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6.3.6: 6. Imaging

  • Page ID
    18312
  • Minority of parotid tumours require imaging

    • Only required if it might change management
    • Infrequently indicated for clinically benign, mobile parotid tumours as it rarely alters surgical management

    Indications

    • Suspect non-neoplastic disease e.g. HIV lymphoepithelial cyst, TB, benign cyst, lipoma (US / CT)
    • Deep vs superficial lobe parotid tumour
    • Mobile tumour: Only if surgeon does not have skill to resect a deep lobe tumour (CT with contrast / MRI)
    • Reduced mobility/fixed tumour
    • Deep lobe tumour (CT with contrast / MRI)
    • Extension to parapharyngeal space (CT with contrast / MRI)
    • Invasion of local structures (CT / MRI)
    • Recurrence of benign or malignant tumours (MRI)
    • Neurological deficits e.g. facial nerve to determine extent of perineural invasion (MRI with Gd)
    • Metastases to parotid gland (skin, conjunctiva), to plan selective vs therapeutic neck dissection (US / CT / MRI)
    • Exclude lung metastases with suspected/known malignancy (CXR / CT)

    Types of imaging

    • Ultrasound
      • Cystic vs solid; associated cervical lymph nodes
      • Not good for deep vs superficial lobe, or for parapharyngeal extension
    • CT with contrast
      • Cystic vs solid; associated cervical lymph nodes
      • Deep vs superficial lobe mass, or for parapharyngeal extension (Need to identify retromandibular vein (Need to identify retromandibular vein)
    • MRI
      • Tumour “stuck” around stylomastoid foramen area
      • Local invasion (Good soft tissue differentiation)
      • Deep vs superficial lobe mass, or for parapharyngeal extension
      • Perineural invasion

    PET-CT: Unhelpful as benign pathology (pleomorphic adenoma, Warthin tumours, TB, abscesses, lymphoma) are PET-avid