Female, 75 years old, with history of right nasal pharyngeal carcinoma, status post treatment with radiation and chemotherapy. Please note that fat-suppressed images are degraded in the region of the nasopharynx. The non-fat suppressed images, both T1 and T2, are of adequate quality.Since the prior examination, progressive thickening and surface irregularity is seen along the midline and right nasopharynx (see image 24 through 26 of series 1201). The tissue in question is of low signal on T2-weighted images and does not enhance suggesting a fibrous component. In association with this, progressive T1 hypointense marrow replacement is seen involving the basal clivus, the anterior arch and lateral masses of C1. The dura along the basal clivus may also be slightly thickened.Enhancement is seen within the right muscles of mastication but without any discrete masslike process. Elsewhere, there is mild aerodigestive mucosal edema likely related to prior therapy. No definite evidence of pathologic adenopathy is seen. One or two slightly prominent right level Ib lymph nodes have not significantly changed from prior. The salivary glands and thyroid are unremarkable. Patchy fluid signal is seen in the right mastoid air cells similar to prior. Lobular mucosal thickening in the maxillary sinuses has progressed at least on the right.Except as above, marrow signal characteristics are within normal limits. Cervical spondylosis is again seen with reversal of the lordosis and disc osteophyte disease from C4 through C6 resulting in at least mild spinal canal narrowing.
1.Since the prior examination, the midline and right nasopharyngeal soft tissues have thickened and become irregular in contour. This tissue is of low signal on T2-weighted images and does not enhance. In association, there is new marrow replacement involving the inferior clivus, anterior arch and lateral masses of C1. Findings are concerning for progressive tumor with osseous involvement. The possibility of a treatment related effect can also be considered, though the appearance is atypical for this. Direct visual inspection is highly recommended.2.New enhancement within the right masticator space is seen without any frank masslike lesion. This finding is nonspecific and could simply represent treatment related inflammation.3.No definite pathologic adenopathy is seen in the neck.