{"doi":"10.1002/pbc.30151","title":"Imaging of pediatric head and neck tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper","abstract":"Head and neck cancer comprises approximately 12% of all childhood malignancies.1 Common head and neck tumors include those that can occur in other regions of the body, such as neuroblastoma, rhabdomyosarcoma, lymphoma, Ewing sarcoma, and osteosarcoma, as well as those arising in tissues specific to the head and neck, such as salivary gland malignancies, nasopharyngeal carcinoma, and odontogenic neoplasms.1 The presenting signs and symptoms of pediatric head and neck tumors are variable. However, most head and neck tumors come to attention due to the presence of a visible or palpable mass, or a functional deficit that varies by location, such as epistaxis, difficulty swallowing, and malocclusion. While there are a variety of staging systems for head and neck tumors, common themes including size, location, and trans-spatial involvement, and nodal and distant metastatic disease are important across diagnoses. While staging may be tumor-specific, there is a growing trend to increase the uniformity of techniques used to assess outcomes and response to therapy. Both tumor staging and outcomes assessment require high spatial and contrast resolution, shaping imaging recommendations. The recommendations for imaging reflect available evidence and consensus expert opinion. Consensus recommendations are guided by the following principles: (a) use of hardware and software available to the majority of pediatric cancer centers across the world; (b) facilitation of existing staging and tumor response systems, such as RECIST 1.12; and (c) compliance with existing guidelines for image appropriateness, as outlined by the American College of Radiology Appropriateness Criteria. While the general advantages and disadvantages of each imaging modality are summarized in Table 1, the discussion below highlights the attributes of each modality that carries implications for imaging structures of the head and neck. Magnetic resonance imaging (MRI) exhibits excellent soft tissue contrast on account of the variable signal intensity of various tissues within the body due to different density and local environment of protons. This contrast is exploited in certain “anatomic” sequences, such as T1- and T2-weighted images, to yield high-resolution details. Contrast can be further enhanced by administration of intravenous gadolinium-based contrast agents, with the added benefit of distinguishing between cystic and solid lesions. The excellent contrast and spatial resolution of magnetic resonance (MR) is particularly useful in the assessment of tumors arising within the soft tissues of the head and neck, where tumor location has important implications for diagnosis, staging, as well as treatment.3 A prime example of this involves detection of perineural spread of tumor, particularly when neural invasion spans multiple spaces, such as intracranial and extracranial compartments.4, 5 Here, high-resolution, contrast-enhanced, fat-suppressed MRI, in addition to comprehensive knowledge of anatomy, is required to evaluate for perineural spread. In addition to anatomic depiction, MR sequences have been designed to assess tissue composition such as cellularity, vascularity, and the presence of fat, providing additional information of relevance to diagnosis and treatment response assessment3 (Table 2). Fluid sensitive: T2 T2FS Short tau Inversion recovery (STIR) T2W Dixon T1 pre-contrast: Traditional T1 T1 FS Dixon (water-only) T1 post-contrast: Traditional T1 T1 FS Dixon (water-only) Diffusion: EPI DWI Non-EPI DWI Perfusion: DCE ASL Vascular: 2D-TOF without time-resolved MRA Computed tomography (CT) is a fast, relatively motion-resistant technique capable of obtaining high spatial resolution images of the head and neck. However, soft-tissue contrast is poor relative to MRI, limiting its use as a primary diagnostic or monitoring tool. Nevertheless, there are certain tumors that uniquely benefit from CT imaging, namely those involving the maxilla, mandible, and paranasal sin","journal":"Pediatric Blood & Cancer","year":2022,"id":285863,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.965,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":964787,"name":"Usha D. Nagaraj","orcid":"0000-0001-8251-7481","position":1,"is_corresponding":false},{"id":964788,"name":"Lillian M. Lai","orcid":"0000-0002-5778-2643","position":2,"is_corresponding":false},{"id":964789,"name":"Christopher Liu","orcid":"0000-0003-4775-462X","position":3,"is_corresponding":false},{"id":965284,"name":"Jason W. Schroeder","orcid":null,"position":4,"is_corresponding":false},{"id":964790,"name":"Paritosh C. Khanna","orcid":"0000-0001-7819-953X","position":5,"is_corresponding":false},{"id":531733,"name":"Nathaniel A. Chuang","orcid":"0000-0002-3432-2564","position":6,"is_corresponding":false},{"id":278957,"name":"Sara Strauß","orcid":"0000-0001-7766-2721","position":7,"is_corresponding":false},{"id":788031,"name":"Gabriel Gomez","orcid":"0000-0002-5921-4180","position":8,"is_corresponding":false},{"id":964791,"name":"R.L. Clarke","orcid":"0000-0003-1859-2502","position":9,"is_corresponding":false},{"id":964792,"name":"Sumit Singh","orcid":"0000-0003-3753-5861","position":10,"is_corresponding":false},{"id":447464,"name":"Asim F. Choudhri","orcid":"0000-0002-3154-6319","position":11,"is_corresponding":false},{"id":503115,"name":"Matthew T. Whitehead","orcid":"0000-0001-5077-693X","position":12,"is_corresponding":false},{"id":964786,"name":"Zachary Abramson","orcid":"0000-0001-7875-1187","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T00:29:48.841035Z","pmid":"36546312","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}