Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CT and MRI (original) (raw)
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European Radiology, 2017
Purpose To determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/ DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy. Materials and methods This was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiationinduced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering. Results The proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p < 0.001). Conclusion FDG-PET/DWIMRI yields excellent results for d et ec t i o n an d T-c l a s s i f i c a t i o n o f H N S C C af t e r radio(chemo)therapy. Key points • FDG-PET/DWIMRI yields excellent results for the detection of post-radio(chemo)therapy HNSCC recurrence. • Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage. • 97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence. • 87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions. • Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.
Post treatment imaging in head and neck tumours
Cancer Imaging, 2005
Cancer is a leading cause of death in most parts of the world. Most patients will undergo multiple imaging studies following treatment. The regular follow up of these patients often leads to the early detection of tumour recurrence or the onset of treatment complications. Early diagnosis may result in the timely institution of appropriate therapy thereby improving the survival and morbidity rates. This review addresses difficulties related to demonstrating early tumour recurrence and nodal metastasis and focuses on the complications seen in the central nervous system, cranial nerves and brachial plexus following radiotherapy.
Imaging in Head and Neck Cancers
Otorhinolaryngology Clinics An International Journal, 2010
This article reviews the role of imaging, imaging characteristics and significance of individual imaging modalities as well as the newer imaging modalities in the evaluation of head and neck cancer. In the pretreatment evaluation, imaging is performed primarily to determine the stage of tumor and to look for an occult primary. It helps in obtaining tissue samples to establish the diagnosis, and treatment planning if radiotherapy is considered. Postsurgery and radiotherapy changes can be differentiated from residual or recurrent pathology on imaging. Imaging also plays an important role in assessing the response to treatment.
American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Although diffusion-weighted imaging combined with morphologic MRI (DWIMRI) is used to detect posttreatment recurrent and second primary head and neck squamous cell carcinoma, the diagnostic criteria used so far have not been clarified. We hypothesized that precise MRI criteria based on signal intensity patterns on T2 and contrast-enhanced T1 complement DWI and therefore improve the diagnostic performance of DWIMRI. MATERIALS AND METHODS: We analyzed 1.5T MRI examinations of 100 consecutive patients treated with radiation therapy with or without additional surgery for head and neck squamous cell carcinoma. MRI examinations included morphologic sequences and DWI (bϭ0 and bϭ1000 s/mm 2). Histology and follow-up served as the standard of reference. Two experienced readers, blinded to clinical/histologic/follow-up data, evaluated images according to clearly defined criteria for the diagnosis of recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment, post-radiation therapy inflammatory edema, and late fibrosis. DWI analysis included qualitative (visual) and quantitative evaluation with an ADC threshold. RESULTS: Recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment was present in 36 patients, whereas 64 patients had post-radiation therapy lesions only. The Cohen for differentiating tumor from post-radiation therapy lesions with MRI and qualitative DWIMRI was 0.822 and 0.881, respectively. Mean ADCmean in recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment (1.097 Ϯ 0.295 ϫ 10 Ϫ3 mm 2 /s) was significantly lower (P Ͻ .05) than in post-radiation therapy inflammatory edema (1.754 Ϯ 0.343 ϫ 10 Ϫ3 mm 2 /s); however, it was similar to that in late fibrosis (0.987 Ϯ 0.264 ϫ 10 Ϫ3 mm 2 /s, P Ͼ .05). Although ADCs were similar in tumors and late fibrosis, morphologic MRI criteria facilitated distinction between the 2 conditions. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95% CI) of DWIMRI with ADCmean Ͻ 1.22 ϫ 10 Ϫ3 mm 2 /s and precise MRI criteria were 92.1% (83.5-100.0), 95.4% (90.3-100.0), 92.1% (83.5-100.0), 95.4% (90.2-100.0), 19.9 (6.58-60.5), and 0.08 (0.03-0.24), respectively, indicating a good diagnostic performance to rule in and rule out disease. CONCLUSIONS: Adding precise morphologic MRI criteria to quantitative DWI enables reproducible and accurate detection of recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment. ABBREVIATIONS: DWIMRI ϭ combined MRI with morphologic sequences and DWI; HN ϭ head and neck; HNSCC ϭ head and neck squamous cell carcinoma; LR ϭ likelihood ratio; pHNSCC ϭ primary head and neck squamous cell carcinoma; rHNSCC ϭ recurrent head and neck squamous cell carcinoma; RTH ϭ radiation therapy; sHNSCC ϭ second primary head and neck squamous cell carcinoma occurring after treatment S quamous cell carcinoma accounts for 95% of all cancers in the head and neck (HN) region. 1 The aim of treatment is to provide a cure with the maximum possible preservation of organ function. Treatment options comprise radiation therapy (RTH) and/or chemotherapy and/or an operation. 1,2 Up to 25% of early-stage primary head and neck squamous cell carcinomas (pHNSCCs) and up to 50% of advanced-stage tumors show treatment failure in the form of residual/recurrent HNSCC (rHNSCC), whereas 15% of patients develop second primary HN cancer (sHNSCC). 2,3 Early
PET/MRI and PET/CT in follow-up of head and neck cancer patients
2014
Purpose Positron emission tomography (PET)/MRI combines the functional ability of PET and the high soft tissue contrast of MRI. The aim of this study was to assess contrastenhanced (ce)PET/MRI compared to cePET/CT in patients with suspected recurrence of head and neck cancer (HNC). Methods Eighty-seven patients underwent sequential cePET/ CT and cePET/MRI using a trimodality PET/CT-MRI set-up. Diagnostic accuracy for the detection of recurrent HNC was evaluated using cePET/CT and cePET/MRI. Furthermore, image quality, presence of unclear 18 F-fluorodeoxy-D-glucose (FDG) findings of uncertain significance and the diagnostic advantages of use of gadolinium contrast enhancement were analysed.
Oral Oncology, 2019
Role of diffusion-weighted (DW) MR imaging in differentiating residual or recurrent neck malignancies from postoperative/post-radiation changes with histopathological correlation and comparison with PET-CT. Methods and materials: Prospective observational study for a period of 1 year in 62 post-radiation/post-operative patients suspected to have residual/recurrent tumors of neck with lesion diameter more than 5 mm measured on MRI. Results: Mean ADC for recurrent/residual tumors: 1.008 ± 0.220 × 10 −3 mm 2 /s-significantly lower than mean ADC value for post-treatment changes of 1.69 ± 0.40 × 10 −3 mm 2 /s (p < 0.0001). The overall diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the qualitative assessment for the use of DWI in differentiating tumors recurrence from post-treatment changes were 96.6%, 96% and 83.3%, respectively. Upon quantitative analysis of the DW imaging data, a threshold ADC value of 1.3 × 10 −3 mm 2 /s used for differentiating between post-treatment changes and recurrent cancers showed the highest combined sensitivity of 94%, specificity of 83.3%, accuracy of 93.6%, positive predictive value of 95.9%, and negative predictive value of 83.3%. Conclusion: DW MRI is a promising non-invasive MRI technique used to differentiate recurrent/residual head and neck malignancies from posttreatment changes based on ADC values. DWI offers advantage as it has a short scanning time and can be safely added to standard MRI protocol with minimum patient discomfort. Complementary use of DWI and PET/CT imaging may increase diagnostic confidence for differentiating recurrent disease from radiation therapy-induced changes after 6-12 months in posttreatment cases.
PET-CT in recurrent head neck cancers: A study to evaluate impact on patient management
Journal of Surgical Oncology, 2009
Background and Objectives: PET-CT has shown promise in the management of head neck cancers. However, there have been only few studies evaluating its impact on management of patients with recurrent cancers in the presence of available clinicoradiologic methods of assessment. We conducted this study to assess the same in patients with suspected recurrent head and neck cancer. Methods: Case histories were presented to two oncologists, who were blinded to PET-CT reports. Treatment plans were made by these oncologists based on clinical findings and other conventional imaging. These plans were then compared to the actual treatment received by patients after PET-CT. Any change was recorded as "change in management." Results: Forty-nine patients with suspected recurrent head and neck cancer were evaluated in the study. Overall, there was a 38.7% change in management because of the addition of PET-CT to conventional methods of assessment. Eight patients (16.3%) had a major change in therapy while in 11 patients (22.4%), diagnostic procedures like endoscopies, biopsies and examination under anesthesia were avoided. Conclusion: In our study, PET-CT had a significant impact on the management of patients with suspected recurrent head neck cancer.
American Journal of Neuroradiology, 2013
BACKGROUND AND PURPOSE: T2-weighted MRI shows potential in early posttreatment assessment of the primary tumor. Residual masses composed entirely of low T2-signal scar tissue suggest local control and those Ն1 cm of similar signal to untreated tumor suggest local failure. The purpose of this study was to investigate the diagnostic accuracy of T2-weighted MR imaging early after chemoradiotherapy for identifying primary tumor treatment failure in squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: At 6 weeks after treatment, T2-weighted MR images of 37 primary tumors in 37 patients were assessed. Residual masses were divided into 3 patterns: pattern 1 ϭ scar tissue only (flat-edged/retracted mass of low T2 signal intensity); pattern 2 ϭ mass without features described in pattern 1 or 3; and pattern 3 ϭ any pattern that included an expansile mass Ն1 cm of intermediate T2 signal intensity (similar grade of signal intensity to the untreated tumor). T2 patterns were analyzed for local outcome (Fisher exact test) and time to local failure (univariate and multivariate analysis of T2 pattern, age, T stage, and tumor size by use of the Cox regression model). RESULTS: Residual masses after treatment were present in 34 (92%) of 37 patients. Local failures occurred in residual masses with pattern 1 in 0 (0%) of 14 patients; pattern 2 in 6 (55%) of 11 patients; and pattern 3 in 9 (100%) of 9 patients. Significant associations were found between local control and pattern 1 (P ϭ Ͻ.