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Canali L, Costantino A, Mari G, Festa BM, Russo E, Giannitto C, Spriano G, De Virgilio A. Diffusion-Weighted MRI for Recurrent/Persistent Head and Neck Squamous-Cell Carcinoma After Radiotherapy: Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39154260 DOI: 10.1002/ohn.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 07/23/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To evaluate the accuracy of diffusion-weighted magnetic resonance imaging (DWI-MRI) in diagnosing persistent/recurrent head and neck squamous cell carcinomas (HNSCCs) after primary chemoradiotherapy (CRT). DATA SOURCES Scopus, PubMed/MEDLINE, and Cochrane Library databases were searched for relevant publications until April 18, 2023. REVIEW METHODS A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Test Accuracy statement. The search was conducted independently by 2 investigators. Methodological quality of included studies was assessed using the Quality Assessment of Diagnostic Studies-2 questionnaire. Extracted data were used to calculate the pooled DWI-MRI sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratio. RESULTS A total of 618 patients from 10 studies were included for calculation of diagnostic accuracy parameters. At the level of the primary tumor, the pooled sensitivity and specificity were, respectively, 0.96 (95% confidence interval [CI]: 0.89-1.00) and 0.81 (95% CI: 0.54-0.98) in the case of qualitative analysis, and, respectively, 0.79 (95% CI: 0.66-0.89) and 0.88 (95% CI: 0.77-0.96) for quantitative analysis. At the level of the neck, the pooled sensitivity and specificity were, respectively, 0.87 (95% CI: 0.75-0.95) and 0.84 (95% CI: 0.74-0.93) when images were analyzed qualitatively, and 0.79 (95% CI: 0.60-0.94) and 0.90 (95% CI: 0.82-0.97) when analyzed quantitatively. CONCLUSION DWI-MRI showed high diagnostic accuracy and should be considered if persistent/recurrent HNSCCs is suspected after primary CRT. No significant differences were found between qualitative and quantitative imaging assessment.
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Affiliation(s)
- Luca Canali
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Andrea Costantino
- Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida, USA
| | - Giulia Mari
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Radiology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
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Parsaei M, Sanjari Moghaddam H, Mazaheri P. The clinical utility of diffusion-weighted imaging in diagnosing and predicting treatment response of laryngeal and hypopharyngeal carcinoma: A systematic review and meta-analysis. Eur J Radiol 2024; 177:111550. [PMID: 38878501 DOI: 10.1016/j.ejrad.2024.111550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/24/2024] [Accepted: 06/02/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Laryngeal and Hypopharyngeal Carcinomas (LC/HPC) constitute about 24 % of head and neck cancers, causing more than 90,000 annual deaths worldwide. Diffusion-Weighted Imaging (DWI), is currently widely studied in oncologic imaging and can aid in distinguishing cellular tumors from other tissues. Our objective was to review the effectiveness of DWI in three areas: diagnosing, predicting prognosis, and predicting treatment response in patients with LC/HPC. METHODS A systematic search was conducted in PubMed, Web of Science, and Embase. A meta-analysis by calculating Standardized Mean Difference (SMD) and 95 % Confidence Interval (CI) was conducted on diagnostic studies. RESULTS A total of 16 studies were included. All diagnostic studies (n = 9) were able to differentiate between the LC/HPC and other benign laryngeal/hypopharyngeal lesions. These studies found that LC/HPC had lower Apparent Diffusion Coefficient (ADC) values than non-cancerous lesions. Our meta-analysis of 7 diagnostic studies, that provided ADC values of malignant and non-malignant tissues, demonstrated significantly lower ADC values in LC/HPC compared to non-malignant lesions (SMD = -1.71, 95 %CI: [-2.00, -1.42], ADC cut-off = 1.2 × 103 mm2/s). Furthermore, among the studies predicting prognosis, 67 % (4/6) accurately predicted outcomes based on pretreatment ADC values. Similarly, among studies predicting treatment response, 50 % (2/4) successfully predicted outcomes based on pretreatment ADC values. Overall, the studies that looked at prognosis or treatment response in LC/HPC found a positive correlation between pretreatment ADC values in larynx/hypopharynx and favorable outcomes. CONCLUSION DWI aids significantly in the LC/HPC diagnosis. However, further research is needed to establish DWI's reliability in predicting prognosis and treatment response in patients with LC/HPC.
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Affiliation(s)
| | - Hossein Sanjari Moghaddam
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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Roushdy MMM, Elsherif MMR, Kayed EMS, Farghaly S, Sayed AR. Does Diffusion Magnetic Resonance Imaging (DWI) has Role in Irradiated Laryngeal Carcinoma? Indian J Otolaryngol Head Neck Surg 2022; 74:6339-6346. [PMID: 36742495 PMCID: PMC9895342 DOI: 10.1007/s12070-021-03071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
DWI involves acquisition of signal of movement of water proton in cellular spaces of body (Brownian motion). It includes qualitative method either restricted or facilitated and quantitive method which is apparent diffusion coefficient value(ADC) which is related to proportion of extracellular and intracellular components of the tissue., ADC is calculated with use of at least two b value more accurate using more DWI with different b value,ADC levels is low in increased tissue cellularity, as malignancy., ADC levels is high in non-tumoral tissue alterations such as direct endoscopy oedema, radiotherapy necrosis are expected to have minimal cellularity. ADC is most accurate in the detection of malignancy versus tissue edema or radionecrosis the aim of study to assess value of ADC as regarding measuring sensitivity and specificity and accuracy to differentiate tumor recurrence from radionecrosis. This study includes 36 patients who were suspected patients of tumor recurrence after radiotherapy; it is a prospective randomized comparative clinical trial. The patients were assessed using direct laryngoscopic examination under general anaesthesia and biopsy, and diffusion weighted image on the neck (b0 and b1000), ADC map and ADC value measured al lesion and normal tissues and compared with pathology results. ADC value (mean 0.93 ± 0.30 X 10-3 mm2/s) in patients had recurrent carcinoma was significantly lower (P < .0001) than the mean ADC of normal tissue in the same patients (1.26 ± 0.134) while mean ADC of tumour recurrence (P < .0001) was lower than mean ADC value of radio necrosis (1.63 ± 0.21 × 10-3 mm2/s). MRI ADC value is a sensitive and non-invasive method in detection of a recurrent laryngeal lesion from radionecrosis.
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Affiliation(s)
| | | | - Ezzat Mohamed Saleh Kayed
- Otorhinolaryngology Department, Assiut University Hospital, Assiut University, 5thfloor main building, Assiut, Egypt
| | - Shimaa Farghaly
- Radio-diagnosis Department, Assiut University Hospital, Assiut University, First Floor Main Building, Assiut, Egypt
| | - Ahmed Ragab Sayed
- Otorhinolaryngology Department, Assiut University Hospital, Assiut University, 5thfloor main building, Assiut, Egypt
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Touska P, Connor S. Imaging of human papilloma virus associated oropharyngeal squamous cell carcinoma and its impact on diagnosis, prognostication, and response assessment. Br J Radiol 2022; 95:20220149. [PMID: 35687667 PMCID: PMC9815738 DOI: 10.1259/bjr.20220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 06/07/2022] [Indexed: 01/13/2023] Open
Abstract
The clinical behaviour and outcomes of patients with oropharyngeal cancer (OPC) may be dichotomised according to their association with human papilloma virus (HPV) infection. Patients with HPV-associated disease (HPV+OPC) have a distinct demographic profile, clinical phenotype and demonstrate considerably better responses to chemoradiotherapy. This has led to a reappraisal of staging and treatment strategies for HPV+OPC, which are underpinned by radiological data. Structural modalities, such as CT and MRI can provide accurate staging information. These can be combined with ultrasound-guided tissue sampling and functional techniques (such as diffusion-weighted MRI and 18F-fludeoxyglucose positron emission tomography-CT) to monitor response to treatment, derive prognostic information, and to identify individuals who might benefit from intensification or deintensification strategies. Furthermore, advanced MRI techniques, such as intravoxel incoherent motion and perfusion MRI as well as application of artificial intelligence and radiomic techniques, have shown promise in treatment response monitoring and prognostication. The following review will consider the contemporary role and knowledge on imaging in HPV+OPC.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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Jajodia A, Aggarwal D, Chaturvedi AK, Rao A, Mahawar V, Gairola M, Agarwal M, Goyal S, Koyyala VPB, Pasricha S, Tripathi R. Value of diffusion MR imaging in differentiation of recurrent head and neck malignancies from post treatment changes. Oral Oncol 2019; 96:89-96. [PMID: 31422219 DOI: 10.1016/j.oraloncology.2019.06.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/22/2019] [Accepted: 06/29/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Role of diffusion-weighted (DW) MR imaging in differentiating residual or recurrent neck malignancies from postoperative/post-radiation changes with histopathological correlation and comparison with PET-CT. METHODS AND MATERIALS Prospective observational study for a period of 1 year in 62 post-radiation/post-operative patients suspected to have residual/recurrent tumors of neck with lesion diameter more than 5 mm measured on MRI. RESULTS Mean ADC for recurrent/residual tumors: 1.008 ± 0.220 × 10-3 mm2/s - significantly lower than mean ADC value for post-treatment changes of 1.69 ± 0.40 × 10-3 mm2/s (p < 0.0001). The overall diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the qualitative assessment for the use of DWI in differentiating tumors recurrence from post-treatment changes were 96.6%, 96% and 83.3%, respectively. Upon quantitative analysis of the DW imaging data, a threshold ADC value of 1.3 × 10-3 mm2/s used for differentiating between post-treatment changes and recurrent cancers showed the highest combined sensitivity of 94%, specificity of 83.3%, accuracy of 93.6%, positive predictive value of 95.9%, and negative predictive value of 83.3%. CONCLUSION DW MRI is a promising non-invasive MRI technique used to differentiate recurrent/residual head and neck malignancies from posttreatment changes based on ADC values. DWI offers advantage as it has a short scanning time and can be safely added to standard MRI protocol with minimum patient discomfort. Complementary use of DWI and PET/CT imaging may increase diagnostic confidence for differentiating recurrent disease from radiation therapy-induced changes after 6-12 months in posttreatment cases.
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Affiliation(s)
- Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India.
| | - Deepa Aggarwal
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Arvind K Chaturvedi
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Avinash Rao
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Vivek Mahawar
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Mudit Agarwal
- Department of Surgical Head & Neck Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Venkata Pradeep Babu Koyyala
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Sunil Pasricha
- Department of Histopathology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini 110085, Delhi, India
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Driessen JP, Peltenburg B, Philippens MEP, Huijbregts JE, Pameijer FA, de Bree R, Janssen LM, Terhaard CHJ. Prospective comparative study of MRI including diffusion-weighted images versus FDG PET-CT for the detection of recurrent head and neck squamous cell carcinomas after (chemo)radiotherapy. Eur J Radiol 2018; 111:62-67. [PMID: 30691667 DOI: 10.1016/j.ejrad.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/18/2018] [Accepted: 12/04/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This prospective study aims to test if MRI including diffusion weighted images can replace FDG PET-CT in the diagnosis of patients with suspicion of local recurrent head and neck squamous cell carcinomas after (chemo)radiation. METHODS Seventy-five patients suspected of local recurrence underwent a MRI and a FDG PET-CT. Qualitative assessment of the images was performed. Reference standard was the results of biopsy or the absence of a recurrence during follow up. RESULTS Seventy patients were included. Fifty percent had local recurrence. FDG PET-CT had accuracy of 71% compared to 73% for MRI. The sensitivity and specificity were 97% compared to 69% and 46% compared to 77% for FDG PET-CT and MRI respectively. CONCLUSIONS MRI showed similar diagnostic accuracy, superior specificity but inferior sensitivity compared to FDG PET-CT. Based on current results, we consider MRI including diffusion weighted sequences unable to replace FDG PET-CT as a single imaging modality when local recurrent disease of HNSCC after (C)RT is suspected.
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Affiliation(s)
- Juliette P Driessen
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Boris Peltenburg
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Julia E Huijbregts
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank A Pameijer
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
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Ailianou A, Mundada P, De Perrot T, Pusztaszieri M, Poletti PA, Becker M. MRI with DWI for the Detection of Posttreatment Head and Neck Squamous Cell Carcinoma: Why Morphologic MRI Criteria Matter. AJNR Am J Neuroradiol 2018; 39:748-755. [PMID: 29449279 DOI: 10.3174/ajnr.a5548] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although diffusion-weighted imaging combined with morphologic MRI (DWIMRI) is used to detect posttreatment recurrent and second primary head and neck squamous cell carcinoma, the diagnostic criteria used so far have not been clarified. We hypothesized that precise MRI criteria based on signal intensity patterns on T2 and contrast-enhanced T1 complement DWI and therefore improve the diagnostic performance of DWIMRI. MATERIALS AND METHODS We analyzed 1.5T MRI examinations of 100 consecutive patients treated with radiation therapy with or without additional surgery for head and neck squamous cell carcinoma. MRI examinations included morphologic sequences and DWI (b=0 and b=1000 s/mm2). Histology and follow-up served as the standard of reference. Two experienced readers, blinded to clinical/histologic/follow-up data, evaluated images according to clearly defined criteria for the diagnosis of recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment, post-radiation therapy inflammatory edema, and late fibrosis. DWI analysis included qualitative (visual) and quantitative evaluation with an ADC threshold. RESULTS Recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment was present in 36 patients, whereas 64 patients had post-radiation therapy lesions only. The Cohen κ for differentiating tumor from post-radiation therapy lesions with MRI and qualitative DWIMRI was 0.822 and 0.881, respectively. Mean ADCmean in recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment (1.097 ± 0.295 × 10-3 mm2/s) was significantly lower (P < .05) than in post-radiation therapy inflammatory edema (1.754 ± 0.343 × 10-3 mm2/s); however, it was similar to that in late fibrosis (0.987 ± 0.264 × 10-3 mm2/s, P > .05). Although ADCs were similar in tumors and late fibrosis, morphologic MRI criteria facilitated distinction between the 2 conditions. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95% CI) of DWIMRI with ADCmean < 1.22 × 10-3 mm2/s and precise MRI criteria were 92.1% (83.5-100.0), 95.4% (90.3-100.0), 92.1% (83.5-100.0), 95.4% (90.2-100.0), 19.9 (6.58-60.5), and 0.08 (0.03-0.24), respectively, indicating a good diagnostic performance to rule in and rule out disease. CONCLUSIONS Adding precise morphologic MRI criteria to quantitative DWI enables reproducible and accurate detection of recurrent head and neck squamous cell carcinoma/second primary head and neck squamous cell carcinoma occurring after treatment.
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Affiliation(s)
- A Ailianou
- From the Division of Radiology (A.A., P.M., T.D.P., P.-A.P., M.B.), Department of Imaging and Medical Informatics
| | - P Mundada
- From the Division of Radiology (A.A., P.M., T.D.P., P.-A.P., M.B.), Department of Imaging and Medical Informatics
| | - T De Perrot
- From the Division of Radiology (A.A., P.M., T.D.P., P.-A.P., M.B.), Department of Imaging and Medical Informatics
| | - M Pusztaszieri
- Division of Clinical Pathology (M.P.), Department of Laboratory and Genetics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - P-A Poletti
- From the Division of Radiology (A.A., P.M., T.D.P., P.-A.P., M.B.), Department of Imaging and Medical Informatics
| | - M Becker
- From the Division of Radiology (A.A., P.M., T.D.P., P.-A.P., M.B.), Department of Imaging and Medical Informatics
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State of the art MRI in head and neck cancer. Clin Radiol 2017; 73:45-59. [PMID: 28655406 DOI: 10.1016/j.crad.2017.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
Head and neck cancer affects more than 11,000 new patients per year in the UK1 and imaging has an important role in the diagnosis, treatment planning, and assessment, and post-treatment surveillance of these patients. The anatomical detail produced by magnetic resonance imaging (MRI) is ideally suited to staging and follow-up of primary tumours and cervical nodal metastases in the head and neck; however, anatomical images have limitations in cancer imaging and so increasingly functional-based MRI techniques, which provide molecular, metabolic, and physiological information, are being incorporated into MRI protocols. This article reviews the state of the art of these functional MRI techniques with emphasis on those that are most relevant to the current management of patients with head and neck cancer.
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Dickerson E, Srinivasan A. Advanced Imaging Techniques of the Skull Base. Radiol Clin North Am 2017; 55:189-200. [DOI: 10.1016/j.rcl.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Driessen JP, van Kempen PMW, van der Heijden GJ, Philippens MEP, Pameijer FA, Stegeman I, Terhaard CHJ, Janssen LM, Grolman W. Diffusion-weighted imaging in head and neck squamous cell carcinomas: A systematic review. Head Neck 2014; 37:440-8. [DOI: 10.1002/hed.23575] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 11/17/2013] [Accepted: 12/10/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- Juliette P. Driessen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
| | - Paulina M. W. van Kempen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Geert J. van der Heijden
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Frank A. Pameijer
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiotherapy; University Medical Center Utrecht; Utrecht The Netherlands
| | - Luuk M. Janssen
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery; University Medical Center Utrecht; Utrecht The Netherlands
- Rudolf Magnus Institute of Neuroscience; Utrecht The Netherlands
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