Abstract
PurposeTo compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) and fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detection of residual or recurrent tumors and their local extension in patients with head and neck squamous cell carcinoma after treatment with (chemo) radiotherapy (CRT). MethodTwenty-five patients (17 men, 8 women, median age 64 years, range 49–79) who underwent surgical salvage for residual or recurrent tumors after CRT were included. The histopathologic analysis after the surgical salvage served as the gold standard. ResultsBoth DW-MRI and 18F-FDG PET/CT had a sensitivity of 92 % (23/25) in the detection of residual or recurrent tumors. MRI had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting perineural spread of 62 % (5/8), 88 % (15/17), 71 % (5/7) and 83 % (15/18), respectively; in comparison, PET/CT did not detect any cases of perineural spread. The sensitivity, specificity, PPV and NPV of MRI in detecting muscle infiltration was 75 % (9/12), 77 % (10/13), 75 % (9/12) and 77 % (10/13) respectively, while the values for 18F-FDG PET/CT were 58 % (7/12), 69 % (9/13), 64 % (7/11) and 64 % (9/14). ConclusionsDW-MRI- and 18F-FDG PET/CT-imaging have an identical detection rate of residual or recurrent tumors after (chemo) radiotherapy. MRI has a higher sensitivity in detecting local perineural spread, has a better accuracy in the detection of muscle infiltration and more accurately correlates the lesion size to the histopathologic specimen.
Highlights
Squamous-cell carcinoma (SCC) is the most frequent malignant tumor in the head and neck region and represents more than 90 % of all head and neck cancers [1]
The histopathologic analysis after the surgical salvage served as the gold standard. Both diffusion-weighted magnetic resonance imaging (DW-mag netic resonance imaging (MRI)) and 18F-fluorine fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) had a sensitivity of 92 % (23/25) in the detection of residual or recurrent tumors
MRI had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting perineural spread of 62 % (5/8), 88 % (15/17), 71 % (5/7) and 83 % (15/18), respectively; in comparison, PET/CT did not detect any cases of perineural spread
Summary
Squamous-cell carcinoma (SCC) is the most frequent malignant tumor in the head and neck region and represents more than 90 % of all head and neck cancers [1]. It is well known that (chemo) radiotherapy, in addition to its anti-tumoral effects causes local edema, inflamma tion, fibrosis and less commonly necrosis [6,7,8,9]. Clinical assessment of these HNSCC patients after therapy can be hampered by edema, Abbreviations: DW-MRI, diffusion-weighted magnetic resonance imaging; ADC, apparent diffusion coefficient; 18F FDG, fluorine 18 fluorodeoxyglucose; PET/CT, positron emission tomography and computed tomography; HNSCC, head and neck squamous cell carcinoma; SCC, squamous cell carcinoma; CRT, chemor adiotherapy
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