Published in:
Open Access
01-02-2018 | Head and Neck
Local recurrence of squamous cell carcinoma of the head and neck after radio(chemo)therapy: Diagnostic performance of FDG-PET/MRI with diffusion-weighted sequences
Authors:
Minerva Becker, Arthur D. Varoquaux, Christophe Combescure, Olivier Rager, Marc Pusztaszeri, Karim Burkhardt, Bénédicte M. A. Delattre, Pavel Dulguerov, Nicolas Dulguerov, Eirini Katirtzidou, Francesca Caparrotti, Osman Ratib, Habib Zaidi, Christoph D. Becker
Published in:
European Radiology
|
Issue 2/2018
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Abstract
Purpose
To determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy.
Materials and methods
This was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering.
Results
The proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p < 0.001).
Conclusion
FDG-PET/DWIMRI yields excellent results for detection and T-classification of HNSCC after radio(chemo)therapy.
Key points
• FDG-PET/DWIMRI yields excellent results for the detection of post-radio(chemo)therapy HNSCC recurrence.
• Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage.
• 97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence.
• 87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions.
• Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.