Abstract
PurposeTumor size and depth of invasion (DOI) are mandatory assessments for tumor classification in tongue cancer but are often non-assessable on CT due to dental artifacts. This study investigated whether subtraction iodine imaging (SII) would improve tumor delineation and measurability.Materials and methodsFifty-seven consecutive patients with tongue cancer, who underwent scanning with a 320-row area detector CT with contrast administration and were treated with surgical resection, were retrospectively evaluated. CT was reconstructed with single-energy projection-based metallic artifact reduction (sCT). SII was generated by subtracting the pre-contrast volume scans from the post-contrast volume scans using a high-resolution deformable registration algorithm. MRI scans were also evaluated for comparing the ability of measurements. Two radiologists visually graded the tumor delineation using a 5-point scale. Tumor size and DOI were measured wherever possible. The tumor delineation score was compared using the Wilcoxon signed-rank method. Spearman’s correlations between imaging and pathological measurements were calculated. Intraclass correlation coefficients of measurements between readers were estimated.ResultsThe tumor delineation score was greater on sCT-plus-SII than on sCT alone (medians: 3 and 1, respectively; p < 0.001), with higher number of detectable cases observed with sCT-plus-SII (36/57 [63.2%]) than sCT alone (21/57 [36.8%]). Tumor size and DOI measurability were higher with sCT-plus-SII (29/57 [50.9%]) than with sCT alone (17/57 [29.8%]). MRI had the highest detectability (52/57 [91.2%]) and measurability (46/57 [80.7%]). Correlation coefficients between radiological and pathological tumor size and DOI were similar for sCT (0.83–0.88), sCT-plus-SII (0.78–0.84), and MRI (0.78–0.90). Intraclass correlation coefficients were higher than 0.95 for each modality.ConclusionsSII improves detectability and measurability of tumor size and DOI in patients with oral tongue squamous cell carcinoma, thus increasing the diagnostic potential. SII may also be beneficial for cases unevaluable on MRI due to artifacts or for patients with contraindications to MRI.
Highlights
Oral tongue squamous cell carcinoma (OTSCC) is the most common carcinoma among oral cavity cancers [1]
Tumor size and depth of invasion (DOI) are mandatory for tumor classification in OTSCC according to the American Joint Committee on Cancer (AJCC) eighth edition [2]
The metallic artifact reduction (MAR) algorithm is an effective artifact reduction technique for CT [9,10,11,12,13,14,15,16,17]. It is well-established that the MAR algorithm improves the imaging quality of the oral cavity [11,12,13,14,15,16,17], there are numerous cases in which tongue cancer cannot be clinically delineated despite the use of MAR
Summary
Oral tongue squamous cell carcinoma (OTSCC) is the most common carcinoma among oral cavity cancers [1]. Tumor size and depth of invasion (DOI) are mandatory for tumor classification in OTSCC according to the American Joint Committee on Cancer (AJCC) eighth edition [2]. The metallic artifact reduction (MAR) algorithm is an effective artifact reduction technique for CT [9,10,11,12,13,14,15,16,17] It is well-established that the MAR algorithm improves the imaging quality of the oral cavity [11,12,13,14,15,16,17], there are numerous cases in which tongue cancer cannot be clinically delineated despite the use of MAR
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