Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma

Pravin Mundada; Arthur Damien Varoquaux; Vincent Lenoir; Claudio de Vito; Nicolas Dulguerov; Angeliki Ailianou; Francesca Caparrotti; Minerva Becker

doi:10.1016/j.ejrad.2018.02.026

Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma

Eur J Radiol. 2018 Apr:101:162-169. doi: 10.1016/j.ejrad.2018.02.026. Epub 2018 Feb 21.

Authors

Pravin Mundada¹, Arthur Damien Varoquaux², Vincent Lenoir³, Claudio de Vito⁴, Nicolas Dulguerov⁵, Angeliki Ailianou⁶, Francesca Caparrotti⁷, Minerva Becker⁸

Affiliations

¹ Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. Electronic address: [email protected].
² Center for Magnetic Resonance in Biology and Medicine, Aix-Marseille Medical University, Marseille, France. Electronic address: [email protected].
³ Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. Electronic address: [email protected].
⁴ Division of Clinical Pathology, Department of Laboratory Medicine, Genetics and Pathology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. Electronic address: [email protected].
⁵ Clinic of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. Electronic address: [email protected].
⁶ Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. Electronic address: [email protected].
⁷ Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland. Electronic address: [email protected].
⁸ Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. Electronic address: [email protected].

PMID: 29571791
DOI: 10.1016/j.ejrad.2018.02.026

Abstract

Purpose: To determine the diagnostic performance of morphologic MRI with diffusion weighted imaging (DWIMRI) for the detection of post-treatment lymph node (LN) recurrence of head and neck squamous cell carcinoma (HNSCC).

Methods: This retrospective study is based on 33 HNSCC patients who underwent DWIMRI with apparent diffusion coefficient (ADC) measurements for suspected post-treatment loco-regional failure. Two radiologists, blinded to clinical/histopathological data, analyzed MR images according to established morphologic criteria and measured ADC values by drawing regions of interest on each normal/abnormal looking lymph node (LN). Histopathological findings in 40 neck dissections, 133 LN-levels and 755 LNs served as gold standard.

Results: Malignant LNs had lower ADCmean values than benign LNs (1.15 ± 0.35 × 10^-3 mm²/s versus 1.28 ± 0.28 × 10^-3 mm²/s, p = .028). The optimal ADCmean threshold to differentiate malignant from benign LNs was 1.1695 × 10^-3 mm²/s. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (95%CI in parentheses) of DWIMRI with morphologic criteria and ADCmean <1.1695 × 10^-3 mm²/s were: (a) 100%(86.2;100), 44.4%(15.3;77.3), 86.1%(69.7;94.7), and 100%(39.5;100) per neck dissection; (b) 83.6%(69.7;92.2), 91.6%(83.0;96.2), 85.4%(71.6;93.4), and 90.5%(81.7;95.5) per LN-level; (c) 53.1%(43.5;62.4), 95.5%(93.5;96.9), 67.4%(56.6;76.7), and 92.0%(89.6;93.9) per LN, respectively.

Conclusion: The high NPV of DWIMRI irrespective of analysis type (per neck dissection/per neck level/per lymph node) make it a useful follow-up tool after treatment.

Keywords: Diffusion weighted imaging; Head and neck squamous cell carcinoma; Lymph node recurrence; MRI; Post-treatment loco-regional failure.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell / therapy*
Diffusion Magnetic Resonance Imaging / methods
Female
Head and Neck Neoplasms / therapy*
Humans
Lymph Nodes / diagnostic imaging*
Lymph Nodes / pathology*
Lymphatic Metastasis
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Neck
Neoplasm Recurrence, Local / diagnostic imaging*
Neoplasm Recurrence, Local / pathology*
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Squamous Cell Carcinoma of Head and Neck