OncologyTier 2Topic

CT of head, chest, abdomen, and pelvis

Role

Contrast-enhanced CT of the head, chest, abdomen, and pelvis is the primary anatomical imaging modality for cancer staging - assessing local extent, nodal involvement, and distant metastatic spread in one systematic survey
Forms the backbone of the TNM staging workup for most solid tumours, alongside site-specific additional imaging (MRI, PET) as indicated

IV contrast timing (arterial, portal venous, delayed phases) is chosen based on the organ/tumour type being assessed - e.g. arterial-phase imaging is essential for characterising hepatocellular carcinoma, which would be missed on portal-venous-phase imaging alone

Systematic review by region: primary tumour extent/local invasion, regional lymphadenopathy (size criteria, though imaging cannot reliably distinguish reactive from malignant nodes at intermediate sizes), and distant metastatic sites (liver, lung, adrenal, bone, peritoneum)
CT is limited for detecting small peritoneal deposits, leptomeningeal disease, and bone marrow infiltration - these require complementary modalities (diagnostic laparoscopy, MRI, bone marrow biopsy) when clinically relevant

Findings directly determine TNM stage and therefore treatment intent (curative vs palliative) and modality (surgical resectability assessment, radiotherapy planning)
Requires adequate renal function for IV contrast; alternative/reduced-contrast protocols or pre-medication used in contrast allergy or renal impairment

Cancer staging (TNM), treatment response assessment (RECIST criteria - comparing tumour measurements pre- and post-treatment), surveillance for recurrence

Serial CT is used for structured response assessment during treatment and for surveillance after curative treatment, with imaging intervals defined by tumour type and recurrence risk

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