Response evaluation after chemoradiotherapy for advanced nodal disease in head and neck cancer using diffusion-weighted MRI and 18F-FDG-PET–CT. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Schouten, Charlotte S.; de Graaf, Pim; Alberts, Femke M.; Hoekstra, Otto S.; Comans, Emile F.I.; Bloemena, E.; Witte, Birgit I.; Sanchez, E.; Leemans, C. René; Castelijns, Jonas A.; de Bree, Remco
• Is Part Of: Oral oncology. Volume 51:Issue 5(2015:May)
• Page Start: 541
• Page End: 547
• Publication Date: 2015-05
• Subjects: ADC apparent diffusion coefficient -- CRT chemoradiotherapy -- DW-MRI diffusion-weighted magnetic resonance imaging -- EPI echo planar imaging -- FWHM full width at half maximum -- HNSCC head and neck squamous cell carcinoma -- PET–CT positron emission tomography–computed tomography -- PROPLELLER periodically rotated overlapping parallel lines -- STIR short T1 inversion recovery -- SUV standardized uptake value -- 18F-FDG 18F-fluorodeoxyglucose; Head and neck cancer -- Chemoradiotherapy -- Diffusion-weighted MRI -- Positron emission tomography–computed tomography -- Neoplasm recurrence, regional; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2015.01.017
• Languages: English
• ISSNs: 1368-8375

Abstract

Summary: Objectives: Evaluation of accuracy and interobserver variation of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDGPET–CT) to detect residual lymph node metastases after chemoradiotherapy (CRT) in advanced staged head and neck squamous cell carcinoma (HNSCC). Materials and methods: Retrospectively, routinely performed DW-MRI ( n = 73) and 18F-FDG-PET–CT ( n = 58) 3 months after CRT in HNSCC-patients with advanced nodal disease (N2–N3) were assessed by two radiologists and two nuclear medicine physicians (individually and in consensus). Imaging was scored dichotomously and on a five-point Likert scale. We also explored different scenarios for the potential added value of DW-MRI to PET–CT using the consensus Likert scale. Histopathology and a follow-up of 9 months after CRT served as reference standard. Results: Five patients (7%) had residual regional disease. DW-MRI showed a sensitivity of 60% and a specificity of 93%, vs. 100% and 84% for PET–CT, respectively. DW-MRI and PET–CT observers had 'moderate' and 'substantial' interobserver agreement ( κ = 0.58 and κ = 0.64, respectively) with the dichotomous system. The combination of PET–CT and DW-MRI showed a sensitivity of 100% and a specificity of 95%. Conclusion: The high sensitivity of PET–CT authorizes a neck dissection in all patients with a positive test result and the high specificity of DW-MRI justifies avoidance of invasive neck dissections if the test is negative. Interobserver agreement varied as a function of test positivity criteria. Adding DW-MRI to PET–CT seemed to increase the specificity of PET–CT alone, thereby ensuring that less patients are exposed to unnecessary neck dissections.