This document discusses the application of magnetic resonance techniques to evaluate pharyngeal cancer. It begins with an introduction to nasopharyngeal carcinoma and the benefits of MRI for diagnosis and staging. The procedure section describes patient preparation, machine setup, imaging planes and protocols. Results show MRI is feasible and provides detailed images of tumor origin, signals, enhancement and T/N classifications in 30 patients. MRI is concluded to be a safe and effective technique for detecting and assessing pharyngeal cancer stage despite some limitations and costs.

1. 9/6/2019
1
APPLICATION OF MAGNETIC
RESONANCE TECHNIQUES
TO EVALUATION OF
PHARYNGEAL CANCER
Presenter
R.T TRẦN BÀI
CONTENTS
I. Introduction
II. Procedure
III. Results - Discussion
IV. Conclusion

2. 9/6/2019
2
I. INTRODUCTION
-Nasopharyngeal carcinoma is very common in-Nasopharyngeal carcinoma is very common in
our country, ranks first in head and neck cancer.
-With a superior soft tissue contrast resolution on
many planes, Magnetic Resonance Imaging
(MRI) is a method to diagnose and stage
h l l h l d lpharyngeal cancer accurately, helps develop a
treatment strategy, and is especially important for
planning in radiotherapy.
I. INTRODUCTION
- At Hue Central Hospital, pharyngeal MRI
for assessing cancer stage and planning
di th i d d dradiotherapy is used as an advanced
technical measure.
- Therefore, we study the topic “Application
of magnetic resonance techniques to
evaluation of pharyngeal cancer” with thep y g
following objectives: Assessing the
feasibility, effectiveness, safety, advantages
and disadvantages in applying an advanced
technical measure.
hinhanhykhoa.com

3. 9/6/2019
3
II. PROCEDURE
Patient preparation
- Check for absolute contraindications of MRI:
+ Pacemaker MRI-incompatible artificial heart+ Pacemaker, MRI-incompatible artificial heart
valve.
+ Vena cava filter, carotid stent… placed under
2 weeks.
+ Aneurysm clip, more than 10 years.
f ld d d l l+ Magnetic field adjusted Ventriculoperitoneal
Shunt.
+ Cochlear implant unit, catheters in deep brain
stimulation treatment (Parkinson’s disease).
* Relative contraindications:
PROCEDURE
- Metal devices: cervical fixation
devices.
- Fixed dentures.
- Relating to high frequency
effect.
- Patients with claustrophobia,
agitation.
Table of Recommendation for
Magnetic items

4. 9/6/2019
4
PROCEDURE
Patient preperation
1
11 Patient is asked to urinate before taking the MRI.
2222
Explain the procedure to the patient and ask him to limit
his movements and not to swallow.
33 Remove all jewelry or objects with metal, dentures,
magnetic items (magnetic cards, …).
44 Set an IV infusion.
55 Check the medical records, clinical symptoms and other
necessary tests.
Machine and tools preparation
1 5 T MRI hi
PROCEDURE
 1.5 T MRI machine.
 Select the appropriate Coil for the
surveyed body part (Head-neck
Coil)Coil)
 IV MRI contrast agent (Magnevist
or Dotarem).

5. 9/6/2019
5
PROCEDURE
-The patient lies face up and motionless on the table
with his head toward the center of the magnetic field.
-Position the patient’s head and neck in the Coil.
Position the Centering laser at the center of the neck-Position the Centering laser at the center of the neck
region.
-Set 3 planes: axial, coronal and sagittal.
Patient positioning in
Pharyngeal MRI
CORONAL
AXIAL
SAGITTAL

6. 9/6/2019
6
PROCEDURE
Protocol
1
T1W axial, sagittal sequence: skull and fat
layers invasion.
T2W axial, T2 STIR coronal sequence: evaluate
2
, q
the early spreading of the tumor, paranasal
sinuses invasion.
T1W Gd FS axial, sagittal, coronal sequence:
detect the spreading of the tumor around the
cranial nerves and inside the skull.
3
4
Sequences that have limited proven clinical values
such as Whole-body MRI, Diffusion-weighted
imaging, MRI Spectroscopy are not performed.
PROCEDURE
Sequence Plane Slice Gap Matrix FOV
T1W axial 3-5mm 10% 320x320 270-290
sagittal 3-5mm 10% 320x320 290-300
T2W axial 3-5mm 10% 320x320 270-290
T2STIR coronal 3-5mm 10% 384x320 280-300
T1 GD FS axial 3-5mm 10% 320x320 270-290
sagittal 3-5mm 10% 320x320 290-300
coronal 3-5mm 10% 384x320 280-300

7. 9/6/2019
7
RESULTS – DISCUSSION
1.Feasibility
- 30 patients with pharyngeal cancer were30 patients with pharyngeal cancer were
assigned MRI, all of whom followed the
procedure and the obtained images were
of diagnostic quality.
I b id h h l MRI- It can be said that pharyngeal MRI can
be performed on most patients.
RESULTS – DISCUSSION
2. Advantages and disadvantages
Availability:
- Pharyngeal MRI requires a 1.5-3.0 T MRI
machine which is expensive and not widely
available in many hospitals.
- It requires skilled R.Ts and highly
specialized radiologists.
- It is costly.

8. 9/6/2019
8
RESULTS – DISCUSSION
2. Advantages and disadvantages
Disadvantages
-MRI contraindications: any metal implant (pacemaker, insulin
hl i l t ) i th ti t’ b dpump, cochlear implant, …) in the patient’s body.
-Aneurysm clip (unless made of titanium).
-Metal foreign objects (especially in the eye socket).
-Patients with Claustrophobia.
-Long scanning time.
-Swallowing creates artifacts so good cooperation from the
patient is req iredpatient is required.
-Higher cost than CT-Scan.
-Limitation in assessing bone invasion compared to CT-Scan.
RESULTS – DISCUSSION
2. Advantages and disadvantages
Advantages
- MRI images have detailed structural resolution, MRI
has become valuable in diagnosing and assess the
level of invasion as well as regional lymph node
metastasis.
- Multi-plane imaging helps evaluate the lesion
t laccurately.
- It is safe due to no ion radiation used.
- Not many contraindications, contrast agents do not
have much affect on the body.

9. 9/6/2019
9
RESULTS – DISCUSSION
2. Advantages and disadvantages
Safety issues in MRI
Anesthetics may be used on children and require- Anesthetics may be used on children and require
doctor’s advice.
-No harmful effects of magnetic fields have been
seen on the body currently. However, high powered
magnetic field can affect metal implants.
Complicationsp
No patients were reported to have complications
during the scanning process.
RESULTS – DISCUSSION
3. Effects in Diagnosis
The Study was conducted on 30 patients
Table 1: Tumor originTable 1: Tumor origin
Location Number %
Rosenmuller 28 93,3
Mid line 2 6,7
Anterior 0 0
Comment: 93.3% of nasopharyngeal tumors originated from the
Rosenmuller, none from the anterior pharyngeal region.
Sum 30 100

10. 9/6/2019
10
RESULTS – DISCUSSION
Table : Signal of tumor
Signal T1W T2W
Number % Number %
Hyper-signal 0 0 22 73,3
Iso-signal 17 56,7 6 20
Hypo-signal 13 43,3 2 6,7
Sum 30 100 30 100
Comment: Iso-signal and hypo-signal intensity occurs on
T1W images with the same ratio. Hyper-signal intensity
occurs on T2W in 73.3% of the cases.
Sum 30 100 30 100
RESULTS – DISCUSSION
Table: Level of enhancement
Level of enhancement Number %
No enhancement 0 0
Low enhancement 2 6,7
High enhancement 28 93,3
Sum 30 100
Comment: 93.3% of the tumors have high enhancement.
hinhanhykhoa.com

11. 9/6/2019
11
RESULTS – DISCUSSION
Table : T classification (primary tumor)
T classification Number %T classification Number %
T1 4 13,3
T2 14 46,7
T3 10 33,3
T4 2 6,7
Sum 30 100
Comment: Most patients in the study is diagnosed
with cancer in late stage, only 13.3% discovered
in T1 Stage.
Sum 30 100
RESULTS – DISCUSSION
Table: N classification (Lymph node)
N classification Number %
N1 4 13 3N1 4 13,3
N2 13 43,4
N3 9 30
N4 4 13,3
Sum 30 100
Comment: Only 13.3% had postpartum lymph nodes,
most had lymph node metastasis. N4 stage
accounted for 13.3% including 1 case (3.3%) with
lymph nodes in the supraclavicular pit and 4 cases
(13.3%) with lymph nodes > 6 cm.
Sum 30 100

12. 9/6/2019
12
IV: RESULTS
• T2W -Axial
IV: RESULTS
• T1- Axial before Gado injection
hinhanhykhoa.com

13. 9/6/2019
13
IV: RESULTS
STIR CORONAL SEQUENCE
IV: RESULTS
T1 CORONAL SEQUENCE

14. 9/6/2019
14
IV: RESULTS
• After Gado injection
IV: RESULTS
After Gado injection
hinhanhykhoa.com

15. 9/6/2019
15
IV: RESULTS
T1FS after Gado injection on Coronal, Sagital, Axial planes
CONCLUSION
Magnetic Resonance Imaging is a safe technique to
help detect and assess accurately the stage ofp y g
nasopharyngeal carcinoma, help develop treatment
strategy, and especially important in planning for
radio therapy.
However, there are certain limitations:
Long scanning time
CostlyCostly
Some absolute contraindications
The limitation of the study is that it can not verify
the T and N stage pathologically after surgery.

16. 9/6/2019
16
REFERENCES
1. A.D. King, A.C. Vlantis, R.K.Y. Tsang, “Magnetic Resonance Imaging for the
Detection of Nasopharyngeal Carcinoma”, American Journal of Neuroadiology June
2006, 27 (6), 1288-1291.
2. Ahmed Abdel Khalek Abdel Razek and Ann King, “MRI and CT of Nasopharyngeal
Carcinoma”, Neuroradiology/Head and Neck ImagingJanuary 2012, 198 (1).Carcinoma , Neuroradiology/Head and Neck ImagingJanuary 2012, 198 (1).
Ann Dorothy King, Kunwar Suryaveer Singh Bhatia, “Magnetic resonance imaging
staging of nasopharyngeal carcinoma in the head and neck”,World J Radiol 2010
May 28; 2(5), 159–165.
3. Hilda E. Stambuk, Snehal G. Patel, “Nasopharyngeal Carcinoma: Recognizing the
Radiographic Features in Children”,American Journal of Neuroradiology June 2005,
26 (6), 1575-1579.
4.MRI parameters and positioning 2003, Thieme.
5. Mrimaste.com
THANK YOU FOR
LISTENING!
hinhanhykhoa.com