Skip to main content
Top
Published in: European Journal of Nuclear Medicine and Molecular Imaging 12/2014

01-12-2014 | Original Article

Use of diffusion-weighted imaging (DWI) in PET/MRI for head and neck cancer evaluation

Authors: Marcelo A. Queiroz, Martin Hüllner, Felix Kuhn, Gerhardt Huber, Christian Meerwein, Spyros Kollias, Gustav von Schulthess, Patrick Veit-Haibach

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2014

Login to get access

Abstract

Objective

The purpose of this study was to analyze whether diffusion-weighted imaging (DWI) adds significant information to positron emission tomography/magnetic resonance imaging (PET/MRI) on lesion detection and characterization in head and neck cancers.

Methods

Seventy patients with different head and neck cancers were enrolled in this prospective study. All patients underwent sequential contrast-enhanced (ce) PET/computed tomography (CT) and cePET/MRI using a tri-modality PET/CT-MR setup either for staging or re-staging. First, the DWI alone was evaluated, followed by the PET/MRI with conventional sequences, and in a third step, the PET/MRI with DWI was evaluated. McNemar’s test was used to evaluate differences in the accuracy of PET/MRI with and without DWI compared to the standard of reference.

Results

One hundred eighty-eight (188) lesions were found, and of those, 118 (62.8 %) were malignant and 70 (37.2 %) were benign. PET/MRI without DWI had a higher accuracy in detecting malignant lesions than DWI alone (86.8 % vs. 60.6 %, p < 0.001). PET/MRI combined with DWI detected 120 concurrent lesions (89 malignant and 31 benign), PET/MRI alone identified 48 additional lesions (20 malignant and 28 benign), and DWI alone detected 20 different lesions (nine malignant and 11 benign). However, lesions detected on DWI did not change overall staging. SUV maximum and mean were significantly higher in malignant lesions than in benign lesions. DWI parameters between malignant and benign lesions were not statistically different.

Conclusion

The use of DWI as part of PET/MRI to evaluate head and neck cancers does not provide remarkable information. Thus, the use of DWI might not be needed in clinical PET/MRI protocols for the staging or restaging of head and neck cancers.
Literature
1.
go back to reference Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.PubMedCrossRef Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.PubMedCrossRef
3.
go back to reference Hustinx R, Lucignani G. PET/CT in head and neck cancer: an update. Eur J Nucl Med Mol Imaging. 2010;645–51. Hustinx R, Lucignani G. PET/CT in head and neck cancer: an update. Eur J Nucl Med Mol Imaging. 2010;645–51.
4.
5.
go back to reference Thoeny HC, De Keyzer F. Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol. 2007;17:1385–93.PubMedCrossRef Thoeny HC, De Keyzer F. Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol. 2007;17:1385–93.PubMedCrossRef
6.
go back to reference Srinivasan A, Mohan S, Mukherji SK. Biologic imaging of head and neck cancer: the present and the future. AJNR Am J Neuroradiol. 2012;33:586–94.PubMedCrossRef Srinivasan A, Mohan S, Mukherji SK. Biologic imaging of head and neck cancer: the present and the future. AJNR Am J Neuroradiol. 2012;33:586–94.PubMedCrossRef
7.
go back to reference Friedrich KM, Matzek W, Gentzsch S, Sulzbacher I, Czerny C, Herneth AM. Diffusion-weighted magnetic resonance imaging of head and neck squamous cell carcinomas. Eur J Radiol. 2008;68:493–8.PubMedCrossRef Friedrich KM, Matzek W, Gentzsch S, Sulzbacher I, Czerny C, Herneth AM. Diffusion-weighted magnetic resonance imaging of head and neck squamous cell carcinomas. Eur J Radiol. 2008;68:493–8.PubMedCrossRef
8.
go back to reference Herneth AM, Guccione S, Bednarski M. Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. Eur J Radiol. 2003;45:208–13.PubMedCrossRef Herneth AM, Guccione S, Bednarski M. Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. Eur J Radiol. 2003;45:208–13.PubMedCrossRef
9.
go back to reference Higgins KA, Hoang JK, Roach MC, Chino J, Yoo DS, Turkington TG, et al. Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value. Int J Radiat Oncol Biol Phys. 2012;82:548–53.PubMedCrossRef Higgins KA, Hoang JK, Roach MC, Chino J, Yoo DS, Turkington TG, et al. Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value. Int J Radiat Oncol Biol Phys. 2012;82:548–53.PubMedCrossRef
10.
go back to reference Sadick M, Schoenberg SO, Hoermann K, Sadick H. Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:1–24. Sadick M, Schoenberg SO, Hoermann K, Sadick H. Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:1–24.
11.
go back to reference Thoeny HC, De Keyzer F, King AD. Diffusion-weighted MR imaging in the head and neck. Radiology. 2012;263:19–32.PubMedCrossRef Thoeny HC, De Keyzer F, King AD. Diffusion-weighted MR imaging in the head and neck. Radiology. 2012;263:19–32.PubMedCrossRef
12.
go back to reference Buchbender C, Hartung-Knemeyer V, Beiderwellen K, Heusch P, Kühl H, Lauenstein TC, et al. Diffusion-weighted imaging as part of hybrid PET/MRI protocols for whole-body cancer staging: does it benefit lesion detection? Eur J Radiol. 2013;82:877–82.PubMedCrossRef Buchbender C, Hartung-Knemeyer V, Beiderwellen K, Heusch P, Kühl H, Lauenstein TC, et al. Diffusion-weighted imaging as part of hybrid PET/MRI protocols for whole-body cancer staging: does it benefit lesion detection? Eur J Radiol. 2013;82:877–82.PubMedCrossRef
13.
go back to reference Veit-Haibach P, Kuhn FP, Wiesinger F, Delso G, von Schulthess G. PET-MR imaging using a tri-modality PET/CT-MR system with a dedicated shuttle in clinical routine. MAGMA. 2013;26:25–35.PubMedCrossRef Veit-Haibach P, Kuhn FP, Wiesinger F, Delso G, von Schulthess G. PET-MR imaging using a tri-modality PET/CT-MR system with a dedicated shuttle in clinical routine. MAGMA. 2013;26:25–35.PubMedCrossRef
14.
go back to reference Kuhn FP, Crook DW, Mader CE, Appenzeller P, von Schulthess GK, Schmid DT. Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen. Eur J Nucl Med Mol Imaging. 2012;44–51. Kuhn FP, Crook DW, Mader CE, Appenzeller P, von Schulthess GK, Schmid DT. Discrimination and anatomical mapping of PET-positive lesions: comparison of CT attenuation-corrected PET images with coregistered MR and CT images in the abdomen. Eur J Nucl Med Mol Imaging. 2012;44–51.
15.
go back to reference Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.PubMedCentralPubMedCrossRef Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.PubMedCentralPubMedCrossRef
16.
go back to reference Kuhn FP, Wiesinger F, Wollenweber SD, Samarin A, Von Schulthess G SD. Sequential integrated PET/CT-MR system: comparison of image registration accuracy of PET/CT versus PET/MR. Melbourne, Australia: International Society for Magnetic Resonance in Medicine (ISMRM); 2012. Kuhn FP, Wiesinger F, Wollenweber SD, Samarin A, Von Schulthess G SD. Sequential integrated PET/CT-MR system: comparison of image registration accuracy of PET/CT versus PET/MR. Melbourne, Australia: International Society for Magnetic Resonance in Medicine (ISMRM); 2012.
17.
go back to reference Lee M-C, Tsai H-Y, Chuang K-S, Liu C-K, Chen M-K. Prediction of nodal metastasis in head and neck cancer using a 3T MRI ADC map. Am J Neuroradiol. 2013;34:864–9.PubMedCrossRef Lee M-C, Tsai H-Y, Chuang K-S, Liu C-K, Chen M-K. Prediction of nodal metastasis in head and neck cancer using a 3T MRI ADC map. Am J Neuroradiol. 2013;34:864–9.PubMedCrossRef
18.
go back to reference Zhang Y, Chen J, Shen J, Zhong J, Ye R, Liang B. Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: differential diagnostic value in cervical lymphadenopathy. Clin Radiol. 2013;68:224–31.PubMedCrossRef Zhang Y, Chen J, Shen J, Zhong J, Ye R, Liang B. Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: differential diagnostic value in cervical lymphadenopathy. Clin Radiol. 2013;68:224–31.PubMedCrossRef
19.
go back to reference Abdel Razek AAK, Nada N. Role of diffusion-weighted MRI in differentiation of masticator space malignancy from infection. Dentomaxillofac Radiol. 2013;42:20120183.PubMedCentralPubMedCrossRef Abdel Razek AAK, Nada N. Role of diffusion-weighted MRI in differentiation of masticator space malignancy from infection. Dentomaxillofac Radiol. 2013;42:20120183.PubMedCentralPubMedCrossRef
20.
go back to reference Perrone A, Guerrisi P, Izzo L, D’Angeli I, Sassi S, Mele L Lo, et al. Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions. Eur J Radiol. 2011;77:281–6. Perrone A, Guerrisi P, Izzo L, D’Angeli I, Sassi S, Mele L Lo, et al. Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions. Eur J Radiol. 2011;77:281–6.
21.
go back to reference Holzapfel K, Duetsch S, Fauser C, Eiber M, Rummeny EJ, Gaa J. Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 2009;72:381–7.PubMedCrossRef Holzapfel K, Duetsch S, Fauser C, Eiber M, Rummeny EJ, Gaa J. Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 2009;72:381–7.PubMedCrossRef
22.
go back to reference Vandecaveye V, De Keyzer F. Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology. 2009;251:134–46.PubMedCrossRef Vandecaveye V, De Keyzer F. Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology. 2009;251:134–46.PubMedCrossRef
23.
go back to reference Queiroz MA, Hüllner M, Kuhn F, Huber G, Meerwein C, Kollias S, et al. PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging. 2014. doi:10.1007/s00259-014-2707-9. Queiroz MA, Hüllner M, Kuhn F, Huber G, Meerwein C, Kollias S, et al. PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging. 2014. doi:10.​1007/​s00259-014-2707-9.
24.
go back to reference Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Langner J, Schramm G, et al. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging. 2013;40:6–11.PubMedCentralPubMedCrossRef Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Langner J, Schramm G, et al. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging. 2013;40:6–11.PubMedCentralPubMedCrossRef
25.
go back to reference Appenzeller P, Mader C, Huellner MW, Schmidt D, Schmid D, Boss A, et al. PET/CT versus body coil PET/MRI: how low can you go? Insights Imaging. 2013;4:481–90.PubMedCentralPubMedCrossRef Appenzeller P, Mader C, Huellner MW, Schmidt D, Schmid D, Boss A, et al. PET/CT versus body coil PET/MRI: how low can you go? Insights Imaging. 2013;4:481–90.PubMedCentralPubMedCrossRef
26.
go back to reference Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, Part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 2012;53:928–38.PubMedCrossRef Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, Part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 2012;53:928–38.PubMedCrossRef
27.
go back to reference Chawla S, Kim S, Dougherty L, Wang S, Loevner LA, Quon H, et al. Pretreatment diffusion-weighted and dynamic contrast-enhanced MRI for prediction of local treatment response in squamous cell carcinomas of the head and neck. Am J Roentgenol. 2013;200:35–43.CrossRef Chawla S, Kim S, Dougherty L, Wang S, Loevner LA, Quon H, et al. Pretreatment diffusion-weighted and dynamic contrast-enhanced MRI for prediction of local treatment response in squamous cell carcinomas of the head and neck. Am J Roentgenol. 2013;200:35–43.CrossRef
28.
go back to reference Heijmen L, Verstappen MCHM, Ter Voert EEGW, Punt CJ, Oyen WJG, de Geus-Oei L-F, et al. Tumour response prediction by diffusion-weighted MR imaging: ready for clinical use? Crit Rev Oncol Hematol Elsevier Ireland Ltd. 2012;83:194–207.CrossRef Heijmen L, Verstappen MCHM, Ter Voert EEGW, Punt CJ, Oyen WJG, de Geus-Oei L-F, et al. Tumour response prediction by diffusion-weighted MR imaging: ready for clinical use? Crit Rev Oncol Hematol Elsevier Ireland Ltd. 2012;83:194–207.CrossRef
29.
go back to reference Vandecaveye V, De Keyzer F, Dirix P, Lambrecht M, Nuyts S, Hermans R. Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology. 2010;52:773–84.PubMedCrossRef Vandecaveye V, De Keyzer F, Dirix P, Lambrecht M, Nuyts S, Hermans R. Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology. 2010;52:773–84.PubMedCrossRef
30.
go back to reference Hwang I, Choi S, Kim Y. Differentiation of recurrent tumor and posttreatment changes in head and neck squamous cell carcinoma: application of high b-value diffusion-weighted imaging. Am J Neuroradiol. 2013;1–7. Hwang I, Choi S, Kim Y. Differentiation of recurrent tumor and posttreatment changes in head and neck squamous cell carcinoma: application of high b-value diffusion-weighted imaging. Am J Neuroradiol. 2013;1–7.
31.
go back to reference Sepahdari AR, Politi LS, Aakalu VK, Kim HJ, Abdel Razek a a K. Diffusion-weighted imaging of orbital masses: multi-institutional data support a 2-ADC threshold model to categorize lesions as benign, malignant, or indeterminate. Am J Neuroradiol. 2013;1–6. Sepahdari AR, Politi LS, Aakalu VK, Kim HJ, Abdel Razek a a K. Diffusion-weighted imaging of orbital masses: multi-institutional data support a 2-ADC threshold model to categorize lesions as benign, malignant, or indeterminate. Am J Neuroradiol. 2013;1–6.
32.
go back to reference Abdel Razek AAK, Kandeel AY, Soliman N, El-shenshawy HM, Kamel Y, Nada N, et al. Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes. Am J Neuroradiol. 2007;28:1146–52.PubMedCrossRef Abdel Razek AAK, Kandeel AY, Soliman N, El-shenshawy HM, Kamel Y, Nada N, et al. Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes. Am J Neuroradiol. 2007;28:1146–52.PubMedCrossRef
33.
go back to reference Sumi M, Sakihama N, Sumi T, Morikawa M, Uetani M, Kabasawa H, et al. Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. Am J Neuroradiol. 2003;24:1627–34.PubMed Sumi M, Sakihama N, Sumi T, Morikawa M, Uetani M, Kabasawa H, et al. Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. Am J Neuroradiol. 2003;24:1627–34.PubMed
34.
go back to reference Ishikita T, Oriuchi N, Higuchi T, Miyashita G, Arisaka Y, Paudyal B, et al. Additional value of integrated PET/CT over PET alone in the initial staging and follow up of head and neck malignancy. Ann Nucl Med. 2010;24:77–82.PubMedCrossRef Ishikita T, Oriuchi N, Higuchi T, Miyashita G, Arisaka Y, Paudyal B, et al. Additional value of integrated PET/CT over PET alone in the initial staging and follow up of head and neck malignancy. Ann Nucl Med. 2010;24:77–82.PubMedCrossRef
35.
go back to reference Goerres GW, Schuknecht B, Schmid DT, Stoeckli SJ, Hany TF. Positron emission tomography/computed tomography for staging and restaging of head and neck cancer: comparison with positron emission tomography read together with contrast-enhanced computed tomography. Clin Imaging. 32:431–7. Goerres GW, Schuknecht B, Schmid DT, Stoeckli SJ, Hany TF. Positron emission tomography/computed tomography for staging and restaging of head and neck cancer: comparison with positron emission tomography read together with contrast-enhanced computed tomography. Clin Imaging. 32:431–7.
36.
go back to reference Chan S-C, Wang H-M, Yen T-C, Lin C-Y, Chin S-C, Liao C-T, et al. 18F-FDG PET/CT and 3.0-T whole-body MRI for the detection of distant metastases and second primary tumours in patients with untreated oropharyngeal/hypopharyngeal carcinoma: a comparative study. Eur J Nucl Med Mol Imaging. 2011;38:1607–19.PubMedCrossRef Chan S-C, Wang H-M, Yen T-C, Lin C-Y, Chin S-C, Liao C-T, et al. 18F-FDG PET/CT and 3.0-T whole-body MRI for the detection of distant metastases and second primary tumours in patients with untreated oropharyngeal/hypopharyngeal carcinoma: a comparative study. Eur J Nucl Med Mol Imaging. 2011;38:1607–19.PubMedCrossRef
37.
go back to reference Ghanooni R, Delpierre I, Magremanne M, Vervaet C, Dumarey N, Remmelink M, et al. 18F-FDG PET/CT and MRI in the follow-up of head and neck squamous cell carcinoma. Contrast Media Mol Imaging. 2011;6:260–6.PubMed Ghanooni R, Delpierre I, Magremanne M, Vervaet C, Dumarey N, Remmelink M, et al. 18F-FDG PET/CT and MRI in the follow-up of head and neck squamous cell carcinoma. Contrast Media Mol Imaging. 2011;6:260–6.PubMed
38.
go back to reference Srinivasan A, Dvorak R, Perni K, Rohrer S, Mukherji SK. Differentiation of benign and malignant pathology in the head and neck using 3T apparent diffusion coefficient values: early experience. Am J Neuroradiol. 2008;29:40–4.PubMedCrossRef Srinivasan A, Dvorak R, Perni K, Rohrer S, Mukherji SK. Differentiation of benign and malignant pathology in the head and neck using 3T apparent diffusion coefficient values: early experience. Am J Neuroradiol. 2008;29:40–4.PubMedCrossRef
39.
go back to reference Choi SH, Paeng JC, Sohn C-H, Pagsisihan JR, Kim Y-J, Kim KG, et al. Correlation of 18F-FDG uptake with apparent diffusion coefficient ratio measured on standard and high b value diffusion MRI in head and neck cancer. J Nucl Med. 2011;52:1056–62.PubMedCrossRef Choi SH, Paeng JC, Sohn C-H, Pagsisihan JR, Kim Y-J, Kim KG, et al. Correlation of 18F-FDG uptake with apparent diffusion coefficient ratio measured on standard and high b value diffusion MRI in head and neck cancer. J Nucl Med. 2011;52:1056–62.PubMedCrossRef
40.
go back to reference Ho K-C, Lin G, Wang J-J, Lai C-H, Chang C-J, Yen T-C. Correlation of apparent diffusion coefficients measured by 3T diffusion-weighted MRI and SUV from FDG PET/CT in primary cervical cancer. Eur J Nucl Med Mol Imaging. 2009;36:200–8.PubMedCrossRef Ho K-C, Lin G, Wang J-J, Lai C-H, Chang C-J, Yen T-C. Correlation of apparent diffusion coefficients measured by 3T diffusion-weighted MRI and SUV from FDG PET/CT in primary cervical cancer. Eur J Nucl Med Mol Imaging. 2009;36:200–8.PubMedCrossRef
41.
go back to reference Nakajo M, Kajiya Y. FDG PET/CT and diffusion-weighted imaging of head and neck squamous cell carcinoma. Clin Nucl Med. 2012;37:475–80.PubMedCrossRef Nakajo M, Kajiya Y. FDG PET/CT and diffusion-weighted imaging of head and neck squamous cell carcinoma. Clin Nucl Med. 2012;37:475–80.PubMedCrossRef
42.
go back to reference Borra R, Catalano O, Catana C, McDermott S, Blake M, Sahani D, et al. Comparison of SUV and whole body diffusion imaging findings in oncological imaging with hybrid PET-MRI. Soc Nucl Med Annu Meet Abstr. 2013;54:1408. Borra R, Catalano O, Catana C, McDermott S, Blake M, Sahani D, et al. Comparison of SUV and whole body diffusion imaging findings in oncological imaging with hybrid PET-MRI. Soc Nucl Med Annu Meet Abstr. 2013;54:1408.
Metadata
Title
Use of diffusion-weighted imaging (DWI) in PET/MRI for head and neck cancer evaluation
Authors
Marcelo A. Queiroz
Martin Hüllner
Felix Kuhn
Gerhardt Huber
Christian Meerwein
Spyros Kollias
Gustav von Schulthess
Patrick Veit-Haibach
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2867-7

Other articles of this Issue 12/2014

European Journal of Nuclear Medicine and Molecular Imaging 12/2014 Go to the issue