History of nasopharyngeal cancer. Evaluate extent of disease. Extensive patient motion limits evaluation, particularly of the lower neck.Redemonstration of extensive posttreatment changes in the neck. There is extensive ill-defined enhancement involving the pharyngeal walls without a discrete measurable mass lesion. The abnormal enhancement extends posteriorly into the anterior arch and lateral mass of C1, left longus colli muscle, and left occipital condyle/skull base. This includes soft tissue extension into the hypoglossal canal and jugular foramen.There is also extension of enhancing soft tissue into the left cavernous sinus and left Meckel's cave that appears progressed from prior, however evaluation of this area is limited on the prior MRI. Definitely new from prior however is loss of the left internal carotid vascular flow void. There is also increased thickening and enhancement of the cisternal trigeminal nerve segment, foramen rotundum, and and ovale indicating worsening perineural tumor spread. Abnromal enhancement is also present in the inferior orbital fissure.Asymmetrically increased T2 signal is present in the masticator space as well as in the left aspect of the tongue. This possibly is related to denervation, but evaluation is limited by motion.There is a new mildly prominent left intraparotid lymph node measuring 11 x 6 mm. No cervical lymph adenopathy in the lower neck is appreciated although images are significantly motion degraded. Mucosal thickening and partial opacification affecting the maxillary sinuses and ethmoid air cells as well as near complete opacification of the sphenoid sinuses is likely inflammatory in etiology. Near complete opacification of the left mastoid air cells and to a lesser extent the right mastoid air cells is similar to prior and likely related to posttreatment change.
1. Extensive posttreatment changes in the neck as described. There is extensive ill-defined enhancement surrounding the nasopharynx without a measurable mass lesion; similar to prior.2. Compared to prior there appears to be increased tumor extension into the left cavernous sinus as well as worsening perineural tumor spread along the trigeminal nerve. This is now associated with loss of the left cavernous ICA vascular flow void. CTA may be considered for further evaluation.3. Abnormal enhancement extends into the left skull base, occipital condyles, and C1 vertebrae. This includes involvement of the left skull base neuroforamina as described above and probably contributing to patient's cranial nerve palsies. These osseous changes appear grossly similar to prior from 9/22/2015. Finding may represent posttreatment change although residual tumor cannot be excluded.4. No definite lymphadenopathy is identified, however evaluation of the lower neck is significantly limited by motion artifact.