Correlation of Diffusion-weighted MR imaging and FDG PET / CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors

Şamil Şahin; Yaşar Kemal Duymaz; Burak Erkmen; Burak Karabulut; İldem Deveci; Mehmet Sürmeli; Aslı Şahin Yılmaz; Çağatay Oysu

doi:10.58600/eurjther.20232902-450.y

Authors

Şamil Şahin Private Clinic, Istanbul, https://orcid.org/0000-0002-7378-6759
Yaşar Kemal Duymaz University of Health Sciences, Umraniye Training and Research Hospital, Department of Otolaryngology https://orcid.org/0000-0002-0215-0614
Burak Erkmen University of Health Sciences, Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital Department of Otolaryngology, İstanbul, https://orcid.org/0000-0002-9990-8099
Burak Karabulut Private Clinic, Istanbul, https://orcid.org/0000-0002-3958-3683
İldem Deveci Private Medient Hospital, Istanbul https://orcid.org/0000-0002-1573-8345
Mehmet Sürmeli Private Medient Hospital, Istanbul https://orcid.org/0000-0002-7936-2957
Aslı Şahin Yılmaz University of Health Science, Lütfi Kırdar Training and Research Hospital, Department of Otolaryngology, Istanbul https://orcid.org/0000-0002-7846-9453
Çağatay Oysu Marmara University, School of Medicine, Department of Otolaryngology. Istanbul https://orcid.org/0000-0002-6756-8456

DOI:

https://doi.org/10.58600/eurjther.20232902-450.y

Keywords:

Diffusion-weighted magnetic resonance imaging, head and neck cancer, squamous cell carcinoma, Fluoro-2-deoxy-d-glucose-Positron emission tomography

Abstract

Objectives: The aim of this study was to investigate the efficacy of DW-MRI as a reliable imaging modality for detecting metastatic neck lymph nodes of head and neck SCC.

Methods: 32 patients underwent FDG PET/CT and diffusion-weighted MRI were evaluated. Histopathologic analysis of lymph node metastases was used as the gold standard for assessment. We analyzed differences in sensitivity, specificity, accuracy, positive predictive value and negative predictive value among the imaging modalities using the Chi-square test. Their discriminative power evaluated using the Receiver-Operating Characteristic curve and calculation of the area under the curve. The correlation between ADCmin and SUVmax was calculated using the Spearman test. SPSS 24 was used for statistical analyses. P value of 0.05 indicates a statistically significant difference.

Results: A total of 32 patients with 50 neck dissections with head and neck SCC included. Sensitivity, specificity, accuracy, positive and negative predictive value of neck palpation was %72, %60, %70, %62 and %80 respectively. Sensitivity, specificity, accuracy, positive and negative predictive value of DW-MRI was %87,5, %96,2, %92, %95,5 and %89,3 respectively, according to ADCmin cutoff value 0.82×10-3s/mm2 . Sensitivity, specificity, accuracy, positive and negative predictive value of FDG-PET/CT was %91,7, %100, %96, %100 and %92,9 , respectively ,according to SUVmax cutoff value 3.4. For all neck dissections, there was a statistically significant inverse correlation between ADCmin and SUVmax (P<001).

Conclusion: DW-MRI is reliable as detecting cervical lymph node metastases as FDG-PET/CT. DWI and FDG PET/CT could play a complementary role in clinical assessment.

Metrics

Metrics Loading ...

References

Gormley M, Creaney G, Schache A, Ingarfield K, Conway DI. Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors. Br Dent J. 2022;233(9):780–6.

Dyba T, Randi G, Bray F, Martos C, Giusti F, Nicholson N, et al. The European cancer burden in 2020: Incidence and mortality estimates for 40 countries and 25 major cancers. Eur J Cancer. 2021;157:308–47.

Rogers SJ, Harrington KJ, Rhys-Evans P, O-Charoenrat P, Eccles SA. Biological significance of c-erbB family oncogenes in head and neck cancer. Cancer Metastasis Rev. 2005;24(1):47–69.

Di Martino E, Nowak B, Hassan HA, Hausmann R, Adam G, Buell U, et al. Diagnosis and staging of head and neck cancer: a comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings. Arch Otolaryngol Neck Surg. 2000;126(12):1457.

Sakamoto J, Yoshino N, Okochi K, Imaizumi A, Tetsumura A, Kurohara K, et al. Tissue characterization of head and neck lesions using diffusion-weighted MR imaging with SPLICE. Eur J Radiol. 2009;69(2):260–8.

Wang J, Takashima S, Takayama F, Kawakami S, Saito A, Matsushita T, et al. Head and neck lesions: Characterization with diffusion-weighted echo-planar MR imaging. Radiology. 2001;220(3):621–30.

Aksoy F, Veyseller B, Binay O, Apuhan T, Yildirim YS, Ozturan O. [Patterns of cervical metastasis from squamous cell carcinoma of the head and neck]. Kulak Burun Bogaz Ihtis Derg. 2010;20(5):249–54.

Ying M, Bhatia KSS, Lee YP, Yuen HY, Ahuja AT. Review of ultrasonography of malignant neck nodes: Greyscale, doppler, contrast enhancement and elastography. Cancer Imaging. 2013;13(4):658–69.

Meng W, Xing P, Chen Q, Wu C. Initial experience of acoustic radiation force impulse ultrasound imaging of cervical lymph nodes. Eur J Radiol [Internet]. 2013;82(10):1788–92. Available from: http://dx.doi.org/10.1016/j.ejrad.2013.05.039

Cho JK, Hyun SH, Choi N, Kim MJ, Padera TP, Choi JY, et al. Significance of lymph node metastasis in cancer dissemination of head and neck cancer. Transl Oncol [Internet]. 2015;8(2):119–25. Available from: http://dx.doi.org/10.1016/j.tranon.2015.03.001

Shibuya K, Mathers CD, Boschi-Pinto C, Lopez AD, Murray CJL. Global and regional estimates of cancer mortality and incidence by site: I. Application of regional cancer survival model to estimate cancer mortality distribution by site. BMC Cancer. 2002;2:1–26.

Sumi M, Sakihama N, Sumi T, Morikawa M. Discrimination of Metastatic Cervical Lymph Nodes with Diffusion-Weighted MR Imaging in Patients with Head and Neck Cancer. Am J Neuroradiol. 2003;24(September):1627–34.

Abdel Razek AAK, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006;16(7):1468–77.

Vandecaveye V, De Keyzer F, Vander Poorten V, Dirix P, Verbeken E, Nuyts S, et al. Head and neck squamous cell carcinoma: Value of diffusion-weighted MR imaging for nodal staging. Radiology. 2009;251(1):134–46.

Huisman TAGM, Loenneker T, Barta G, Bellemann ME, Hennig J, Fischer JE, et al. Quantitative diffusion tensor MR imaging of the brain: Field strength related variance of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) scalars. Eur Radiol. 2006;16(8):1651–8.

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(1):40–4.

Brouwer J, Senft A, De Bree R, Comans EFI, Golding RP, Castelijns JA, et al. Screening for distant metastases in patients with head and neck cancer: Is there a role for 18FDG-PET? Oral Oncol. 2006;42(3):275–80.

Paulus P, Sambon A, Vivegnis D, Hustinx R, Moreau P, Collignon J, et al. 18FDG-PET for the assessment of primary head and neck tumors: Clinical, computed tomography, and histopathological correlation in 38 patients. Laryngoscope. 1998;108(10):1578–83.

Kresnik E, Mikosch P, Gallowitsch HJ, Kogler D, Wieser S, Heinisch M, et al. Evaluation of head and neck cancer with 18F-FDG pet: A comparison with conventional methods. Eur J Nucl Med. 2001;28(7):816–21.

Ng SH, Yen TC, Liao CT, Chang JTC, Chan SC, Ko SF, et al. 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: A prospective study of 124 patients with histologic correlation. J Nucl Med. 2005;46(7):1136–43.

Murakami R, Uozumi H, Hirai T, Nishimura R, Shiraishi S, Ota K, et al. Impact of FDG-PET/CT Imaging on Nodal Staging for Head-And-Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2007;68(2):377–82.

Sun R, Tang X, Yang Y, Zhang C. 18FDG-PET/CT for the detection of regional nodal metastasis in patients with head and neck cancer: A meta-analysis. Oral Oncol [Internet]. 2015;51(4):314–20. Available from: http://dx.doi.org/10.1016/j.oraloncology.2015.01.004

Kitajima K, Suenaga Y, Minamikawa T, Komori T, Otsuki N, Nibu K ichi, et al. Clinical significance of SUVmax in 18F-FDG PET/CT scan for detecting nodal metastases in patients with oral squamous cell carcinoma. Springerplus. 2015;4(1):1–12.

Nakamatsu S, Matsusue E, Miyoshi H, Kakite S, Kaminou T, Ogawa T. Correlation of apparent diffusion coefficients measured by diffusion-weighted MR imaging and standardized uptake values from FDG PET/CT in metastatic neck lymph nodes of head and neck squamous cell carcinomas. Clin Imaging [Internet]. 2012;36(2):90–7. Available from: http://dx.doi.org/10.1016/j.clinimag.2011.05.002