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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

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.

Varoquaux A, Rager O, Dulguerov P et al (2015) Diffusion-weighted and PET/MR imaging after radiation therapy for malignant head and neck tumors. Radiographics 35(5):1502–1527CrossRefPubMed

Omura G, Saito Y, Ando M et al (2014) Salvage surgery for local residual or recurrent pharyngeal cancer after radiotherapy or chemoradiotherapy. Laryngoscope 124(9):2075–2080CrossRefPubMed

Camisasca DR, Silami MA, Honorato J, Dias FL, de Faria PA, Lourenco Sde Q (2011) Oral squamous cell carcinoma: clinicopathological features in patients with and without recurrence. ORL J Otorhinolaryngol Relat Spec 73(3):170–176CrossRefPubMed

Guo T, Qualliotine JR, Ha PK et al (2015) Surgical salvage improves overall survival for patients with HPV-positive and HPV-negative recurrent locoregional and distant metastatic oropharyngeal cancer. Cancer 121(12):1977–1984CrossRefPubMedPubMedCentral

Tshering Vogel DW, Zbaeren P, Geretschlaeger A, Vermathen P, De Keyzer F, Thoeny HC (2013) Diffusion-weighted MR imaging including bi-exponential fitting for the detection of recurrent or residual tumour after (chemo)radiotherapy for laryngeal and hypopharyngeal cancers. Eur Radiol 23(2):562–569CrossRefPubMed

Abdel Razek AA, Kandeel AY, Soliman N et al (2007) Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes. AJNR Am J Neuroradiol 28(6):1146–1152CrossRefPubMed

Vandecaveye V, De Keyzer F, Nuyts S et al (2007) Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo)radiotherapy: correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 67(4):960–971CrossRefPubMed

Abgral R, Querellou S, Potard G et al (2009) Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med 50(1):24–29CrossRefPubMed

Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M (2014) FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging 5(5):585–602CrossRefPubMedPubMedCentral

10.

Zaidi H, Becker M (2016) The promise of hybrid PET/MRI: technical advances and clinical applications. IEEE Signal Proc Mag 33(3):67–85CrossRef

11.

Becker M, Zaidi H (2014) Imaging in head and neck squamous cell carcinoma: the potential role of PET/MRI. Br J Radiol 87(1036):20130677CrossRefPubMedPubMedCentral

12.

Vargas MI, Becker M, Garibotto V et al (2013) Approaches for the optimization of MR protocols in clinical hybrid PET/MRI studies. MAGMA 26(1):57–69CrossRefPubMed

13.

Covello M, Cavaliere C, Aiello M et al (2015) Simultaneous PET/MR head-neck cancer imaging: preliminary clinical experience and multiparametric evaluation. Eur J Radiol 84(7):1269–1276CrossRefPubMed

14.

Purohit BS, Dulguerov P, Burkhardt K, Becker M (2014) Dedifferentiated laryngeal chondrosarcoma: combined morphologic and functional imaging with positron-emission tomography/magnetic resonance imaging. Laryngoscope 124(7):E274–E277CrossRefPubMed

15.

Bailey DL, Antoch G, Bartenstein P et al (2015) Combined PET/MR: the real work has just started. summary report of the third international workshop on PET/MR imaging; February 17-21, 2014, Tubingen, Germany. Mol Imaging Biol 17(3):297–312CrossRefPubMedPubMedCentral

16.

Varoquaux A, Rager O, Poncet A et al (2014) Detection and quantification of focal uptake in head and neck tumours: (18)F-FDG PET/MR versus PET/CT. Eur J Nucl Med Mol Imaging 41(3):462–475CrossRefPubMed

17.

Queiroz MA, Hullner M, Kuhn F et al (2014) PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging 41(6):1066–1075PubMed

18.

Drzezga A, Souvatzoglou M, Eiber M et al (2012) First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses. J Nucl Med: Off Publ, Soc Nucl Med 53(6):845–855CrossRef

19.

Kubiessa K, Purz S, Gawlitza M et al (2014) Initial clinical results of simultaneous 18F-FDG PET/MRI in comparison to 18F-FDG PET/CT in patients with head and neck cancer. Eur J Nucl Med Mol Imaging 41(4):639–648CrossRefPubMed

20.

Weber WA (2014) PET/MR imaging: a critical appraisal. J Nucl Med 55(Supplement 2):56s–58sCrossRefPubMed

21.

Vandecaveye V, Dirix P, De Keyzer F et al (2012) Diffusion-weighted magnetic resonance imaging early after chemoradiotherapy to monitor treatment response in head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 82(3):1098–1107CrossRefPubMed

22.

Vandecaveye V, De Keyzer F, Vander Poorten V et al (2009) Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 251(1):134–146CrossRefPubMed

23.

Lambrecht M, Van Calster B, Vandecaveye V et al (2012) Integrating pretreatment diffusion weighted MRI into a multivariable prognostic model for head and neck squamous cell carcinoma. Radiother Oncol 110(3):429–434CrossRef

24.

Maehara M, Ikeda K, Kurokawa H et al (2014) Diffusion-weighted echo-planar imaging of the head and neck using 3-T MRI: investigation into the usefulness of liquid perfluorocarbon pads and choice of optimal fat suppression method. Magn Reson Imaging 32(5):440–445CrossRefPubMed

25.

Brandão S, Nogueira L, Matos E et al (2015) Fat suppression techniques (STIR vs SPAIR) on diffusion weighted imaging of breast lesions at 3.0 T: preliminary experience. Radiol Med 120(8):705–713CrossRefPubMed

26.

Arabi H, Rager O, Alem A, Varoquaux A, Becker M, Zaidi H (2015) Clinical assessment of MR-guided 3-class and 4-class attenuation correction in PET/MR. Mol Imaging Biol 17(2):264–276CrossRefPubMed

27.

Thoeny HC, De Keyzer F, King AD (2012) Diffusion-weighted MR imaging in the head and neck. Radiology 263(1):19–32CrossRefPubMed

28.

Becker M, Zbären P, Casselman JW, Kohler R, Dulguerov P, Becker CD (2008) Neoplastic invasion of laryngeal cartilage: reassessment of criteria for diagnosis at MR imaging. Radiology 249(2):551–559CrossRefPubMed

29.

Sheikhbahaei S, Taghipour M, Ahmad R et al (2015) Diagnostic accuracy of follow-up FDG PET or PET/CT in patients with head and neck cancer after definitive treatment: a systematic review and meta-analysis. AJR Am J Roentgenol 205(3):629–639CrossRefPubMed

30.

Robin P, Abgral R, Valette G et al (2015) Diagnostic performance of FDG PET/CT to detect subclinical HNSCC recurrence 6 months after the end of treatment. Eur J Nucl Med Mol Imaging 42(1):72–78CrossRefPubMed

31.

Varoquaux A, Rager O, Lovblad KO et al (2013) Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging 40(6):842–852CrossRefPubMedPubMedCentral

32.

Brierley JD, Gospodarowicz MK, Wittekind C (2016). TNM Classification of Malignant Tumours 8th ed. Wiley-Blackwell, Hoboken

33.

Zhou X-H, Obuchowksi NA, McClish DK (2011) Statistical Methods in Diagnostic Medicine, 2nd edn. Wiley-Blackwell, HobokenCrossRef

34.

Obuchowski NA (1997) Nonparametric analysis of clustered ROC curve data. Biometrics 53(2):567–578CrossRefPubMed

35.

Perkins NJ, Schisterman EF (2006) The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163(7):670–675CrossRefPubMedPubMedCentral

36.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed

37.

Fruehwald-Pallamar J, Czerny C, Mayerhoefer ME et al (2011) Functional imaging in head and neck squamous cell carcinoma: correlation of PET/CT and diffusion-weighted imaging at 3 Tesla. Eur J Nucl Med Mol Imaging 38(6):1009–1019CrossRefPubMed

38.

Preda L, Conte G, Bonello L et al (2016) Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma. Eur Radiol 26(12):4432–4441CrossRefPubMed

39.

Adams MC, Turkington TG, Wilson JM et al (2010) A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol 195:310–320CrossRefPubMed

40.

Cheung PK, Chin RY, Eslick GD (2016) Detecting residual/recurrent head neck squamous cell carcinomas using PET or PET/CT: systematic review and meta-analysis. Otolaryngol Head Neck Surg 154(3):421–432CrossRefPubMed

41.

Isles MG, McConkey C, Mehanna HM (2008) A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol 33(3):210–222CrossRefPubMed

42.

Gupta T, Master Z, Kannan S et al (2011) Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 38:2083–2095CrossRefPubMed

43.

Driessen JP, van Kempen PM, van der Heijden GJ (2015) Diffusion-weighted imaging in head and neck squamous cell carcinomas: a systematic review. Head Neck 37(3):440–448CrossRefPubMed

44.

Queiroz MA, Hüllner M, Kuhn F et al (2014) Use of diffusion-weighted imaging (DWI) in PET/MRI for head and neck cancer evaluation. Eur J Nucl Med Mol Imaging 41(12):2212–2221CrossRefPubMed

45.

Zbaren P, Nuyens M, Curschmann J, Stauffer E (2007) Histologic characteristics and tumor spread of recurrent glottic carcinoma: analysis on whole-organ sections and comparison with tumor spread of primary glottic carcinomas. Head Neck 29(1):26–32CrossRefPubMed

46.

Zbaren P, Christe A, Caversaccio MD, Stauffer E, Thoeny HC (2007) Pretherapeutic staging of recurrent laryngeal carcinoma: clinical findings and imaging studies compared with histopathology. Otolaryngol Head Neck Surg 137(3):487–491CrossRefPubMed

Title: 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
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4999-1

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Materials and methods

Results

Conclusion

Key points

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key points

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