SS 308 - Head and neck cancer: value of multiparametric and advanced imaging techniques
SS 308 - Head and neck cancer: value of multiparametric and advanced imaging techniquesWednesday, March 1, 14:00 - 15:30 Room: L 8 Session Type: Scientific Session Topics: Oncologic Imaging, Head and Neck Moderators: P. De Graaf (Amsterdam/NL), N. I. Traykova (Plovdiv/BG) Add session to my schedule In your schedule (remove)
RECIST 1.1, WHO and 3D CT-scan methods predict vocal cord remobilisation after induction chemotherapy in patients with T3 laryngeal squamous-cell carcinoma
Purpose: After induction chemotherapy (ICT) for head and neck squamous cell carcinomas (SCC) CT scan is used to assess tumour response (TR) but lacks rationalized measurement methods. In T3 laryngeal SCC, vocal cord remobilisation (VCR) is a major TR criterion. We compare the performances of RECIST 1.1, WHO and volumetric methods with CT-scan to predict remobilisation.
Methods and Materials: Contrast-enhanced cervical CT-scans were acquired before and during ICT from 43 patients treated for T3 laryngeal SCC with vocal cord fixation. Tumour size was assessed according to RECIST 1.1 (1D), WHO (2D) and volumetric (3D) methods. Tumour shrinkage after ICT was evaluated as predictor of VCR. Areas under the curve (AUC) of receiver operating characteristic curves were compared and sensitivity and specificity of optimal cutoffs were determined.
Results: AUCs were 0.763 (95%CI [0.615; 0.911]) for 1D, 0.779 (95%CI [0.63; 0.971]) for 2D and 0.763 (95%CI [0.623; 0.904]) for 3D evaluations with no significant difference (1D vs 2D p = 0.78; 2D vs 3D p = 0.66; 1D vs 3D p = 1). Optimal cutoffs were -29% (Se = 70.8%; Sp =68.4%), -47% (Se = 91.7%; Sp = 63.2%) and -64% (Se = 75%; Sp = 63.2%) for 1D, 2D and 3D evaluation, respectively.
Conclusion: RECIST 1.1, WHO or volumetric measurements with CT-scan equally predict, VCR after ICT in patient with T3 laryngeal SCC. Cutoff values were very close to these methods’ usual thresholds, we could thus use them to assess TR when vocal cord fixation is absent.
Correlation between locally advanced HPV positive oropharyngeal squamous cell carcinoma and quantitative MRI parameters
Purpose: to evaluate the association between quantitative MR parameters and HPV status in advanced oropharyngeal squamous cell carcinoma (OPSCC).
Methods and Materials: 24 patients with locally advanced OPSCC underwent pre-treatment MR. Histogram analysis was performed on TSE-T2, DWI and post-gadolinuim 3D-VIBE sequences before and after application of a Laplacian of Gaussian spatial scale filter (ssf) at the primary tumor site. Search of HPV DNA on biopsies was performed to evaluate HPV status. Mann-Whitney test was used to assess differences in quantitative MR parameters between HPV+ and HPV- groups.
Results: 10 patients were HPV-positive (41,7%). Mean ADC was significantly lower in HPV+ compared to HPV- patients (0.83 vs 1.04 x 10-3mm2/s respectively, p=0.015). Skewness measured on 3D-VIBE with 1mm-ssf was significantly higher in HPV+ compared to HPV- patients (p=0.03).
Conclusion: quantitative MR parameters, especially mean ADC, may reflect microstructural differences between HPV+ and HPV- OPSCC.
Purpose: Thyroid carcinomas represent the most frequent endocrine malignancies. Recent studies were able to distinguish malignant from benign nodules of the thyroid gland with diffusion weighted imaging (DWI). Although this differentiation is undoubtebly helpful, presurgical discrimination in between well differentiated and undifferentiated carcinomas would be crucial in order to define the optimal treatment algorithm. Therefore the aim of this study was to investigate if DWI is able to differentiate between differentiated and undifferentiated subtypes of thyroid carcinomas.
Methods and Materials: 14 patients with different types of thyroid carcinomas who received preoperative DWI using a RESOLVE sequence were included in our study. In all lesions ADCmin, ADCmean and ADCmax and D were estimated on basis of region of interest (ROI) measurements after coregistration with T1 weighted, postcontrast images. All tumours were resected and analysed histopathologically. Ki-67 index, p53 synthesis, cellularity, total and average nucleic areas were estimated using ImageJ version 1.48
Results: ANOVA revealed a statistically significant difference of ADCmean values between differentiated and undifferentiated thyroid carcinomas (p=0.022). Spearman-Rho calculation identified significant correlations between ADCmax and cell count (r=0.541, p=0.046) as well as between ADCmax and total nuclei area (r=0.605, p=0.022).
Conclusion: DWI can distinguish between differentiated and undifferentiated thyroid carcinomas.
Prognostic significance of pre-treatment FDG PET-CT parameters in laryngeal and hypopharyngeal squamous cell carcinoma
Purpose: To evaluate the prognostic value of adaptive-threshold based metabolic tumour volume (MTV), maximum (SUVmax) and mean (SUVmean) standardised uptake value and total lesional glycolysis (TLG) measured prior to radiotherapy on FDG PET-CT in patients with laryngeal and hypopharyngeal cancer.
Methods and Materials: 43 patients with locally advanced laryngeal or hypopharyngeal squamous cell carcinoma who underwent 18F-FDG PET-CT before curative-intent (chemo)radiotherapy in a single centre (2009-2014) were retrospectively analysed. Imaging parameters including SUVmax, SUVmean, MTV and TLG were calculated for both tumour and nodal disease using an adaptive thresholding method (Homburg algorithm). Univariate and multivariate analyses were used to identify clinico-pathological and imaging variables associated with progression-free survival (PFS) and overall survival (OS). Univariate analyses included the following variables: age, sex, T and N classifications, overall TNM stage, tumour size, nodal size, SUVmax, MTV, and TLG.
Results: The median SUVmax, MTV, and TLG were 11.1 (range, 0-53.9), 3.5 ml (2.0-42.9 ml), and 72.5 g (0-744.9 g) respectively. Univariate analyses showed that there were significant correlations between T stage (p = 0.013), primary tumour MTV (p = 0.031) and nodal TLG ([ = 0.001) and overall survival. Multivariate analyses revealed that T stage, tumour MTV and nodal TLG were independent variables for PFS.
Conclusion: Pre-treatment values of MTV and TLG are independent prognostic factors in patients with laryngeal and hypopharyngeal tumours and may help predict subsequent patient outcome.
Utility of T2-weighted magnetic resonance imaging, MR spectroscopy and diffusion-weighted imaging of thyroid to differentiate malignant from benign nodules
Purpose: To evaluate the diagnostic performance of T2WI mean signal intensity combined with diffusion-weighted imaging and MR spectroscopy to differentiate thyroid carcinomas from benign thyroid nodules.
Methods and Materials: Study included 32 patients ( 12years to 67years) who had 41 solid thyroid nodules detected on high resolution ultrasonography. T2WI,T1WI & STIR sequences were acquired followed by DWI and MR spectroscopy. T2W mean signal intensity and ADC values of each thyroid nodule were calculated.MRS was done to observe the choline value. Histopathology was done in all the cases after MRI.
Results: Papillary carcinoma detected in 14 lesions,metastasis in 5 and lymphoma detected in one lesion ,5 detected thyroiditis and 7 lesions detected adenoma and 9 lesions confirmed colloid nodule on histopathology.T2W SI was lower in the thyroid carcinoma ranging 205-298 mean was 247.4 as compare to benign thyroid nodules ranging from 275-512, mean 391.72. Mean ADC values was 1.32+-38 x10-3 mm2/s in malignant nodules and was 2.58+-53 x10-3 mm2/s in benign nodules. ADC value was significantly lower in malignant nodules as compare to benign (p<0.001). MRS showed high choline value in the malignant nodules though choline was not raised in the benign nodules.Sensitivity to detect malignant lesion by DWI was 80% ( 95% CI 58.4-91.93),specificity 85.7%,(95%CI 65.36-95.02),PPV 84.2% and NPV 81.82%. Sensitivity by MRS was 75%(95%CI 53.13-88.8) and specificity 90.48%,(95% CI 71.09-97.35), PPV 88.24% and NPV 79.17%.
Conclusion: MRI thyroid is an efficient non-invasive imaging modality to differentiate thyroid carcinoma from benign nodules on the basis of MRI T2W SI, ADC values and MR spectroscopy.
Can qualitative and semi-quantitative ultrasound elastography contribute to the diagnosis of salivary gland tumours?
Purpose: The aim of this study was to investigate the contribution of qualitative and semi-quantitative strain sonoelastography in differential diagnosis of salivary gland tumours.
Methods and Materials: Fifty-seven patients (29 men and 28 women) with salivary gland mass, aged between 16 and 85 years (mean age 56,12±15) were enrolled in this prospective study. All masses were examined by qualitative and semi-quantitative strain elastography techniques. The most representative images were recorded to be evaluated according to a 4-scale scoring system. Score 1-2 were accepted to be benign and 3-4 malignant. The strain index of the mass in respect to surrounding parenchyma was measured.
Results: Fifty-three (%92.9) masses were located in the parotid gland, the rest in the submandibular gland (7.02%). Forty-seven (82.4%) masses were benign, and pleomorphic adenomas lesions were in the majority (44.6%). There were 10 malignant lesions (17.5%). Sensitivity, specificity, PPV and NPV were calculated for both qualitative scoring and strain index ratio. For qualitative assessment these values were 90%, 44,6%, 25,7%, 95,4%, respectively. Using the ROC analysis, sensitivity and specificity at the cutoff value of 2.44 for strain ratio were 70% and 100%, respectively (P=0.002). All the lesions with strain indices were malignant.
Conclusion: High sensitivity and negative predictive values for qualitative method may be better to recognise benign rather than malignant. High specificity of strain ratio at proper cutoff values may be helpful for verification of malignant tumours. Qualitative and semi-quantitative sonoelastography may be helpful in deciding the nature of salivary gland masses.
Combination of diffusion weighted imaging and dynamic contrast-enhanced MRI improves differentiation of benign and malignant orbital masses
Purpose: Diffusion weighted imaging (DWI) and dynamic contrast-enhanced MR imaging (DCE-MRI) allow assessment of lesion cellularity and vascularity respectively. We evaluated the combined use of DWI and time-signal intensity curve (TIC) analyses to differentiate benign from malignant orbital masses.
Methods and Materials: We retrospectively studied 54 patients with orbital masses who underwent MR imaging using DWI and DCE-MRI at either 1.5 or 3 Tesla. We calculated apparent diffusion coefficient (ADC) values and performed qualitative assessment of TIC curve patterns generated by DCE-MRI.
Results: 47 (87.0%) patients had benign orbital masses (4 benign tumours, 19 cavernous hemangiomas, 15 inflammatory lesions, 9 vascular malformations); while 7 (13.0%) patients had malignant orbital masses. All malignant masses were histologically proven while benignity was established by histology or clinical follow-up. Mean ADC values were significantly different for benign and malignant subgroups (ANOVA p=0.007). Benign masses had significantly higher ADC values compared with malignant masses (1.49±0.50 vs 0.97±0.45, p=0.01). Type of TIC curve was also significantly different amongst subgroups (p=0.04). 71.4% of benign masses had type 1 TIC pattern while none of the malignant lesions had type 1 pattern (p=0.01). Cavernous hemangiomas were predominantly associated with type I TIC pattern, and the predictive value of a type 1 TIC pattern for cavernous hemangioma was associated with high sensitivity (89.5%) and modest specificity (60.0%). In comparison, vascular malformations had heterogeneous TIC patterns.
Conclusion: Benign and malignant orbital masses have significantly different diffusion and perfusion characteristics and combination of ADC values and TIC pattern analysis improves their differentiation.
Usefulness of microvascular ultrasonography in differentiation between pleomorphic adenoma and Warthin tumour of salivary glands
Purpose: Pleomorphic adenoma (PA) and Warthin tumour (WT) are the most common salivary gland tumours. It is important to differentiate between them because at least partial parotidectomy is necessary for PA, whereas enucleation is sufficient to WT. This study aimed to evaluate the usefulness of vascular pattern analysis using microvascular ultrasonography in differentiation of PA and WT of salivary glands.
Methods and Materials: Sixty-three patients with pathologically proven PA (n=39) and WT (n=24) were included. For all tumours, gray-scale, power-Doppler and microvascular ultrasonography (Superb-Microvascular Imaging) were performed. Differences between vascular patterns (internal vascularity and vascular distribution) on power-Doppler and microvascular ultrasonography and other sonographic features (size, shape, echogenicity, border, cystic change and heterogeneity) on gray-scale ultrasonography for PA and WT were evaluated. Comparison of diagnostic performance of gray-scale with power-Doppler ultrasonography and gray-scale with microvascular ultrasonography was performed. The level of inter-observer agreement of two reviewers in diagnosing tumours was evaluated.
Results: No sonographic features on gray-scale ultrasonography showed significant difference between two tumours. Internal vascularity and vascular distributions on power-Doppler (p=0.002 and 0.008, respectively) and microvascular ultrasonography (all p<0.0001) were significantly different. Diagnostic accuracy of gray-scale with microvascular ultrasonography (79.4%) is higher than that of gray-scale with power-Doppler ultrasonography (73.0%). This difference was significant according to McNemar test (p=0.004). Inter-observer agreement was excellent in diagnosing tumours on both gray-scale with power-Doppler ultrasonography(κ=0.83) and gray-scale with microvascular ultrasonography(κ=0.94).
Conclusion: Vascular pattern analysis using microvascular ultrasonography with other sonographic features is helpful in differentiation between PA and WT in salivary glands.
Thyroid nodules: utility of ultrasound combined to cytopuncture results in diagnosing malignant nodules that must be biopsied
Purpose: To highlight the high utility and accuracy of the ultrasound-guided cytopuncture of the suspect thyroid nodules detected by ultrasonography in assessing malignancy risk and selecting patients for surgery.
Methods and Materials: 19 patients were eligible to participate in a prospective study from March to June, 2016. The mean age of our patients was 51 years old (range, 29-65). It was about 17 women and 2 men. B-scan Ultrasonography, color Doppler imaging and pulsed method was performed using a linear high frequency probe (5-18MHz) (HITACHI). The cytopuncture was performed using 22-gauge fine needle.
Results: Using the risk stratification system for thyroid nodules TIRADS (Thyroid Imagind Reporting And Data System),we found 7 TIRADS "category 3" nodules (36,85%), 7 TIRADS "category 4a" nodules (36,85%) and 5 TIRADS "category 4b" nodules (26,3%). The cytologic results revealed 1 patient with benign cytology (5,27%), 6 with suspect nuclear atypia (31,58%), 5 with cytologic atypia that needs a checking (26,32%), 7 with hypocellular material and hematic cytology (36,85%).
Conclusion: The ultrasonography is the first line examination to select suspect thyroid nodules but the fine-needle cytopuncture of these nodules is the most efficient examination to assess malignancy risk to select the nodules that must be confirmed by tissue examination. Hence the utility of the duo ultrasonography / Ultrasound-guided cytopuncture.
Purpose: To create and implement MRI-based treatment response assessment algorithm in head and neck tumours after chemoradiotherapy (CRT).
Methods and Materials: Study involved 37 patients (age 41-76 years). 1.5T scanner was used. Sagittal T2, T1 WI, axial T1 WI with FS with large-field scanning were used, axial T2 STIR WI and sagittal or coronal Т2 STIR WI were added depending on tumour localisation. Axial DWI and ADC maps were calculated. Post-contrast T1 WI sequences with FS were performed in 3 planes. Slice thickness 1-3 mm. MR examinations were performed before CRT and each 3 months after. For local failure confirmation, PET/CT was performed in 7 cases.
Results: In 37.8% (14 patients) early postradiation changes were detected. DWI helped to distinguish between tumour fragments with high cellularity and oedema and to trace increasing of ADC as sign of tumour regression. If area of pathological changes did not extend beyond area of radiation exposure, such changes were regarded postradiation alterations. Increasing postradiation necrosis was observed on average up to 8 months, with later swelling decreasing. Signs of clinically significant postradiation necrosis were not detected in our studies. In 16 patients tumour regression signs were detected. In 4 patients tumour progression was detected. All cases were confirmed by PET/CT.
Conclusion: Reactions of head and neck tumours after CRT characterised by heterogeneity. Most MR characteristics of tumour progression and postradiation changes are similar. Standard MRI is not enough to differentiate them, it is necessary to perform DWI and compare with PET/CT.
Accuracy of diffusion-weighted imaging and dynamic contrast-enhanced MRI for differentiating benign from malignant non-cystic lesions in floor of the mouth
Purpose: The aim was to evaluate the potential use of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) in differentiating benign from malignant lesions in floor of the mouth (FOM).
Methods and Materials: A retrospective review was conducted of patients with pathologically confirmed non-cystic FOM lesions between January 2010 and December 2014. The apparent diffusion coefficient (ADC) and time-signal intensity curve (TIC) pattern were assessed. Receiver operating characteristic (ROC) and logistic regression analyses were performed to evaluate their differential value and association with malignancy.
Results: Significant differences were detected between benign and malignant lesions in ADC value and TIC pattern (p=0.015 and p<0.001). The areas under the curve (AUCs) for ADC and TIC pattern were 0.754 and 0.704, respectively. The joint association of ADC and TIC with malignancy was most prominent in lesions with both ADC≤1.23×10-3 mm2/s and plateau/wash-out TIC pattern. The AUC of combined use of ADC value and TIC pattern was 0.820 (best sensitivity: 98.3%; best specificity: 88.9%).
Conclusion: Our results suggested that DWI and DCE-MRI contribute to differential diagnosis of non-cystic MOF lesions, especially when used in combination. Additional larger studies are warranted to confirm our findings.