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Chau E, Traylor KS, Branstetter BF. CT of the Larynx: Is an Additional High-Resolution Acquisition Necessary for Diagnostic Accuracy? AJNR Am J Neuroradiol 2023; 44:1421-1424. [PMID: 38050008 PMCID: PMC10714861 DOI: 10.3174/ajnr.a8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/03/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND PURPOSE Diagnostic CT of the larynx is historically performed with a protocol that combines a standard neck CT with dedicated imaging through the larynx. Multichannel CT scanners, however, allow high-resolution reformatted images of the larynx to be created directly from the initial neck acquisition data. The purpose of this study was to determine whether reformatted laryngeal images derived from a standard neck CT acquisition provide information comparable with that of separate dedicated high-resolution laryngeal images. MATERIALS AND METHODS The CT protocol for suspected laryngeal masses at our institution consists of a standard neck acquisition followed by a second acquisition focused on the larynx. We enrolled 200 patients who had undergone this protocol for a suspected laryngeal mass. Two head and neck radiologists independently reviewed each of the 200 scans twice. In one session, the entire scan was available, while in the other session, only images derived from the standard neck acquisition were available. The main outcome variable was the frequency of discrepant tumor staging between the interpretation sessions. No pathologic reference standard was used. RESULTS Radiologist A had discrepant staging in 45 of the 200 scans (23%; 95% CI, 17%-29%). Radiologist B had discrepant staging in 42 of the 200 scans (21%; 95% CI, 16%-27%). Fifty-three of the 87 discrepancies (61%) reflected improper downstaging of the laryngeal tumor on standard images alone, while the other 34 (39%) had improper upstaging on standard images alone. CONCLUSIONS Reformatted images from our institution's standard neck CT acquisition were less accurate than dedicated images of the larynx for analysis of laryngeal tumor extension. Focused images of the larynx were needed to optimize interpretation.
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Affiliation(s)
- Eva Chau
- From the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katie S Traylor
- From the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Cho SJ, Lee JH, Suh CH, Kim JY, Kim D, Lee JB, Lee MK, Chung SR, Choi YJ, Baek JH. Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analysis. Eur Radiol 2020; 30:3803-3812. [PMID: 32152744 DOI: 10.1007/s00330-020-06718-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of contrast-enhanced CT with that of MRI in the detection of cartilage invasion in patients with laryngo-hypopharyngeal cancer. METHODS A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting diagnostic accuracy of CT and/or MRI in detecting cartilage invasion from laryngo-hypopharyngeal cancer between 2000 and 2018. The pooled sensitivity and specificity, and their 95% confidence intervals were calculated for CT and MRI using bivariate random effects modeling. Subgroup and meta-regression analyses were performed. Indirect comparison was also performed by univariable meta-regression. RESULT Fourteen articles including 776 patients were included in the systematic review and meta-analysis: eight for CT, and six for MRI. CT and MRI showed pooled sensitivities of 66% (95% CI, 49-80%) and 88% (95% CI, 79-93%), and pooled specificities of 90% (95% CI, 82-94%) and 81% (95% CI, 76-84%), respectively. MRI showed significantly higher sensitivity than CT (p = 0.02). The specificities showed no statistically significant difference between CT and MRI (p = 0.39). The CT studies showed heterogeneity and a threshold effect, while MRI showed neither heterogeneity nor threshold effect. In the meta-regression analysis for CT, the type of cartilage analyzed (thyroid only vs. thyroid/cricoid/arytenoid, p < 0.001) was a significant factor influencing the heterogeneity in the diagnostic performance of the CT studies. CONCLUSIONS In conclusion, MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer, without a significant difference in the specificity. KEY POINTS • MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer.
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Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jung Youn Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center Kangbuk Samsung Hospital29, Saemunan-ro, Jongno-gu, Seoul, Republic of Korea
| | - Donghyun Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, Republic of Korea
| | - Jung Bin Lee
- Department of Radiology, Soonchunhyang University Buchoen Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Min Kyoung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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