *Eur Radiol*. 20:2229-2240. Ng S, Chan S, Yen T, Chang JT, Liao C, Ko S, Liu F, Chin S, Fan K, Hsu C (2009). Staging of

untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional

metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET.


Yousem DM, Som PM, Hackney DB, Schwaibold F, Hendrix RA (1992). Central nodal necrosis and extracapsular spread in cervical lymph nodes: MR imaging versus CT. *Radiology*. 182:753-759.

**7** 

*China* 

**MRI-Detected Cranial Nerve Involvement** 

The incidence of cranial nerve (CN) palsy is not uncommon in patients with untreated nasopharyngeal cancer (NPC). In the 7th edition of the American Joint Committee on Cancer (AJCC) Staging Manual, the AJCC recommended that CN involvement be assessed by neurological evaluation rather than by cross-sectional imaging (computed tomography [CT] and magnetic resonance imaging [MRI]), because CN involvement is considered a poor

However, evaluation of CN palsy by clinical symptoms and physical examination has limitations. First, the accuracy of the neurological examination depends on the expertise of the examiner and the subjective report of the patient. Second, because CN involvement may be asymptomatic, it is difficult to diagnose CN palsy at an early stage by clinical neurological evaluation. In addition, neurological evaluation is not an optimal diagnostic method for assessing lesion localization and extension, which are critical factors in planning

With the excellent soft tissue contrast resolution and multiplanar imaging capability of MRI, direct visualization of smaller nerves and nerve branches is possible, making MRI a valuable tool in detecting and defining the extent of CN involvement in NPC. The difference and relationship between MRI findings of CN involvement and the symptoms and signs of CN

The goal of this study was to detect the difference and relationship between MRI findings suggestive of CN involvement and the symptoms and signs of CN dysfunction, and to evaluate the prognostic value of MRI-detected CN involvement in a large sample of consecutive patients. These information may contribute to understanding the patterns of spread and biological nature of NPC, and may also prove references in tumor staging and

**Patients:** From January 2003 to December 2004, 924 consecutive patients with newly diagnosed untreated NPC were included in our study. There were 685 male patients and 239 female patients, with a male-female ratio of 2.9:1, and the median age was 45 years (range, 11-78 years). All patients had a pretreatment evaluation that consisted of a

prognostic indicator in NPC patients, those with CN involvement are staged as T4.

treatment, particularly in delineation of target volume.

dysfunction have not been fully addressed.

treatment planning.

**2. Patients and methods** 

**1. Introduction** 

**in Nasopharyngeal Carcinoma** 

Li Li, Wenxin Yuan, Lizhi Liu and Chunyan Cui

*Cancer Center, Sun Yat-Sen University* 

