PMC3684226_01
(A-D) MRI study of the left-sided nasopharyngeal carcinoma before combined CRT plus cetuximab therapy, showing extensive involvement of the left prevertebral and the pterygoid muscles with encasement of the left ICA (A: axial T1WI, B: T2WI with fat suppression, C: Gd+T1WI; D: magnification of the lesion in C). (E and F) One month after treatment (E: Gd+T1WI shows patchy unenhanced areas in the center of the lesion, representing foci of necrosis; F: coronal Gd+T1WI shows the ICA meandering through the lesion). (G and H) Three months after treatment (G: Gd+T1WI shows large unenhanced area, bordering the ICA, in the lesion; H: T2WI shows the unenhanced area to be of moderately high signal intensity, representing coagulative necrosis of the lesion). Notes: Arrowheads indicate the left ICA; arrows indicate coagulative necrosis in the lesion.. Abbreviations: MRI, magnetic resonance imaging; ICA, internal carotid artery; CRT, chemoradiation; T1WI, T1-weighted imaging; T2WI, T2-weighted imaging; Gd+T1WI, gadolinium-enhanced T1-weighted imaging.
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Pretreatment MRI of the nasopharynx (Figure 1A-D) revealed a primary lesion predominantly occupying the left nasopharynx and extending into the left masticator space, with encasement of the left internal carotid artery. MRI scans taken 1 and 3 months after completion of radiotherapy are shown in Figure 1E-H, revealing gradual tumor shrinkage with rapidly spreading coagulative necrosis adjacent to the left internal carotid artery. On September 1, 2011 and 20 days after the last MRI scan (Figure 1G and H), the patient experienced excretion of a large quantity of yellow-grayish debris from the mouth and "felt much better than before," as described by his relatives.