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Many different types of malignant tumors arise within the sinonasal cavities. These tumors constitute less than 1% of all malignant neoplasms. The incidence of these tumors shows geographical differences, being clearly higher in parts of Africa and Japan than in the US. Sinonasal carcinoma is a disease mainly occurring in the age range of 50–70 years, although some tumor types (such as lymphoma, minor salivary gland tumors or esthesioneuroblastoma) also occur in younger patients.

The parotid gland is the largest salivary gland. It is located in the parotid space. The parotid gland can be affected by a variety of pathologic processes, especially neoplastic. Parotid tumors represent less than 3% of all head and neck tumors and are most frequently benign. These tumors require surgery in most cases and imaging is essential in the work-up of these lesions.

Evaluation of skull base lesions is challenging. On the one hand, the skull base is not directly accessible for clinical evaluation, and an underlying lesion is suspected or can be only roughly outlined based on neurological deficits. On the other, cross-sectional radiological studies are excellent in demonstrating a skull base lesion and its extent, but their evaluation is intimidating to the majority of the radiologists. There are three main reasons for the intimidation of the radiologists: The anatomical complexity of the skull base, the ability of normal anatomical structures to mimic pathology and the rarity of skull base lesions preventing dedicated training throughout residency and even during fellowship. In addition, inappropriate choice of an imaging study, imaging parameters and or sequences may amplify the insecurity of the radiologist.

X-rays of the neck, the chest or barium swallows can give hints mainly regarding thyroid disease, such as narrowing of tracheal, hypopharyngeal or oesophageal lumen, their shifting away from the midline, and coarse calcifications (Fig. 14.1). Their importance has remarkably decreased since the development and refinement of modern cross-sectional techniques. Reports on radiographically visible calcified parathyroid adenomas are anecdotal ( and 1971; et al. 1975; et al. 1987).

In the assessment of cervical lymph nodes imaging plays a major role. It is used mainly for N staging in known malignancies, but can also play a role in differential diagnosis of lymphadenopathy. Imaging plays an increasing role in evaluating the degree of extension and spread of the disease in the neck to serve as a prognosticator and determine optimal treatment. Most metastases originate from carcinomas of the mucous membranes, skin, thyroid and salivary glands, and in these cases, apart from staging the neck, the primary tumor is optimally assessed by the imaging modality as well.

The most frequent group of neoplasms in the neck is the carcinomas, followed by the lymphomas. Only 5% of all neoplasms in the neck are malignant lymphomas. Lymphomas are neoplasms of the lymphoreticular system. They arise from lymphocytes and their derivates. Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) are the most common malignancies of the hematopoietic system observed in the head and neck. Frequently, lymphoma is not limited to the head and neck region but also involves other parts of the body. This chapter approaches lymphoma as a systemic disease that can manifest itself in many forms in the head and neck. In many instances, the imaging findings are non-specific and tissue sampling remains the mainstay of making the diagnosis. However, some imaging patterns can (strongly) suggest the diagnosis of lymphoma.

Positron emission tomography (PET) is the most sensitive and specific technique for in vivo imaging of metabolic pathways and receptor–ligand interactions in the tissues of man ( 1996). PET uses positron emitting short living radioisotopes of natural elements, such as oxygen-15, carbon-11, nitrogen-13, and fluorine-18. These radioisotopes allow the synthesis of numerous positron-emitting radiopharmaceuticals targeting specific functional or metabolic expressions (phenotypes) of the disease. Depending on the selected radiopharmaceutical, PET imaging can provide quantitative information regarding blood flow (HO), hypoxia (F-misonidazole), DNA metabolism (C-thymidine; F-fluorothymidine), glucose metabolism (F-2-fluoro-2-deoxy-D-glucose), protein synthesis rate (C-tyrosine), amino acid metabolism (C-methionine), and receptor status. A major advance in PET has been the advent of a new generation of imaging tools combining a PET and a CT module in one camera. This allows the simultaneous acquisition of a whole body CT and PET during one single imaging session. The resulting coregistered whole-body PET-CT images allow a perfect integration of the metabolism with the structural and morphologic characteristics of the disease. This new modality has been used increasingly for clinical oncologic imaging since 2001.

Radiotherapy is used as part of the treatment in the majority of patients with head and neck cancer (HNC) during the course of their disease. In the last decade there have been important advances in the delivery of radiotherapy which have been made possible by the development of more powerful computers for treatment planning, delivery and data processing. The integration with better immobilisation of patients and advances in linear accelerator design such as multileaf beam collimators and on-line portal imaging systems, allow more accurate delivery of high radiation doses to the target volume while sparing the normal tissues. These developments imply, however, a more rigorous delineation of target volumes and organs at risk.