Читать книгу Anterior Skull Base Tumors - Группа авторов - Страница 84

The radiologist who has to evaluate a neoplasm with a potential involvement of the ASB should carry “hand luggage” containing four different epistemic compartments. The first box contains the knowledge of the technical solutions available and the specific strengths/weaknesses of different imaging techniques. For example, even if MRI is superior to CT in solving several of the points delineated in the checklist for local staging, the integration of MRI and CT is advantageous, especially in challenging cases. For neck nodal staging, CT is frequently used. However, ultrasound can adequately evaluate the neck and permits sampling of suspicious nodes with ultrasound-guided FNAC. PET-CT has the greatest sensitivity in detecting distant spread for highly metabolic lesions.

Knowledge of radiological anatomy is contained in the second box. The radiologist must be aware of normal, frequent, and infrequent anatomical configurations, and should be able to translate the CT appearance of structures into the equivalent MR signal (and vice versa). The third box holds the knowledge of the “neighbors”– the radiologist should know what information surgeons and radiation and medical oncologists need to have to plan a proper treatment, in order to provide all the necessary information. This aspect implies that the radiologist must be up-to-date with all the advances in the field of TES and additional treatment options. Hence, the importance of a reporting checklist is highlighted. The fourth and last box details the knowledge of a specific “enemy,” i.e., to be aware of the expected patterns of spread and imaging appearance of neoplasms, which widely vary according to histology.