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Neoplastic invasion of the laryngeal cartilage is a major determinant for clinical staging, treatment planning and prognosis of laryngeal and hypopharyngeal neoplasms. In fact, cartilage involvement is one of the determinants which necessitate total laryngectomy. Computed tomography scan (CT scan) could be used for detecting the involvement.
Laryngeal cartilages are seen in two different histological patterns: nonossified and ossified. This fact causes different attenuation values of laryngeal cartilages in CT scan images. The neoplastic invasion could result in pathological cartilage ossification. Presence of cortex and medullary cavity implies a physiological ossification process, whereas a pathological process presents as cortical thickening and/or partial or complete loss of cortico-medullary differentiation.
However, most arytenoid and some of the thyroid cartilages could physiologically present as cortical thickening and/or absence of cortico-medullary differentiation which in turn reduces the specificity (0.38-0.73) of this finding.
Considering these points, sclerosis would be a relatively sensitive CT finding of neoplastic cartilage invasion (0.59-0.81) which the highest value is seen in the thyroid cartilage.
Regarding chondrolysis and erosion the high specificities (0.91-0.98) for different laryngeal cartilages are seen which could be due to the fact that erosion is caused by direct invasion and it is not an inflammatory response. This fact makes the cartilage erosion a suitable marker for treatment planning.
Physiological ossification of the thyroid cartilage may be mistaken with lysis due to neoplasm. Therefore, arytenoid cartilage erosion has higher specificity for neoplastic invasion.
In conclusion, cartilage sclerosis in CT images is the most sensitive finding and cartilage erosion is the most specific finding for the diagnosis of laryngeal cartilage neoplastic invasion. If we combine both of these findings for an individual laryngeal cartilage, we can consider neoplastic invasion with high specificity in the case of cricoid or arytenoid cartilage