Abstract
The presence of a single nodal metastasis has significant prognostic and treatment implications for patients with head and neck cancer. This study aims to investigate whether dual-energy computed tomography (DECT)-derived iodine content and spectral attenuation curve analysis can improve detection of nodal metastasis in oropharyngeal carcinoma. Eight patients with newly diagnosed oropharyngeal squamous cell carcinoma and pathologically proven nodal metastatic disease (n = 13 metastatic nodes; n = 16 nonmetastatic nodes) who underwent contrast-enhanced DECT of the neck were retrospectively evaluated. DECT-derived iodine content (mg/mL) and monoenergetic attenuation values at 40 keV and 100 keV were obtained via circular regions of interest within metastatic and nonmetastatic cervical lymph nodes. Iodine content was significantly lower in metastatic nodes (0.96 ± 0.28 mg/mL) than in nonmetastatic nodes (1.65 ± 0.38 mg/mL; P = .002). Iodine spectral attenuation slope was significantly lower in metastatic nodes (1.33 ± 0.49 mg/mL) than in nonmetastatic nodes (1.91 ± 0.64 mg/mL; P = .015). A nodal iodine threshold of ≤1.3 mg/mL showed a sensitivity of 84.6% and a specificity of 75.0%, with an area under the curve of 0.839, P < .0001. At a threshold value of ≤1.95 for nodal spectral attenuation slope, an optimized specificity of 92.3% and specificity of 50.0% was achieved, with an area under the curve of 0.68 (P = .049). DECT-derived quantitative iodine data and spectral attenuation curves may improve the diagnostic accuracy of computed tomography for nodal metastasis in patients with squamous cell carcinoma of the oropharynx.
Highlights
Despite growing understanding and continued advances in treatment, both the incidence and mortality rates of head and neck cancer have not significantly changed in the past decade, with ϳ63,000 new cases occurring in 2017 and an overall 5-year survival rate of 60%– 65%
There are many different imaging modalities used in the evaluation and staging of head and neck cancer including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography
Iodine Content The iodine content was significantly lower in metastatic lymph nodes (0.96 Ϯ 0.28 mg/mL) than in nonmetastatic lymph nodes (1.65 Ϯ 0.38 mg/mL; P ϭ .002) (Figures 3 and 4)
Summary
Despite growing understanding and continued advances in treatment, both the incidence and mortality rates of head and neck cancer have not significantly changed in the past decade, with ϳ63,000 new cases occurring in 2017 and an overall 5-year survival rate of 60%– 65%. Imaging plays an important role in the staging of head and neck cancers to define both the extent of invasion of the primary tumor and the presence of locoregional and distant metastases. There are many different imaging modalities used in the evaluation and staging of head and neck cancer including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography. New imaging techniques show promise in integrating morphological and functional changes in lymph nodes to better differentiate metastatic from nonmetastatic nodes
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