1
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[Radiologic evaluation of lymph nodes in cancer patients]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:105-113. [PMID: 36633653 DOI: 10.1007/s00104-022-01802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In solid tumors, the detection of locoregional lymph node metastases is of decisive importance not only for the prognosis but also for selecting the correct treatment. Various noninvasive imaging methods or, classically, lymph node dissection are available for this purpose. OBJECTIVE This article presents the general principles of noninvasive lymph node diagnostics and discusses the value of the clinically available imaging modalities, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). In addition, recent new technical developments of each modality are highlighted. MATERIAL AND METHODS Literature search and summary of the clinical and scientific experience of the authors. RESULTS The available imaging procedures are divided into (1) morphological (US, CT, MRI) and (2) functional modalities (PET, special MRI). The former capture structural lymph node parameters, such as size and shape, while the latter address properties that go beyond morphology (e.g. glucose metabolism). The high diagnostic accuracy required for future treatment algorithms will require a combination of both aspects. DISCUSSION/CONCLUSION Currently, none of the available modalities have sufficient accuracy to replace lymph node dissection in all oncological scenarios. One of the major challenges for interdisciplinary oncological research is to define the optimal interaction between imaging and lymph node dissection for different malignancies and tumor stages.
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2
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Li M, Zhang Q, Yang K. Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment. Front Oncol 2021; 11:645177. [PMID: 34513659 PMCID: PMC8429950 DOI: 10.3389/fonc.2021.645177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) and reduce the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases as more radiation dose utilized during radiation therapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. Thus, the accurate target delineation is crucial. Recently, technological improvements for precise target delineation have obtained more attention in the field of RT. The addition of functional imaging to RT can provide a more accurate anatomy of the tumor and normal tissues (such as location and size), along with biological information that aids to optimize the therapeutic index (TI) of RT. In this review, we discuss the application of some common MRI-based functional imaging techniques in clinical practice. In addition, we summarize the main challenges and prospects of these imaging technologies, expecting more inspiring developments and more productive research paths in the near future.
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Affiliation(s)
- Mei Li
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Kaixuan Yang
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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3
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Su T, Chen Y, Zhang Z, Zhu J, Liu W, Chen X, Zhang T, Zhu X, Qian T, Xu Z, Xue H, Jin Z. Optimization of Simultaneous Multislice, Readout-Segmented Echo Planar Imaging for Accelerated Diffusion-Weighted Imaging of the Head and Neck: A Preliminary Study. Acad Radiol 2020; 27:e245-e253. [PMID: 32005557 DOI: 10.1016/j.acra.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/12/2019] [Accepted: 12/22/2019] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the feasibility of simultaneous multislice (SMS)-accelerated, readout-segmented echo-planar imaging (rs-EPI, RESOLVE) with the use of special-purpose coils for head and neck assessment, particularly in patients diagnosed with head and neck malignant tumors, through comparison with the conventional RESOLVE and RESOLVE with readout partial-Fourier technique (RESOLVE-RPF). MATERIALS AND METHODS Twenty-five healthy volunteers and 24 patients with histologically proven malignant head and neck tumors were included in this prospective study. The MR exam included conventional RESOLVE, RESOLVE-RPF, prototypic SMS-RESOLVE, and prototypic SMS-RESOLVE with special-purpose coils (SMS-RESOLVE + Coils), acquired at b-values of both 0 and 800 s/mm2. Image quality was evaluated qualitatively (reader score) and quantitatively (tumor distortion, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), SNR efficiency) and compared. For volunteer imaging, the image quality of target tissues at three different typical levels (oropharyngeal, hypopharyngeal, and thyroid level) were evaluated. For patient imaging, the image quality of primary tumors and metastatic lymph nodes was evaluated. RESULTS The acquisition time was 3:37 minutes for RESOLVE, 2:58 minutes for RESOLVE-RFP, 2:01 minutes for SMS-RESOLVE and 2:01 minutes for SMS-RESOLVE + Coils, with a 44% reduction compared to the conventional RESOLVE. No significant differences in the reader scores, tumor distortion, or ADC values of the lesions were found among the protocols. The SNR and CNR at the oropharyngeal and hypopharyngeal level of SMS-RESOLVE + Coils were markedly improved and significantly higher than those of RESOLVE, as well as the SNR, SNR efficiency of tumors and lymph nodes. No significant differences in quantitative measurements were found at the thyroid level. CONCLUSION SMS-RESOLVE + Coils protocol is an effective and promising approach to optimally reducing the total acquisition time, and could be a good alternative with a superior SNR and SNR efficiency in comparison with conventional RESOLVE. However, the limited application in the lower neck region needs further investigation.
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Affiliation(s)
- Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Xingming Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoli Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tianyi Qian
- Siemens Healthcare, MR Collaboration NEA, Beijing, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Dongcheng District, Beijing, China.
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4
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Diagnostic ability of contrast-enhanced computed tomography for metastatic cervical nodes in head and neck squamous cell carcinomas: significance of additional coronal reconstruction images. Pol J Radiol 2020; 85:e1-e7. [PMID: 32180847 PMCID: PMC7064011 DOI: 10.5114/pjr.2020.92668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the significance of additional coronal reconstruction images in the diagnostic ability of contrast-enhanced computed tomography (CECT) for metastatic cervical nodes in patients with head and neck squamous cell carcinomas (HNSCC). Material and methods We retrospectively assessed 97 metastatic and 141 reactive histologically proven cervical nodes of 38 patients with HNSCC, who underwent CECT before neck dissection. Observer #1, an expert radiologist in head and neck imaging, and observer #2, a general radiologist, reviewed all CECT images. The observers first assessed the presence of nodal metastasis using axial CECT alone (A-CECT). Three days later, they reassessed its presence using combined axial and coronal CECT (A&C-CECT). Results The sensitivity of A-CECT vs. A&C-CECT was 73.2% vs. 75.3% for observer #1 (p = 0.73) and 69.1% vs. 69.1% for observer #2 (p = 1.00), respectively. The specificity of A-CECT versus A&C-CECT was 92.2% vs. 97.2% for observer #1 (p < 0.05) and 92.9% vs. 95.7% for observer #2 (p = 0.22), respectively. The accuracy of A-CECT versus A&C-CECT was 84.5% vs. 88.2% for observer #1 (p < 0.05) and 83.2% vs. 85.3% for observer #2 (p = 0.30), respectively. The area under the curve (AUC) of A-CECT vs. A&C-CECT was 0.86 vs. 0.91 for observer #1 (p < 0.05) and 0.85 vs. 0.85 for observer #2 (p = 0.80), respectively. Conclusions The specificity, accuracy, and AUC increased with the use of coronal images during the assessment by the expert radiologist. The appropriate use of coronal images allowed proper configuration recognition and improved diagnostic ability.
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5
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Chung MS, Choi YJ, Kim SO, Lee YS, Hong JY, Lee JH, Baek JH. A Scoring System for Prediction of Cervical Lymph Node Metastasis in Patients with Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2019; 40:1049-1054. [PMID: 31072971 DOI: 10.3174/ajnr.a6066] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/13/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE An accurate and comprehensive assessment of lymph node metastasis in patients with head and neck squamous cell cancer is crucial in daily practice. This study constructed a predictive model with a risk scoring system based on CT characteristics of lymph nodes and tumors for patients with head and neck squamous cell carcinoma to stratify the risk of lymph node metastasis. MATERIALS AND METHODS Data included 476 cervical lymph nodes from 191 patients with head and neck squamous cell carcinoma from a historical cohort. We analyzed preoperative CT images of lymph nodes, including diameter, ratio of long-to-short axis diameter, necrosis, conglomeration, infiltration to adjacent soft tissue, laterality and T-stage of the primary tumor. The reference standard comprised pathologic results. Multivariable logistic regression analysis was performed to develop the risk scoring system. Internal validation was performed with 1000-iteration bootstrapping. RESULTS Shortest axial diameter, ratio of long-to-short axis diameter, necrosis, and T-stage were used to develop a 9-point risk scoring system. The risk of malignancy ranged from 7.3% to 99.8%, which was positively associated with increased scores. Areas under the curve of the risk scoring systems were 0.886 (95% CI, 0.881-0.920) and 0.879 (95% CI, 0.845-0.914) in internal validation. The Hosmer-Lemeshow goodness-of-fit test indicated that the risk scoring system was well-calibrated (P = .160). CONCLUSIONS We developed a comprehensive and simple risk scoring system using CT characteristics in patients with head and neck squamous cell carcinoma to stratify the risk of lymph node metastasis. It could facilitate decision-making in daily practice.
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Affiliation(s)
- M S Chung
- From the Department of Radiology (M.S.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Y J Choi
- Departments of Radiology and Research Institute of Radiology (Y.J.C., J.H.L., J.H.B.)
| | - S O Kim
- Clinical Epidemiology and Biostatistics (S.O.K.)
| | | | - J Y Hong
- Oncology (J.Y.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Lee
- Departments of Radiology and Research Institute of Radiology (Y.J.C., J.H.L., J.H.B.)
| | - J H Baek
- Departments of Radiology and Research Institute of Radiology (Y.J.C., J.H.L., J.H.B.)
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D'Cruz AK, Vaish R, Dhar H. Oral cancers: Current status. Oral Oncol 2018; 87:64-69. [PMID: 30527245 DOI: 10.1016/j.oraloncology.2018.10.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 12/09/2022]
Abstract
Oral cancer is a global disease. Despite a well elucidated tumour progression model, these cancers present late. Attempts at early detection by way of adjunctive diagnostic technologies and screening have not lived up to expectations in spite initial promise. Surgery is the mainstay of treatment. Treatment intensification by way of adjuvant radiation/chemo radiation is warranted for those with high risk features. Recent studies have explored intensification in those with intermediate risk factors in an attempt to improve outcomes. There has been generation of recent robust evidence that has influenced the need and extent of neck dissection. Neoadjuvant chemotherapy (NACT) may have a potential role in organ preservation and borderline resectable oral cancers. Recurrent tumours should be offered surgery whenever feasible while the addition of biological agents to chemotherapy gives best results in the palliative settings.
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Affiliation(s)
- Anil K D'Cruz
- Tata Memorial Hospital, Parel, Mumbai 400012, India.
| | - Richa Vaish
- Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Harsh Dhar
- Tata Memorial Hospital, Parel, Mumbai 400012, India
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Long 龙淼淼 M, Wang 王蕾 L, Mou 牟玲 L, Zhang 张可 K, Liu 刘丽华 L, Li 李艳艳 Y, Liu 刘晓斌 X, Yu 于文娟 W, Gao 高光峰 G, Chen 陈新娟 X, Shen 沈文 W, Shrestha A. Z-Score transformation of ADC values: A way to universal cut off between malignant and benign lymph nodes. Eur J Radiol 2018; 106:122-127. [PMID: 30150033 DOI: 10.1016/j.ejrad.2018.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the possibility of a universal cut off value between benign and malignant lymph nodes in patients with tumour by Z-Score transformation method. MATERIALS AND METHODS Diffusion weighted imaging, ADC measurements of malignant and benign lymph nodes of 6 studies (4 body parts), conducted for 5 times, in two institutions with variable technical details were analyzed in their original value as well as the standardized Z-Score value. The standardized Z-Score value was obtained by subtracting the population mean of the control group from an individual raw score and then dividing the difference by the population standard deviation of the control group. General cut off values were obtained by both Mega-analysis by receiver operator characteristic curve analysis, when data from the 6 studies were combined and Meta-analysis with weighting coefficients and cut off values of the six individual studies. Sensitivity, specificity and accuracy with cut offs from individual studies, meta-analysis and mega-analysis were calculated. Kappa test was performed to assess the consistency of diagnostic test accuracy, between optimized cut offs of individual studies and the proposed universal cut offs obtained from meta-analysis and mega-analysis. RESULTS The ADC values of benign and malignant lymph nodes are significantly different, but with large overlap across the studies. The overlap can be minimized by Z-Score transformation. The result of ROC analysis of the collective Z-Score transformed ADC values of 6 studies was superior to that of the collective original ADC values (sensitivity: 87.4% versus 67.2%, specificity: 90.5% versus 87.9%, accuracy: 89.6% versus 81.4%). The universal Z-Score cut off from Meta-analysis is also better than the original ADC cut off (sensitivity: 82.8% versus 76.3%, specificity 92.6% versus 62.9%, accuracy 89.6% versus 67.1%). Applied to the individual studies, the universal transformed Z-Score cut offs produced superior consistency with the individual optimal cut offs (individual and meta Z-Score: 0.7228-0.9793; individual and mega Z-Score: 0.7111-0.9169) compared with the universal original ADC cut offs (individual and meta ADC: 0.3030-1.0000; individual and mega ADC 0.3268-0.9618). CONCLUSION Z-Score transformation could minimize inter-study variations due to heterogeneity of MR systems and sequence parameters, and provide a more consistent universal cut off value between benign and malignant nodes across studies.
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Affiliation(s)
- Miaomiao Long 龙淼淼
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China.
| | - Lei Wang 王蕾
- School of Chinese Medicine, Tianjin University of TCM, Tianjin 300193, China
| | - Ling Mou 牟玲
- Department of Radiology, People's Hospital of Rizhao City, Rizhao, 276827, China
| | - Ke Zhang 张可
- Department of Radiology, People's Hospital of Rizhao City, Rizhao, 276827, China
| | - Lihua Liu 刘丽华
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Yanyan Li 李艳艳
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Xiaobin Liu 刘晓斌
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Wenjuan Yu 于文娟
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Guangfeng Gao 高光峰
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Xinjuan Chen 陈新娟
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China; Academic Affairs Office, Weifang Medical University, City Weifang, 261053, China
| | - Wen Shen 沈文
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Apurwa Shrestha
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
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8
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Peacock ZS, Krishnan DG. Advances in Imaging Over 100 Years: The Impact on Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2018; 76:1387-1399. [DOI: 10.1016/j.joms.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
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9
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Molecular Imaging-Guided Radiotherapy for the Treatment of Head-and-Neck Squamous Cell Carcinoma: Does it Fulfill the Promises? Semin Radiat Oncol 2018; 28:35-45. [PMID: 29173754 DOI: 10.1016/j.semradonc.2017.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With the routine use of intensity modulated radiation therapy for the treatment of head-and-neck squamous cell carcinoma allowing highly conformed dose distribution, there is an increasing need for refining both the selection and the delineation of gross tumor volumes (GTV). In this framework, molecular imaging with positron emission tomography and magnetic resonance imaging offers the opportunity to improve diagnostic accuracy and to integrate tumor biology mainly related to the assessment of tumor cell density, tumor hypoxia, and tumor proliferation into the treatment planning equation. Such integration, however, requires a deep comprehension of the technical and methodological issues related to image acquisition, reconstruction, and segmentation. Until now, molecular imaging has had a limited value for the selection of nodal GTV, but there are increasing evidences that both FDG positron emission tomography and diffusion-weighted magnetic resonance imaging has a potential value for the delineation of the primary tumor GTV, effecting on dose distribution. With the apprehension of the heterogeneity in tumor biology through molecular imaging, growing evidences have been collected over the years to support the concept of dose escalation/dose redistribution using a planned heterogeneous dose prescription, the so-called "dose painting" approach. Validation trials are ongoing, and in the coming years, one may expect to position the dose painting approach in the armamentarium for the treatment of patients with head-and-neck squamous cell carcinoma.
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10
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Queiroz MA, Barbosa FDG, Buchpiguel CA, Cerri GG. Positron emission tomography/magnetic resonance imaging (PET/MRI): An update and initial experience at HC-FMUSP. ACTA ACUST UNITED AC 2018; 64:71-84. [PMID: 29561945 DOI: 10.1590/1806-9282.64.01.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 01/16/2023]
Abstract
The new technology of PET/MRI is a prototype of hybrid imaging, allowing for the combination of molecular data from PET scanning and morphofunctional information derived from MRI scanning. Recent advances regarding the technical aspects of this device, especially after the development of MRI-compatible silicon photomultipliers of PET, permitted an increase in the diagnostic performance of PET/MRI translated into dose reduction and higher imaging quality. Among several clinical applications, PET/MRI gains ground initially in oncology, where MRI per se plays an essential role in the assessment of primary tumors (which is limited in the case of PET/CT), including prostate, rectal and gynecological tumors. On the other hand, the evaluation of the lungs remains an enigma although new MRI sequences are being designed to overcome this. More clinical indications of PET/MRI are seen in the fields of neurology, cardiology and inflammatory processes, and the use of PET/MRI also opens perspectives for pediatric populations as it involves very low radiation exposure. Our review aimed to highlight the current indications of PET/MRI and discuss the challenges and perspectives of PET/MRI at HC-FMUSP.
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Affiliation(s)
- Marcelo A Queiroz
- Institute of Radiology (InRad), Hospital das Clínicas da Faculdade de Medicina da USP (HC-FMUSP), São Paulo, SP, Brazil.,Service of Medical Imaging, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Carlos Alberto Buchpiguel
- Institute of Radiology (InRad), Hospital das Clínicas da Faculdade de Medicina da USP (HC-FMUSP), São Paulo, SP, Brazil.,Service of Medical Imaging, Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Giovanni Guido Cerri
- Institute of Radiology (InRad), Hospital das Clínicas da Faculdade de Medicina da USP (HC-FMUSP), São Paulo, SP, Brazil.,Service of Medical Imaging, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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11
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Zhang SC, Zhou SH, Shang DS, Bao YY, Ruan LX, Wu TT. The diagnostic role of diffusion-weighted magnetic resonance imaging in hypopharyngeal carcinoma. Oncol Lett 2018; 15:5533-5544. [PMID: 29552192 PMCID: PMC5840528 DOI: 10.3892/ol.2018.8053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 12/29/2017] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to assess the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) values in hypopharyngeal carcinoma. A total of 40 hypopharyngeal carcinoma tissues and 15 benign lesion tissues were retrospectively analyzed. DWI, and T1- and T2-weighted magnetic resonance imaging (MRI) was performed. The sensitivity, specificity and accuracy of conventional MRI were 97.5, 66.7, and 89.1%, respectively. The mean ADC value [diffusion sensitive factor (b)=1,000× sec/mm2) for hypopharyngeal carcinomas was (1.0285±0.0328)×10−3 mm2/sec, which was significantly lower than the mean ADC value for benign lesions [(1.5333±0.1061)×10−3 mm2/sec; P<0.001]. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was 0.921 while the optimal threshold for the cut-off point of the ADC was 1.075×10−3 mm2/sec. The mean ADC value of the metastatic nodes was (0.9184±0.0538)×10−3 mm2/sec, lower than the mean value for the benign nodes [(1.2538±0.1145)×10−3 mm2/sec; P=0.005]. Two groups were created according to the mean of the ADC value of hypopharyngeal carcinomas [≤(1.0285±0.0328)×10−3 mm2/sec vs. >(1.0285±0.0328)×10−3 mm2/sec]. The 2-year survival rates of the two groups were 55.6 and 100.0%, respectively (P=0.024). ADC values may aid in distinguishing hypopharyngeal carcinomas from benign lesions and differentiating metastatic lymph nodes of hypopharyngeal squamous cell carcinomas from reactive cervical lymph nodes. In conclusion, mean ADC values may be useful prognostic factors in univariate analysis of hypopharyngeal carcinoma.
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Affiliation(s)
- Si-Cong Zhang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China.,Department of Otolaryngology, People's Hospital of Cixi City, Cixi, Zhejiang 315300, P.R. China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - De-Sheng Shang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Ling-Xiang Ruan
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Ting-Ting Wu
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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12
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Comparison of DWI and 18F-FDG PET/CT for assessing preoperative N-staging in gastric cancer: evidence from a meta-analysis. Oncotarget 2017; 8:84473-84488. [PMID: 29137440 PMCID: PMC5663612 DOI: 10.18632/oncotarget.21055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 12/18/2022] Open
Abstract
The diagnostic values of diffusion weighted imaging (DWI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for N-staging of gastric cancer (GC) were identified and compared. After a systematic search to identify relevant articles, meta-analysis was used to summarize the sensitivities, specificities, and areas under curves (AUCs) for DWI and PET/CT. To better understand the diagnostic utility of DWI and PET/CT for N-staging, the performance of multi-detector computed tomography (MDCT) was used as a reference. Fifteen studies were analyzed. The pooled sensitivity, specificity, and AUC with 95% confidence intervals of DWI were 0.79 (0.73–0.85), 0.69 (0.61–0.77), and 0.81 (0.77–0.84), respectively. For PET/CT, the corresponding values were 0.52 (0.39–0.64), 0.88 (0.61–0.97), and 0.66 (0.62–0.70), respectively. Comparison of the two techniques revealed DWI had higher sensitivity and AUC, but no difference in specificity. DWI exhibited higher sensitivity but lower specificity than MDCT, and 18F-FDG PET/CT had lower sensitivity and equivalent specificity. Overall, DWI performed better than 18F-FDG PET/CT for preoperative N-staging in GC. When the efficacy of MDCT was taken as a reference, DWI represented a complementary imaging technique, while 18F-FDG PET/CT had limited utility for preoperative N-staging.
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Accuracy of Whole-Body DWI for Metastases Screening in a Diverse Group of Malignancies: Comparison With Conventional Cross-Sectional Imaging and Nuclear Scintigraphy. AJR Am J Roentgenol 2017; 209:477-490. [PMID: 28678578 DOI: 10.2214/ajr.17.17829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the role of whole-body (WB) DWI as a screening modality for the detection of metastases and to compare it to conventional cross-sectional imaging modalities or nuclear scintigraphy in a population with various histopathologic malignancies. SUBJECTS AND METHODS WB DWI and conventional imaging (CT, MRI, or scintigraphy) were performed for patients with known malignancies for metastatic workup, and these patients were followed up for a period of 1 year. Two radiologists assessed WB DW images separately, and conventional images were assessed by the senior radiologist. The metastatic lesions were classified into four regions: liver, lung, skeletal system, and lymph nodes. The reference standard was considered on the basis of histopathologic confirmation or clinical follow-up of the metastatic lesions. RESULTS WB DWI was slightly inferior to conventional imaging modalities for the detection of hepatic metastases (sensitivity, 86.6% vs 93.3%; specificity, 91.6% vs 95.8%; and accuracy, 89.7% vs 94.8%) and skeletal metastases (sensitivity, 81.8% vs 89.4%; specificity, 86.4% vs 94.3%; and accuracy, 85.2% vs 93.0%); however, the differences were not statistically significant (p = 0.625 for hepatic metastases and p = 0.0953 for skeletal metastases, McNemar test). WB DWI was statistically significantly inferior to conventional imaging for the detection of lymph node metastases (sensitivity, 74.0% vs 81.5%; specificity, 87.9% vs 90.1%; accuracy, 81.4% vs 86.0%; p = 0.0389). WB DWI was statistically significantly inferior to conventional imaging for the detection of pulmonary metastases (sensitivity, 33.3% vs 100.0%; specificity, 90.9% vs 100.0%; accuracy, 60.8% vs 100.0%; p = 0.045). CONCLUSION WB DWI can be used for screening hepatic and skeletal metastases, but its reliability as the sole imaging sequence for the detection of lymph nodal and pulmonary metastases is poor and, at present, it cannot replace conventional imaging modalities.
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Squamous Cell Carcinoma of the Lip—A Review of Squamous Cell Carcinogenesis of the Mucosal and Cutaneous Junction. Dermatol Surg 2017; 43:494-506. [DOI: 10.1097/dss.0000000000001020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Peerlings J, Troost EGC, Nelemans PJ, Cobben DCP, de Boer JCJ, Hoffmann AL, Beets-Tan RGH. The Diagnostic Value of MR Imaging in Determining the Lymph Node Status of Patients with Non-Small Cell Lung Cancer: A Meta-Analysis. Radiology 2016; 281:86-98. [PMID: 27110732 DOI: 10.1148/radiol.2016151631] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To summarize existing evidence of thoracic magnetic resonance (MR) imaging in determining the nodal status of non-small cell lung cancer (NSCLC) with the aim of elucidating its diagnostic value on a per-patient basis (eg, in treatment decision making) and a per-node basis (eg, in target volume delineation for radiation therapy), with results of cytologic and/or histologic examination as the reference standard. Materials and Methods A systematic literature search for original diagnostic studies was performed in PubMed, Web of Science, Embase, and MEDLINE. The methodologic quality of each study was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2, tool. Hierarchic summary receiver operating characteristic curves were generated to estimate the diagnostic performance of MR imaging. Subgroup analyses, expressed as relative diagnostic odds ratios (DORs) (rDORs), were performed to evaluate whether publication year, methodologic quality, and/or method of evaluation (qualitative [ie, lesion size and/or morphology] vs quantitative [eg, apparent diffusion coefficients in diffusion-weighted images]) affected diagnostic performance. Results Twelve of 2551 initially identified studies were included in this meta-analysis (1122 patients; 4302 lymph nodes). On a per-patient basis, the pooled estimates of MR imaging for sensitivity, specificity, and DOR were 0.87 (95% confidence interval [CI]: 0.78, 0.92), 0.88 (95% CI: 0.77, 0.94), and 48.1 (95% CI: 23.4, 98.9), respectively. On a per-node basis, the respective measures were 0.88 (95% CI: 0.78, 0.94), 0.95 (95% CI: 0.87, 0.98), and 129.5 (95% CI: 49.3, 340.0). Subgroup analyses suggested greater diagnostic performance of quantitative evaluation on both a per-patient and per-node basis (rDOR = 2.76 [95% CI: 0.83, 9.10], P = .09 and rDOR = 7.25 [95% CI: 1.75, 30.09], P = .01, respectively). Conclusion This meta-analysis demonstrated high diagnostic performance of MR imaging in staging hilar and mediastinal lymph nodes in NSCLC on both a per-patient and per-node basis. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jurgen Peerlings
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Esther G C Troost
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Patricia J Nelemans
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - David C P Cobben
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Johannes C J de Boer
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Aswin L Hoffmann
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
| | - Regina G H Beets-Tan
- From the Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology (J.P., E.G.C.T., A.L.H.), Department of Radiology (J.P., R.G.H.B.), and Department of Epidemiology (P.J.N.), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, the Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, the Netherlands (D.C.P.C., J.C.J.d.B.); and Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands (D.C.P.C.)
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The value of fluorine-18 fluorodeoxyglucose PET/MRI in the diagnosis of head and neck carcinoma: a meta-analysis. Nucl Med Commun 2015; 36:312-8. [PMID: 25514551 DOI: 10.1097/mnm.0000000000000248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/MRI has been used in the diagnosis of head and neck carcinoma. The aim of this study was to systematically review and perform a meta-analysis of published data on the performance of F-PET/MRI in the diagnosis of head and neck carcinoma. MATERIALS AND METHODS We conducted a comprehensive review of the literature on the role of soft-based fusion and integrated 18F-FDG PET/MRI in the diagnosis of head and neck carcinoma. Pooled sensitivity, specificity, and area under the receiver-operating characteristic curve of soft-based fusion and integrated 18F-FDG PET/MRI in the diagnosis of head and neck carcinoma were calculated. RESULTS Ten studies comprising 421 patients, which included 1879 head and neck primary carcinoma and metastatic lesions, were included in this meta-analysis. 18F-FDG PET/MRI had a pooled sensitivity of 91%, a pooled specificity of 63%, and an area under the receiver-operating characteristic curve of 0.96 on a per lesion-based analysis in detecting head and neck carcinoma lesions. Soft-based fusion and integrated 18F-FDG PET/MRI had a pooled sensitivity of 92 and 90%, a pooled specificity of 53 and 87%, and an area under the receiver-operating characteristic curve of 0.95 and 0.96, respectively, on a per lesion-based analysis in detecting head and neck carcinoma lesions. CONCLUSION 18F-FDG PET/MRI demonstrated high sensitivity and moderate specificity in the diagnosis of head and neck carcinoma lesions. 18F-FDG PET/MRI is an accurate method in the diagnosis of head and neck carcinoma.
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Li H, Liu XW, Geng ZJ, Wang DL, Xie CM. Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma. Dentomaxillofac Radiol 2014; 44:20140126. [PMID: 25430557 DOI: 10.1259/dmfr.20140126] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic value of diffusion-weighted MRI for differentiating metastatic from non-metastatic retropharyngeal lymph nodes (RLNs) in patients with nasopharyngeal carcinoma (NPC). METHODS Untreated patients with NPC (n = 145) were scanned with both morphological MRI and diffusion-weighted imaging (DWI). RLNs (n = 335) were classified as metastatic on the basis of response to therapy as assessed on follow-up MRI. Morphological (short- and long-axial diameters) and functional [mean apparent diffusion coefficient (ADC) and minimum ADC values] parameters of the RLNs were derived from DWI and compared between metastatic and non-metastatic groups. A receiver operating characteristic curve and the area under the curve were used to evaluate the effectiveness of individual criteria and to generate threshold values to diagnose RLN metastases. RESULTS Statistically significant differences between metastatic and non-metastatic RLNs were found for all four parameters derived from DWI (p < 0.001). At threshold values, accuracies of the ADC-based criteria (0.938 and 0.965 for mean and minimum ADC values, respectively) were greater than that of size-based criteria (0.838 and 0.809 for short- and long-axial diameters). The minimum ADC value at the threshold of 0.89 × 10(-3) mm(2) s(-1) was the most effective of all parameters in differentiating metastatic from non-metastatic RLNs with the sensitivity of 95.7%, specificity of 95.1% and accuracy of 96.5%. CONCLUSIONS DWI is feasible for differentiating metastatic RLNs from non-metastatic nodes in patients with NPC with high accuracy, and the minimum ADC derived from DWI could serve as a standard clinical marker for disease status.
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Affiliation(s)
- H Li
- 1 State Key Laboratory of Oncology in Southern China, Guangzhou, China
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Lim HK, Lee JH, Baek HJ, Kim N, Lee H, Park JW, Kim SY, Cho KJ, Baek JH. Is diffusion-weighted MRI useful for differentiation of small non-necrotic cervical lymph nodes in patients with head and neck malignancies? Korean J Radiol 2014; 15:810-6. [PMID: 25469094 PMCID: PMC4248638 DOI: 10.3348/kjr.2014.15.6.810] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/21/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness of measuring the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging to distinguish benign from small, non-necrotic metastatic cervical lymph nodes in patients with head and neck cancers. MATERIALS AND METHODS Twenty-six consecutive patients with head and neck cancer underwent diffusion-weighted imaging (b value, 0 and 800 s/mm(2)) preoperatively between January 2009 and December 2010. Two readers independently measured the ADC values of each cervical lymph node with a minimum-axial diameter of ≥ 5 mm but < 11 mm using manually drawn regions of interest. Necrotic lymph nodes were excluded. Mean ADC values were compared between benign and metastatic lymph nodes after correlating the pathology. RESULTS A total of 116 lymph nodes (91 benign and 25 metastatic) from 25 patients were included. Metastatic lymph nodes (mean ± standard deviation [SD], 7.4 ± 1.6 mm) were larger than benign lymph nodes (mean ± SD, 6.6 ± 1.4 mm) (p = 0.018). Mean ADC values for reader 1 were 1.17 ± 0.31 × 10(-3) mm(2)/s for benign and 1.25 ± 0.76 × 10(-3) mm(2)/s for metastatic lymph nodes. Mean ADC values for reader 2 were 1.21 ± 0.46 × 10(-3) mm(2)/s for benign and 1.14 ± 0.34 × 10(-3) mm(2)/s for metastatic lymph nodes. Mean ADC values between benign and metastatic lymph nodes were not significantly different (p = 0.594 for reader 1, 0.463 for reader 2). CONCLUSION Measuring mean ADC does not allow differentiating benign from metastatic cervical lymph nodes in patients with head and neck cancer and non-necrotic, small lymph nodes.
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Affiliation(s)
- Hyun Kyung Lim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea. ; Department of Radiology, Soonchunhyang University Hospital, Seoul 140-743, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hye Jin Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hayoung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jee Won Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Kyung Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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O'Hara J, Simo R, McQueen A, Andi K, Lester S, Giddings C, Repanos C, Moor J, Kelly C, Jennings C, Wilson J, Paleri V. Management of metastatic neck disease--summary of the 11th Evidence Based Management Day. Clin Otolaryngol 2014; 39:3-5. [PMID: 24575924 DOI: 10.1111/coa.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/05/2023]
Affiliation(s)
- J O'Hara
- Sunderland Royal Hospital, Sunderland and Newcastle University, Newcastle-upon-Tyne, UK
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de Bree R, Takes RP, Castelijns JA, Medina JE, Stoeckli SJ, Mancuso AA, Hunt JL, Rodrigo JP, Triantafyllou A, Teymoortash A, Civantos FJ, Rinaldo A, Pitman KT, Hamoir M, Robbins KT, Silver CE, Hoekstra OS, Ferlito A. Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head Neck 2014; 37:1829-39. [PMID: 24954811 DOI: 10.1002/hed.23814] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/02/2014] [Accepted: 06/18/2014] [Indexed: 12/19/2022] Open
Abstract
Regional metastasis is a prominent feature of head and neck squamous cell carcinoma (HNSCC) and is an important prognostic factor. The currently available imaging techniques for assessment of the neck have limitations in accuracy; thus, elective neck dissection has remained the usual choice of management of the clinically N0 neck (cN0) for tumors with significant (≥20%) incidence of occult regional metastasis. As a consequence, the majority of patients without regional metastasis will undergo unnecessary treatment. The purpose of this review was to discuss new developments in techniques that potentially improve the accuracy of the assessment of the neck in patients with HNSCC. Although imaging has improved in the last decades, a limitation common to all imaging techniques is a lack of sensitivity for small tumor deposits. Therefore, complementary to improvements in imaging techniques, developments in more invasive diagnostic procedures, such as sentinel node biopsy (SNB) will add to the accuracy of diagnostic algorithms for the staging of the neck.
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Affiliation(s)
- Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jesus E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sandro J Stoeckli
- Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
| | - Anthony A Mancuso
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | | | - Afshin Teymoortash
- Department of Otolaryngology-Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | - Karen T Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St. Luc University Hospital and Cancer Center, Brussels, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Carl E Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Alfio Ferlito
- University of Udine School of Medicine, Udine, Italy
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Arya S, Rane P, Deshmukh A. Oral cavity squamous cell carcinoma: Role of pretreatment imaging and its influence on management. Clin Radiol 2014; 69:916-30. [DOI: 10.1016/j.crad.2014.04.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/31/2014] [Accepted: 04/15/2014] [Indexed: 11/28/2022]
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van Enst WA, Ochodo E, Scholten RJPM, Hooft L, Leeflang MM. Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study. BMC Med Res Methodol 2014; 14:70. [PMID: 24884381 PMCID: PMC4035673 DOI: 10.1186/1471-2288-14-70] [Citation(s) in RCA: 250] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/06/2014] [Indexed: 12/13/2022] Open
Abstract
Background The validity of a meta-analysis can be understood better in light of the possible impact of publication bias. The majority of the methods to investigate publication bias in terms of small study-effects are developed for meta-analyses of intervention studies, leaving authors of diagnostic test accuracy (DTA) systematic reviews with limited guidance. The aim of this study was to evaluate if and how publication bias was assessed in meta-analyses of DTA, and to compare the results of various statistical methods used to assess publication bias. Methods A systematic search was initiated to identify DTA reviews with a meta-analysis published between September 2011 and January 2012. We extracted all information about publication bias from the reviews and the two-by-two tables. Existing statistical methods for the detection of publication bias were applied on data from the included studies. Results Out of 1,335 references, 114 reviews could be included. Publication bias was explicitly mentioned in 75 reviews (65.8%) and 47 of these had performed statistical methods to investigate publication bias in terms of small study-effects: 6 by drawing funnel plots, 16 by statistical testing and 25 by applying both methods. The applied tests were Egger’s test (n = 18), Deeks’ test (n = 12), Begg’s test (n = 5), both the Egger and Begg tests (n = 4), and other tests (n = 2). Our own comparison of the results of Begg’s, Egger’s and Deeks’ test for 92 meta-analyses indicated that up to 34% of the results did not correspond with one another. Conclusions The majority of DTA review authors mention or investigate publication bias. They mainly use suboptimal methods like the Begg and Egger tests that are not developed for DTA meta-analyses. Our comparison of the Begg, Egger and Deeks tests indicated that these tests do give different results and thus are not interchangeable. Deeks’ test is recommended for DTA meta-analyses and should be preferred.
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Affiliation(s)
- W Annefloor van Enst
- Dutch Cochrane Centre and Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
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Dmytriw AA, El Beltagi A, Bartlett E, Sahgal A, Poon CS, Forghani R, Fatterpekar G, Yu E. CRISPS: a pictorial essay of an acronym to interpreting metastatic head and neck lymphadenopathy. Can Assoc Radiol J 2013; 65:232-41. [PMID: 24209637 DOI: 10.1016/j.carj.2013.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/01/2013] [Accepted: 07/15/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Adam A Dmytriw
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
| | | | - Eric Bartlett
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Colin S Poon
- Department of Diagnostic Radiology, Yale Medical School, New Haven, Connecticut, USA
| | - Reza Forghani
- Department of Radiology, McGill University, Montreal, Quebec, Canada
| | | | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Attariwala R, Picker W. Whole body MRI: improved lesion detection and characterization with diffusion weighted techniques. J Magn Reson Imaging 2013; 38:253-68. [PMID: 23960006 PMCID: PMC3795449 DOI: 10.1002/jmri.24285] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 05/24/2013] [Indexed: 12/21/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is an established functional imaging technique that interrogates the delicate balance of water movement at the cellular level. Technological advances enable this technique to be applied to whole-body MRI. Theory, b-value selection, common artifacts and target to background for optimized viewing will be reviewed for applications in the neck, chest, abdomen, and pelvis. Whole-body imaging with DWI allows novel applications of MRI to aid in evaluation of conditions such as multiple myeloma, lymphoma, and skeletal metastases, while the quantitative nature of this technique permits evaluation of response to therapy. Persisting signal at high b-values from restricted hypercellular tissue and viscous fluid also permits applications of DWI beyond oncologic imaging. DWI, when used in conjunction with routine imaging, can assist in detecting hemorrhagic degradation products, infection/abscess, and inflammation in colitis, while aiding with discrimination of free fluid and empyema, while limiting the need for intravenous contrast. DWI in conjunction with routine anatomic images provides a platform to improve lesion detection and characterization with findings rivaling other combined anatomic and functional imaging techniques, with the added benefit of no ionizing radiation.
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Heusch P, Sproll C, Buchbender C, Rieser E, Terjung J, Antke C, Boeck I, Macht S, Scherer A, Antoch G, Heusner TA, Handschel J. Diagnostic accuracy of ultrasound, ¹⁸F-FDG-PET/CT, and fused ¹⁸F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig 2013; 18:969-78. [PMID: 23892450 DOI: 10.1007/s00784-013-1050-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to compare (18)F-fluorodesoxyglucose positron emission tomography/MRI ((18)F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), (18)F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Eighteen patients prospectively underwent ultrasound examination, (18)F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference. RESULTS The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for (18)F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for (18)F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for (18)F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between (18)F-FDG-PET-MRI and (18)F-FDG-PET/CT (p = 0.839) and between (18)F-FDG-PET-MRI plus DWI and (18)F-FDG-PET/CT (p = 0.286), respectively. US was significantly more accurate than (18)F-FDG-PET/CT (p = 0.009), whereas no significant difference was seen between (18)F-FDG-PET-MRI and US (p = 0.223) or (18)F-FDG-PET-MRI plus DWI and US (p = 0.115). The nodal stage was correctly rated by (18)F-FDG-PET-MRI in eight patients, (18)F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and (18)F-FDG-PET/CT in five out of 18 patients. CONCLUSION Software-based fusion of (18)F-FDG-PET-MRI and (18)F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and (18)F-FDG-PET/CT. CLINICAL RELEVANCE Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.
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Affiliation(s)
- Philipp Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany
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Hartman MJ, Gentry LR. Aggressive inflammatory and neoplastic processes of the paranasal sinuses. Magn Reson Imaging Clin N Am 2012; 20:447-71. [PMID: 22877951 DOI: 10.1016/j.mric.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although uncommon, sinonasal malignancies and aggressive inflammatory processes are entities every radiologist will encounter during the evaluation of routine sinus imaging studies. A high index of suspicion is necessary for prompt diagnosis. It is important to consider aggressive inflammatory disease in all patients having routine sinus computed tomography because any delay in diagnosis can adversely affect the patients' care. Magnetic resonance (MR) will often provide a better assessment of the lesion extent, allowing for better surgical treatment. MR is crucial for the accurate assessment of neoplastic lesions. A proficient understanding of the complex anatomy of the region is essential.
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Affiliation(s)
- Michael J Hartman
- Department of Radiology, University of Wisconsin Hospital, Madison, WI 53711, USA.
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Quon H, Brizel DM. Predictive and Prognostic Role of Functional Imaging of Head and Neck Squamous Cell Carcinomas. Semin Radiat Oncol 2012; 22:220-32. [DOI: 10.1016/j.semradonc.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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