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MRI Evaluation Using DWI and T2WI of Residual Lymph Nodes in patients Affected by Head and Neck Squamous Cell Carcinoma Treated with Chemo-Radiotherapy

[ Vol. 14 , Issue. 4 ]

Author(s):

Francesca Piludu, Emma Gangemi*, Laura Marucci, Antonino Guerrisi, Raul Pellini, Renato Covello, Paolo Carlini, Giuseppe Spriano, Giuseppe Sanguineti, Simona Marzi and Antonello Vidiri   Pages 599 - 608 ( 10 )

Abstract:


Objective: the purpose of this study was to assess residual neck nodes after Chemo- Radiotherapy (CRT) using diffusion and T2 weighted imaging.

Methods: Apparent Diffusion Coefficient (ADC) and T2 signal intensity were retrospectively analyzed in 45 residual nodes 8 weeks after the end of CRT. Sensitivity, specificity, Positive and Negative Predictive Values (PPV, NPV) and accuracy of diffusion and T2 weighted sequences were calculated. In a subgroup of 25 patients ADC and T2 signal intensity were compared to Positron Emission Tomography - Computed Tomography (PET-CT) results. Histopathology and a 24 months follow- up after CRT were used as reference standard.

Results: T2 signal intensity showed an accuracy of 63%, a sensitivity of 73.3%, a specificity of 55.6%, a PPV of 53.8% and a NPV of 75%. ADC showed an accuracy of 71.1%, using a threshold of 1.25 10-3 mm2/s, a sensitivity of 52.6%, a specificity of 84.6%, a PPV of 71.4% and a NPV of 71%. The combination of T2 signal intensity and ADC showed an accuracy of 73.3%, a sensitivity of 50%, a specificity of 84.6%, a PPV of 60% and a NPV of 78.7%. In the subset of 25 patients we correlated ADC and T2 data with PET-CT data: the latter showed higher accuracy, sensitivity and NPV and lower specificity; the PPV was similar between the two methods.

Conclusion: Our results demonstrated that MRI, using diffusion and T2 weighted imaging, has high specificity in detecting post-CRT residual neck nodes but it has a lower accuracy, sensitivity and NPV than PET-CT.

Keywords:

Lymph nodes, diffusion weighted imaging, T2 weighted imaging, magnetic resonance imaging, treatment response, head and neck squamous cell carcinoma, residual tumour.

Affiliation:

Department of Radiology, National Cancer Institute Regina Elena, Rome, Department of Radiology, National Cancer Institute Regina Elena, Rome, Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Department of Radiology, National Cancer Institute Regina Elena, Rome, Department of Otolaryngology, Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Department of Pathology, National Cancer Institute Regina Elena, Rome, Department of Oncology, National Cancer Institute Regina Elena, Rome, Department of Otolaryngology, Head & Neck Surgery, National Cancer Institute Regina Elena, Rome, Department of Radiotherapy, National Cancer Institute Regina Elena, Rome, Medical Physics Laboratory, Regina Elena Cancer Institute, Rome, Department of Radiology, National Cancer Institute Regina Elena, Rome

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