Search

Background Different clinical high-risk factors for the development of distant metastases have been identified but not tested in the same cohort of patients with head and neck squamous cell carcinoma (HNSCC). Methods In 145 patients with previously identified clinical high risk factors, the presence of extranodal spread (ENS) and matted node on pretreatment CT (n = 96) and/or MRI (n = 111) were determined. Results Of 145 patients, ENS was detected in 87 patients (60.0%) and matted nodes in 53 patients (36.6%). Kaplan–Meier curves for presence or absence of ENS (on CT and/or MRI) and matted nodes (on CT) differ significantly. In a Cox regression analysis, only ENS was a significant risk factor (hazard ratio [HR] = 3.3; 95% confidence interval [CI] = 2.0–5.5; p < .001). Conclusion In patients with high-risk HNSCC with clinically (palpably or radiologically) ENS and matted nodes, both determined radiologically, are high risk factors for development of distant metastases. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

BACKGROUND AND PURPOSE: DWI is typically performed with EPI sequences in single-center studies. The purpose of this study was to determine the reproducibility of ADC values in the head and neck region in healthy subjects. In addition, the reproducibility of ADC values in different tissues was assessed to identify the most suitable reference tissue. MATERIALS AND METHODS: We prospectively studied 7 healthy subjects, with EPI and TSE sequences, on 5 MR imaging systems at 3 time points in 2 institutions. ADC maps of EPI (with 2 b-values and 6 b-values) and TSE sequences were compared. Mean ADC values for different tissues (submandibular gland, sternocleidomastoid muscle, spinal cord, subdigastric lymph node, and tonsil) were used to evaluate intra- and intersubject, intersystem, and intersequence variability by using a linear mixed model. RESULTS: On 97% of images, a region of interest could be placed on the spinal cord, compared with 87% in the tonsil. ADC values derived from EPI-DWI with 2 b-values and calculated EPI-DWI with 2 b-values extracted from EPI-DWI with 6 b-values did not differ significantly. The standard error of ADC measurement was the smallest for the tonsil and spinal cord (standard error of measurement = 151.2 × 10(−6) mm/s(2) and 190.1 × 10(−6) mm/s(2), respectively). The intersystem difference for mean ADC values and the influence of the MR imaging system on ADC values among the subjects were statistically significant (P < .001). The mean difference among examinations was negligible (ie

ObjectivesTo assess disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy ([C]RT).MethodsPretreatment MR-images of 78 patients were retrospectively studied. Apparent diffusion coefficients (ADC) were calculated with two sets of two b-values: 0–750s/mm2 (ADC750) and 0–1000s/mm2 (ADC1000). One observer assessed tumor volume on T1-WI. Two independent observers assessed ADC-values of primary tumor and largest lymph node in two sessions (i.e. without and with including CE-T1WI in image analysis). Interobserver and intersession agreement were assessed with intraclass correlation coefficients (ICC) separately for ADC750 and ADC1000. Lesion volumes and ADC-values were related to DFS using Cox regression analysis.ResultsMedian follow-up was 18 months. Interobserver ICC was better without than with CE-T1WI (primary tumor: 0.92 and 0.75–0.83, respectively; lymph node: 0.81–0.83 and 0.61–0.64, respectively). Intersession ICC ranged from 0.84 to 0.89. With CE-T1WI, mean ADC-values of primary tumor and lymph node were higher at both b-values than without CE-T1WI (P

Different clinical high-risk factors for the development of distant metastases have been identified but not tested in the same cohort of patients with head and neck squamous cell carcinoma (HNSCC).In 145 patients with previously identified clinical high risk factors, the presence of extranodal spread (ENS) and matted node on pretreatment CT (n = 96) and/or MRI (n = 111) were determined.Of 145 patients, ENS was detected in 87 patients (60.0%) and matted nodes in 53 patients (36.6%). Kaplan-Meier curves for presence or absence of ENS (on CT and/or MRI) and matted nodes (on CT) differ significantly. In a Cox regression analysis, only ENS was a significant risk factor (hazard ratio [HR] = 3.3; 95% confidence interval [CI] = 2.0-5.5; p.001).In patients with high-risk HNSCC with clinically (palpably or radiologically) ENS and matted nodes, both determined radiologically, are high risk factors for development of distant metastases. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1452-E1458, 2016.

PURPOSE: To retrospectively assess the prognostic meaning of tumor characteristics depicted on pretreatment magnetic resonance (MR) images for local outcome in supraglottic squamous cell carcinoma treated with definitive radiation therapy. MATERIALS AND METHODS: Pretreatment MR images acquired in 84 patients with supraglottic carcinoma treated with curative radiation therapy were reviewed for tumor involvement of laryngeal sites including glottis, subglottis, pre-epiglottic space, laryngeal cartilages, and hypopharynx, and for extralaryngeal extension. The volume of each tumor was estimated, and mean tumor volume was calculated for the group of tumors in each T staging category. RESULTS: Results of univariate analysis showed MR imaging-determined primary tumor volume (P = .03), involvement of pre-epiglottic space (P = .008), abnormal signal intensity in thyroid cartilage (P = .04), and extralaryngeal extension beyond thyroid and/or cricoid cartilage (P = .02) to be significant predictors of local control rate. Results of multivariate analysis with the Cox regression model confirmed statistical significance for invasion of pre-epiglottic space (P = .004) and for abnormal signal intensities in thyroid cartilage adjacent to the anterior commissure (P = .04) and in cricoid cartilage (P = .01). Five-year local control rates were calculated from the regression coefficients of three independent MR imaging prognostic factors, and three prognostic groups were identified on the basis of these control rates. The 5-year local control rate in the high-risk group was 35%, significantly lower than the rates in the intermediate- and low-risk groups (60% and 89%, respectively; P = .002). CONCLUSION: MR imaging-determined pre-epiglottic space involvement and abnormal signal intensities in the thyroid cartilage adjacent to the anterior commissure and/or the cricoid cartilage are strong predictors of local outcome in supraglottic carcinoma treated with definitive radiation therapy.

To the Editor, Chemoradiotherapy (CRT) is the standard treatment for locally advanced head and neck cancer (HNC), offering comparable survival to surgery with the benefit of organ preservation. How...

BACKGROUND AND PURPOSE: Several studies have reported on the clinical utility of DWI in head and neck cancer, but none of these studies compared HASTE with EPI-DWI in patients with head and neck cancer. The aim of our study was to compare detection and delineation of primary tumors and lymph nodes by using HASTE and EPI-DWI techniques in patients with HNSCC. MATERIALS AND METHODS: Twelve patients with HNSCC and a total of 12 primary tumors and 77 visualized lymph nodes on MR imaging underwent DWI by using both EPI-based and HASTE techniques. Interobserver agreement for detection, delineation, and ADC values of primary tumors and lymph nodes was assessed by 2 radiologists, and artifacts for both DWI techniques were described. RESULTS: The number of lesions (primary tumors and lymph nodes) identified on pretreatment EPI-DWI was higher compared with pretreatment HASTE-DWI, with means of total lesions of 88.5 and 69.0, respectively. Delineation of lesions was also better on pretreatment EPI-DWI compared with pretreatment HASTE-DWI, with means of well-delineated lesions of 80.5 and 27.5, respectively. Both EPI- and HASTE-DWI showed good interobserver agreement between radiologists of ADC values in lesions with ICC values of 0.79 and 0.92, respectively. Intraobserver agreement for ADC values in lesions assessed with EPI- versus HASTE-DWI techniques was low, with ICC values of 0.31 and 0.42, respectively. Significant interobserver disagreement concerning detection was only seen with HASTE-DWI, and none of the DWI techniques showed significant interobserver disagreements regarding delineation. EPI-DWI was more prone to susceptibility artifacts than HASTE-DWI: Ninety-one percent of primary tumors and 16% of lymph nodes were affected by susceptibility artifacts on pretreatment EPI-DWI, whereas these artifacts were not seen on HASTE-DWI. CONCLUSIONS: Primary tumors and lymph nodes are more easily visualized on EPI-DWI compared with HASTE-DWI. EPI-DWI has geometric distortion, however, which has a negative effect on interobserver agreement of ADC values.

The presence of paratracheal lymph node (PTLN) metastasis harbours a worse prognosis. Uniform guidelines on PTLN dissection are missing, mainly because of the value of diagnostic techniques for the detection of PTLN metastasis are not clear. This study is performed to identify CT and MRI criteria for detection of PTLN metastasis. 149 patients who underwent laryngectomy and a PTLN dissection between 1990 and 2010 were included. Patient, tumour, treatment and follow up data were collected. On computed tomography (CT) and magnetic resonance imaging (MRI) different test criteria were examined. Considering PTLN with a maximal axial diameter of ≥5 mm as positive predicts PTLN metastasis best: sensitivity and specificity 70% and 36% (CT) and 50% and 71% (MRI). Other risk factors for PTLN metastasis were subglottic extension of the tumour (sensitivity is 45%) and clinical positive neck status (sensitivity is 59%). When at least one of these risk factors was present and the status of PTLN was considered positive, a high sensitivity (90% for CT and 100% for MRI) and a lower specificity (19% for CT and 32% for MRI) was found. If at least one of the risk factors such as subglottic extension, clinical positive neck and PTLN with a maximal axial diameter of ≥5 mm is present, sensitivity and negative predictive value for the prediction of PTLN metastasis are high, but the specificity is low. These risk factors can be used to select laryngectomy patients for PTLN dissection.

The purpose was to determine if pre-radiotherapy (RT) and/or post-radiotherapy magnetic resonance (MR) imaging can predict response in patients with laryngeal carcinoma treated with RT. Pre- and post-RT MR examinations of 80 patients were retrospectively reviewed and associated with regard to local control. Pre-RT MR imaging parameters such as tumor involvement of specific laryngeal anatomic subsites including laryngeal cartilages and post-RT changes, i.e., complete resolution of the tumor or focal mass/asymmetric obliteration of laryngeal tissue and signal pattern on T2-weighted images, were evaluated. Local control was defined as absence of a recurrence at the primary site for 2 years. Local control rates based on pretreatment MR findings were 73% for low pre-RT risk-profile and 29% for high pre-RT risk-profile patients (p = 0.0001). Based on posttreatment MR findings, local control rates were 100% score 1, 64% score 2, and 4% score 3 (p

BACKGROUND AND PURPOSE: Our aim was to retrospectively investigate the prognostic significance of the degree of contrast enhancement in tumors and its additional value in previously considered MR imaging parameters with regard to local control of laryngeal cancer treated with radiation therapy (RT) alone.MATERIALS AND METHODS: Pretreatment MR images of 64 consecutive patients (54 men and 10 women, 43-80 years of age) with supraglottic and glottic cancer were retrospectively reviewed on clinical and previously considered MR imaging parameters such as tumor involvement of specific laryngeal anatomic subsites, including laryngeal cartilages, tumor volume, extralaryngeal tumor spread, and, in addition, the degree of contrast enhancement. Clinical and MR imaging parameters were associated with regard to local control at 2 years by using the Cox regression model. "Local control" was defined as absence of primary tumor recurrence.RESULTS: When using a threshold of the mean average contrast enhancement of 77%, the 2-year local control rate in the groups of patients with a degree of enhancement below and above this threshold was 57% and 70%, respectively (P =.3). Enhancement of tumor tissue in pre-epiglottic space (PES) was low, most probably due to its adipose tissue and poor vascular content, whereas tumor tissue involving paraglottic space (PGS) did enhance. Results of multivariate analysis indicated that the degree of contrast enhancement yielded the prognostic information (P =.07) with 2 independent prognostic factors: primary tumor volume (P =.007) and subglottic extension (P =.002) with regard to local control. Using these previously mentioned 3 MR imaging parameters as potential risk factors, we defined 4 categories, resulting in the following local control rates respectively: 90% for the group without risk factors, 73% for the group with 1, 60% for the group with 2, and finally 0% for the group with 3 risk factors, which was significantly lower than the rates in previous risk groups (PCONCLUSION: PES has a lower degree of contrast enhancement than the PGS and may correlate with the worse outcome. Including a low degree of contrast enhancement as a parameter to primary tumor volume and subglottic extension may increase the predictive value of MR imaging for local outcome and may be helpful to identify a subset of patients whose tumors all recurred locally within 2 years after primary RT.

Purpose: To retrospectively evaluate the prognostic significance of magnetic resonance ( MR) imaging - determined tumor parameters, especially the presence of cartilage invasion, regarding local control of glottic squamous cell carcinoma treated with radiation therapy ( RT) alone.Materials and Methods: The study was performed with the approval of our institutional review board; direct patient consent was waived. Pretreatment MR images of 118 patients aged 41 - 86 years ( 110 men, eight women) with glottic carcinoma treated with RT alone were reviewed for tumor involvement of specific laryngeal anatomic subsites ( including laryngeal cartilage), tumor volume, and extralaryngeal tumor spread; these findings were compared with local control. Local control was defined as absence of a recurrence at the primary site for 2 years. Statistical significance of differences between curves for local control estimated with the Kaplan- Meier method was tested with log- rank test.Results: Results of univariate analysis showed all MR imaging determined parameters to be significant predictors of local control rate, compared with clinical parameters where T classification and vocal cord mobility were the only significant parameters associated with local control. Multivariate analysis ( Cox regression model) of clinical and radiologic parameters revealed that hypopharyngeal extension ( P = .04) and intermediate T2 signal intensity ( SI) in cartilage similar to tumor SI ( P Conclusion: Intermediate T2 SI in cartilage, which may suggest cartilage invasion, and hypopharyngeal extension of tumor, predict greater likelihood of local failure, whereas high T2 SI, which may suggest inflammatory tissue in cartilage, predicts lower likelihood of local failure. (c) RSNA, 2007.

Purpose: To evaluate retrospectively the prognostic significance of lymph node parameters assessed on pretreatment magnetic resonance (MR) images for development of distant metastases in patients with head and neck squamous cell carcinomas.Materials and methods: Pretreatment MR images of 311 patients were retrospectively reviewed for the presence of lymph nodes at specific neck node levels as well as the size and the presence of a number of lymph node characteristics including extranodal spread, central necrosis and number and volume of ipsi- and contralateral nodes. Of these patients, 174 (56%) had MRI-positive nodes (defined as nodes with minimum axial diameter >8 and >4 mm for paratracheal level and retropharyngeal nodes).Results: The 2-year distant-metastasis free survival rate (DMFSR) for patients without MRI-positive nodes was 94% compared to 75% for those patients with MRI-positive nodes. In patients with MRI-positive nodes, results of multivariate analysis with the Cox regression model yielded statistical significance for presence of extranodal spread (ENS), detected on MRI, as the only independent prognostic factor associated with the 2-year DMFSR (p = 0.002). Based on the analysis, three risk groups regarding the DMFSR could be identified. Low-risk group (DMFSR:94%) consisted of patients without MRI-positive nodes. Intermediate-risk group (DMFSR: 81%) consisted of patients with MRI-positive nodes without ENS. High-risk group (DMFSR:59%) consisted of patients with MRI-positive nodes and ENS as shown on MRI (p 5 cm(3) (larynx: p = 0.03; oral cavity: p = 0.02) to be significant predictors with regard to DMFSR.Conclusion: Especially patients with on MRI demonstrating extranodal spread and with suspicious nodes at lowjugular/posterior triangle (oropharyngeal cancer) or paratracheal level (laryngeal cancer), or with contralateral enlarged nodes (laryngeal and oral cavity cancer) are at high risk for developing distant metastases and this subset of patients might benefit from supplementary imaging screening (CT-chest, PET-scan). (C) 2006 Elsevier Ireland Ltd. All rights reserved.